NAURU: New MSF report shows the disastrous mental health impact of Australia’s offshore processing policy

03 Dec 2018

Among 208 refugee and asylum seeker patients, 60% had suicidal thoughts and 30% attempted suicide


Canberra, 3 December 2018. Médecins Sans Frontières/Doctors Without Borders (MSF) is today releasing the first independent medical data demonstrating the extreme mental health suffering on Nauru, due to the Australian policy of indefinite offshore processing. MSF strongly reiterates its urgent call for the Australian government to end this policy and immediately evacuate all refugees and asylum seekers – men, women and children from Nauru to avoid further deterioration of their health.

According to the medical report Indefinite Despair, the mental health suffering on Nauru is among the most severe MSF has ever seen around the world, including in projects providing care for victims of torture.

“The medical data we release today confirms the heart-breaking reality that I witnessed on Nauru. Every day I worried which of my patients might attempt to take their own lives because after five years of waiting people had lost all sense of hope.” Dr Christine Rufener, clinical psychologist and MSF Mental Health Activities Manager.

Among the 208 asylum seekers and refugees MSF treated on Nauru, 124 had suicidal thoughts and 63 had attempted suicide. Twelve adults and children who MSF treated were diagnosed with resignation syndrome, existing in a semi-comatose state and unable to eat or drink.

Although three-quarters of refugee and asylum seeker patients reported experiencing traumatic events before reaching Nauru, such as conflict situations or detention, MSF’s report shows that it was the situation on Nauru that was most damaging to their mental health. A total of 65% of asylum seekers and refugee patients felt they lacked control over their lives, and these patients were significantly more likely to be suicidal or diagnosed with major psychiatric conditions.

“While many of our patients had experienced trauma, it was the Australian policy of indefinite processing that destroyed all their hope for the future and devastated their mental health,” says Dr Rufener.

More than one-third of asylum seeker and refugee patients were separated from close family members. People who were split from their families because some members had been medically evacuated from the island – a tactic used by the Australian government to coerce medically evacuated refugees to return to Nauru – were 40% more likely to be suicidal.

In 11 months on Nauru, MSF provided mental healthcare to 285 patients, including Nauruans, refugees and asylum seekers. A total of 1,526 consultations were provided for refugees and asylum seekers, and 591 for Nauruans.

The mental health situation of Nauruans was also concerning; almost half MSF’s Nauruan patients had psychosis, with many requiring psychiatric hospitalisation that was not available. MSF appeals to the Nauruan Government to recognise the importance of mental health by investing in staffing and inpatient facilities to meet the needs of their own population.

Strikingly, more than half of MSF’s Nauruan patients showed improvements in their mental health functioning under MSF’s care, while only 11% of asylum seeker and refugee patients improved.

“Our Nauruan patients’ mental health improved in a way that was not mirrored in our asylum seeker and refugee patients, despite receiving the same quality of care. This illustrates that living under a policy of indefinite processing creates a perpetual state of despair, making it impossible for asylum seekers and refugees to recover.” Dr Stewart Condon, MSF Australia President.

“The current mental health crisis on Nauru is tragically predictable. After five years of arbitrary deprivation of liberty, the situation is desperate. The Australian government must stop this brutal policy and immediately evacuate all refugees and asylum seekers from Nauru, as well as Manus island. There is no time to waste.” 

The Nauruan Government forced MSF to leave the island in early October, when more than 200 patients were still under our care. MSF remains deeply concerned for the ongoing care of the patients we left behind, Nauruan nationals, asylum seekers and refugees.  

“My former patients tell me that they are suffering more than ever. People who were previously functioning are now unable to get out of bed. People are forced to wait weeks for medical appointments and I hear disturbing reports of serious and potentially life-threatening self-harm,” adds Dr Rufener.MSF urges Australia to immediately end the containment of asylum seekers and refugees offshore.

MSF welcomes any resettlement options, including New Zealand’s, as long as they are fast, voluntary, respect family unity and allow people to rebuild their lives and mental health. 



Note to the editor

MSF began providing psychological and psychiatric healthcare on Nauru in November 2017, under a Memorandum of Understanding with the Nauruan Ministry of Health. Mental health support was available to everyone living on Nauru under a “one-door-for-all” strategy. A total of 73% of our patients were refugees or asylum seekers, while 22% were Nauruan nationals (the rest were foreign workers or had unknown status). On 5 October 2018, the Nauruan government told MSF that our services were “no longer required” and that we must cease activities within 24 hours.