Seven years of offshore processing. Enough is enough.

09 Jul 2020

Seven years. That’s how long many asylum seekers and refugees have been held on Nauru and Papua New Guinea, with still no end in sight. 

Seven years of various forms of detention, uncertainty about the future and a lack of control over even the basic details of their lives.  

Australia’s offshore processing system is dangerous, causing devastating mental health suffering. 


The Naoero Public Health Centre, one of the locations where MSF provided mental health services to asylum seekers, refugees and Nauruan locals. © MSF

Médecins Sans Frontières (MSF) has provided free, independent mental healthcare to people held under Australia’s immigration policy on both Nauru and Papua New Guinea. We’ve seen firsthand how this system causes severe psychological damage, resulting in self harm and suicide.  

We have been calling for an end to this harmful policy for years, and after seven years, enough is enough.  

There are now around 400 refugees and asylum seekers held on Nauru and Papua New Guinea. It’s time to finally end this inhumane policy, and allow these people the chance to settle in a safe country like Australia or New Zealand and begin rebuilding their lives. 

We’re calling on the Australian Government to: 

  • accept New Zealand’s offer to resettle 150 refugees and asylum seekers each year from Nauru and PNG    
  • offer permanent resettlement in Australia to all remaining asylum seekers and refugees held on Nauru and Papua New Guinea or detained within Australia  

Ultimately, there is no therapeutic solution for asylum seekers and refugees until they are permanently and voluntarily resettled in a place of safety.  


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Seven years of offshore detention has had a devastating impact on asylum seekers and refugees held on Papua New Guinea and Nauru.
The Australian Government must resettle everyone held in offshore detention. It's been #7yearstoolong.  


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Australia’s offshore processing policy 

Under Australian Government policy, any asylum seeker trying to reach Australia by boat is sent offshore for an indefinite period of time while their refugee claim is processed.  

Since 19 July 2013, even if these asylum seekers receive refugee status they are unable to be permanently resettled in Australia. This is despite the fact that seeking asylum by boat is legal, under both Australian and international law. Between July 2013 and December 2014 more than 2,000 asylum seekers were sent to Nauru and Papua New Guinea under this policy.  

Many refugees have since been resettled to third countries, mainly the USA. However as of July 2020, seven years after this policy was introduced, around 400 refugees and asylum seekers remain in limbo on Nauru and Papua New Guinea, with still no certainty about their future.  

More than 1,000 more have been medically transferred to Australia, some of whom remain detained in places including hotels and immigration detention centres. 

Often I find myself wishing the boat had sunk…that I had drowned rather than endure these past seven years. I have so few choices, I feel I am in prison.

Port Moresby

How has MSF supported refugees in Papua New Guinea and Nauru? 


For 11 months from November 2017 until October 2018, MSF provided free psychological and psychiatric treatment on Nauru to refugees and asylum seekers, as well as to Nauruan nationals, under an official agreement with the Nauruan government. 

  • Of 285 patients, 73% were refugees or asylum seekers and 22% were Nauruan nationals (the rest were foreign workers or had unknown status).
  • Of the refugee and asylum seeker patients, 193 (93%) were recognised refugees while 15 (7%) were asylum seekers. 
  • MSF also worked on building local capacity in treating mental health disorders, increasing mental health awareness, and decreasing stigmatisation of mental illness. 

In October 2018, the Nauruan government forced the closure of MSF’s mental health activities on the island, advising that our services were “no longer required”. In February 2019 the Nauruan government prohibited telemedicine in Nauru, again preventing patients and their families from accessing our services.  This came after MSF had raised the alarm about the mental health crisis on the island, as described below. 

Papua New Guinea

In late 2017, MSF attempted to assess medical needs among refugees and asylum within the regional processing centre on Manus Island, Papua New Guinea. However, despite receiving official authorisation, the team was never granted access to the centre or nearby transit centres. 

In December 2019, MSF commenced tele-mental health services for refugees and asylum seekers held in Port Moresby, who had been transferred from Manus Island. MSF psychologists and cultural mediators conducted over 140 tele-health counselling sessions for 18 patients over the three-month program, with activities concluding in March 2020.  

The project aimed to prevent further mental health deterioration among asylum seekers and refugees after the repeal of the Medevac bill, which had given independent doctors more decision-making power on medical transfers to Australia. 

As well as these mental health projects, MSF has also provided medical administrative support to assist with patient assessments for people seeking medical transfer. We have also continued to advocate to the Australian government that asylum seekers and refugees held on Nauru and PNG need to be permanently resettled because of the impact of indefinite ‘processing’ on their mental health.  

How has the policy affected people’s mental health? 

Australia’s ‘offshore processing’ of asylum seekers and refugees is an undeniably harmful policy with devastating mental health impacts. After providing mental healthcare to patients on Nauru and PNG, MSF is deeply concerned by the persistent, and in many cases deteriorating, levels of mental health distress.  


MSF analysed our medical data from Nauru in a report called Indefinite Despair

This analysis found that the mental health suffering on Nauru is among the worst MSF has ever seen, including in projects providing care for victims of torture. One of the key factors contributing to the mental health distress was the lengthy and indefinite time period of the ‘processing’: people simply had no idea how long they would be held offshore.

Other factors included the lack of control that people felt over any aspect of their lives, the separation from family members and violence they had experienced in Nauru. 

Of the 208 refugees and asylum seekers MSF treated in Nauru, 124 patients (60%) had suicidal thoughts and 63 patients (30%) attempted suicide. Almost two-thirds of our refugee and asylum seeker patients were diagnosed with moderate or severe depression. A total of 12 adults and children were diagnosed with resignation syndrome, a rare psychiatric condition where people enter a comatose state. 

Our team also found that the local Nauruan health system was ill-equipped to manage the mental health crisis, with insufficient staffing and no inpatient facilities. 

Papua New Guinea

All the patients in Port Moresby that we supported through tele-mental health counselling met the criteria for depression and at least one other diagnosis. Ninety per cent of our patients had experienced suicidal thoughts, and 50 per cent had attempted suicide prior to the tele-health program. 

“In offshore detention, for hundreds of people who were only seeking a peaceful life, a life free of persecution, there is no end. I witnessed people become immobilised by depression and helplessness.”
—Sue Mitchell, Mental Health Activity Manager, Port Moresby tele-mental health program. 

The case histories of our patients revealed that their mental health had deteriorated from moderate to severe mental health disorders over the years of the policy. Many now had such poor psychological health that they were effectively incapable of engaging with the processes required to apply for resettlement.  Many also raised concerns about the quality of healthcare they were able to access in Port Moresby. 

“I have no energy to think or make a decision. They make decisions for me, they think for me."
—Refugee, Port Moresby, 2020. 

These poor mental health outcomes are tragically not surprising, as the effects of detention and family separation are well documented by mental health research. As long as refugees and asylum seekers remain in limbo, their mental health is likely to further deteriorate. 


A patient is attended by MSF's mental health team in Nauru. © MSF

How is the coronavirus pandemic affecting this group? 

Papua New Guinea has thankfully recorded very few cases of the new coronavirus, COVID-19, while Nauru has not recorded any (as of June 2020). Nonetheless, the pandemic has placed additional stress on this already vulnerable group of people. The closure of international borders has caused distress, particularly when resettlement options are already so restricted, although some resettlement has continued throughout the pandemic. Many are concerned about family members in countries with high case numbers, such as Iran. In addition, the lockdowns have been retraumatising as people recall the confinement in detention centres that they have experienced. 

Some asylum seekers and refugees who have been medically evacuated to Australia are also concerned that their accommodation puts them more at risk during the pandemic. For example, some are detained in hotel accommodation where they are forced to share rooms and communal living spaces, making it impossible to comply with social distancing guidelines.  

What needs to happen? 

MSF has consistently called for an end to Australia’s harmful offshore processing policy and for permanent resettlement for all asylum seekers and refugees still held on Nauru and Papua New Guinea. While mental healthcare can help stabilise patients and relieve some symptoms, it won’t provide a ‘cure’ while the stressor of indefinite detention remains. 

After seven years of suffering, enough is enough.  

The Australian Government seems to have no clear plan to resettle the remaining refugees and asylum seekers held offshore and onshore.  

With the COVID-19 pandemic further limiting international resettlement options, and with the group of asylum seekers and refugees held offshore now numbering only around 400, it is time for the Australian Government to end their policy and: 

  • Take up New Zealand’s offer to resettle 150 refugees or asylum seekers each year from those held on Nauru and Papua New Guinea
  • Offer permanent resettlement in Australia to all remaining asylum seekers and refugees held on Nauru and Papua New Guinea or detained within Australia 

I think I’m sick, I’m very unwell and this scares me. I feel 180-degrees different to the person I was.  To change, I need to leave here. It’s the only way to return to who I want to be. I am a prisoner still.  It’s impossible to become the person I want to be in this environment.

Port Moresby


Show your support for refugees held offshore

Seven years of offshore detention has had a devastating impact on asylum seekers and refugees held on Papua New Guinea and Nauru.
The Australian Government must resettle everyone held in offshore detention. It's been #7yearstoolong.  


Share our Facebook post to show your support for refugees held offshore.