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    A Young Man With Severe Mental Health Conditions Needs To Live In The Community, His Doctor Says

    As the coronavirus spreads, so does anxiety in immigration detention — where very sick refugees have been detained for months on end with little explanation.

    In August 2017, 26-year-old refugee Hamed set himself alight outside an Australian-run detention camp on the small island of Nauru.

    Eighteen months earlier, he had watched his friend Omid Masoumali self-immolate. Masoumali, who was just 23, later died from his injuries in April 2016.

    “I saw when he was burning,” Hamed, who is Iranian, told BuzzFeed News. “His death destroyed the fear of death for me more than ever.”

    Hamed was immediately doused with water and he was left with minor burns, the worst damage done to his nose. But his mental health condition was so serious that he was hospitalised in a psychiatric unit for two months when he was finally brought to Australia a year later.

    Then, four security guards escorted him straight from Melbourne’s Alfred Hospital to the Melbourne Immigration Transit Accommodation (MITA) detention centre. His doctor believes he should be released into the community. But Hamed has remained in detention for more than a year.

    “They told me the process would take about one week. But I have been waiting for more than 15 months for the [Australian Border Force] to finish the process and send me into the community,” Hamed said.

    Hamed is one of a number of refugees and asylum seekers who were brought to Australia from Nauru and Papua New Guinea for medical treatment, but have instead waited in onshore detention centres for months.

    The coronavirus outbreak has now further thrust their predicament into the spotlight, as fear and panic spreads in MITA and other detention centres.

    In the United Kingdom, a group of 10 organisations have called for immigration centre detainees to be released to avoid a coronavirus outbreak. In Australia, Doctors 4 Refugees has written to Comcare, the federal government’s workplace health and safety organisation, to warn of a lack of infection control at MITA, and argue that having multiple people per room makes self-isolation impossible.

    Community detention is one option, but sick refugees in Australia for treatment need a minister in the home affairs portfolio to personally intervene before they can be released. In this type of detention, they cannot study or work and have to obey a curfew — but are not under constant supervision. A smaller number of refugees can get bridging visas, which allow them to work, but they first require an invitation from the minister to apply.

    In October 2019, 547 people who had been held offshore were in Australia for medical treatment and the majority (297) were in community detention. Among those who had been on Nauru, 264 out of 365 were in community detention. The average waiting time for all who had been held in offshore detention to receive a residence determination was 65 days.

    But refugees and advocates say the wait is now much longer. And it’s unclear why.

    On March 31, 2019, four months after Hamed arrived in Australia, home affairs minister Peter Dutton formally refused to intervene in his case. Hamed made another request in January and is still waiting to hear the outcome.

    His lawyer told him this week that the coronavirus outbreak made things even more uncertain, and it was hard to know whether the government would be releasing anyone from detention.

    His treating psychiatrist at Alfred Hospital noted that Hamed had severe psychological symptoms stemming from his exposure to traumatic events, including Masoumali’s suicide.

    “[Hamed] has been in immigration detention since the age of 18. There was no information in his history to suggest significant personality dysfunction prior to his migration,” wrote the doctor in January 2019.

    The doctor said his recovery would be aided by “progress towards resettlement” and stability.

    “At the moment [Hamed] conceives that his symptoms are entirely dependent on his circumstances and environment and thus he feels there is little he can do personally to improve his outlook. He has expressed a desire to move to a community based detention setting and I would support any advocacy that can be provided to assist him with this process.”

    While on Nauru, Hamed was involved in a car accident, in which he sustained a brain injury. Doctors on Nauru recommended he be transferred to Australia so he could be treated in a specialised outpatient facility for traumatic brain injury.

    Hamed’s medical records indicate he has a serious history of self-harming from his time on Nauru.

    While in the MITA, he has seen a psychiatrist, but he says they have been unable to help him: “My doctors in MITA say they can’t help me further than increasing my medication doses. It was exactly the same thing that my doctor could offer me in Nauru.”

    Hamed said increasing his dose led him to start hearing voices in Nauru, and he began self-harming in order to cope. “I was terribly fearful of the voices I was hearing. I was scared to go to the toilet or shower alone. The voices constantly were calling my name,” he said.

    Hamed is among a number of refugees who remain in prolonged, indefinite detention in Australia, now facing even more uncertainty due to the coronavirus.

    His roommate Vahid, a 30-year-old Iranian refugee, began to hear voices, started harming, and developed anxiety and depression while on Nauru. He arrived in Australia a month after Hamed, on Dec. 30, 2018, but it has not improved his health.

    His doctors say the risk is likely to remain significant so long as he remains separated from his family. He travelled to Australia with two brothers, a sister, and their children, but has largely been separated from them in the seven years since. One brother and his family are in Sydney, and the other brother and sister both live in the community with their families in Melbourne.

    “I have no other choice but to give pain to my body in order to rid my mental pain. I feel like I'm choked whenever I think that I still can't be with my family,” he told BuzzFeed News. “I still hear many voices. I try to help myself by listening to the music with my headphones or keep the TV on all the time but sometimes I can't help myself in any way."

    While his family members in Melbourne visit him in detention, a new rule in response to the coronavirus means he is not allowed to hug them or sit close to them during visits.

    Elline, a 33-year-old Iranian refugee, has been in detention in Australia for the past seven months, after being transferred from Nauru for urological and other health issues. “Despite both behavioural and medical therapy the symptoms have continued to progress,” a urologist reported in mid-2018.

    She has also been diagnosed with major depressive disorder, and has had kidney stones, gynecological issues, and chronic back pain.

    Now in the MITA, after spending several weeks detained in a Brisbane hotel, she has not seen a gynaecologist or specialist since she arrived, she said. She also suffers from anxiety. She feels nervous about the outbreak of coronavirus, and worried she is particularly vulnerable in detention.

    “Visitors are still coming inside the detention centre without any checking [for the virus],” she told BuzzFeed News. “MITA feels like a prison. The staff treat me like a criminal. Security doesn’t give me any space when I’m overwhelmed, anxious and struggling to breathe,” she said.

    In MITA, Hamed hears the screams of refugees having nightmares of being deported, he said.

    “I’m still fearful of the darkness and am suffering from the feeling that I am being followed. Since late last year, I've been constantly suffering from a headache.”

    The Department of Home Affairs did not respond to a request for comment.

    * Surnames have been withheld.

    If you or someone you know needs help, you can call Lifeline Australia on 13 11 14 or Beyond Blue Australia on 1300 22 4636.