UNHCR, the UN Refugee Agency, appeals to the Government of Australia to take urgent action for all refugees and asylum-seekers in Papua New Guinea and Nauru today. UNHCR appreciates the efforts of doctors, independent experts, lawyers and elected representatives from all sides of politics to highlight the human cost of "offshore processing" and its consequences in recent weeks. This reflects growing recognition that lives are at immediate and critical risk, as well as increased community concern. Despite this, decisive action is still to be taken.
The immediate evacuation of refugees and asylum-seekers from Papua New Guinea and Nauru to Australia does not require legislative change. Further, constraints upon freedom of movement and any differentiated treatment of refugees are both unnecessary and contrary to fundamental principles of refugee protection. Concerted action, founded upon a clear humanitarian imperative, is needed to prevent further deaths and harm to innocent men, women and children alike.
"While children are an obvious priority, there are many other acutely vulnerable men and women in both Papua New Guinea and Nauru who must not be forgotten," urged UNHCR Regional Representative, Thomas Albrecht. "Australia has both the ability and responsibility to take action and save lives today."
The movement of only children and their families would do nothing to address the predicament of others with urgent medical needs, a number of whom were also children when they were forcibly sent to Nauru over five years ago. Equally, the desperate situation of refugees and asylum-seekers in Papua New Guinea and Nauru is now such that evacuation of only some individuals would heighten the despair and exacerbate severe mental health risks of those left behind.
As early as 2016, UNHCR medical consultants found that cumulative rates of depression, anxiety and post-traumatic stress disorder exceeded 80% among the surveyed population in both countries. Circumstances have continued to deteriorate since that time.
The circumstances of refugees and asylum-seekers in Papua New Guinea and Nauru are entirely distinct from those of nationals and people who have migrated voluntarily. The unique needs of human beings who have fled war and persecution, have been forcibly transferred, detained and subject to harrowing conditions require an intensive response that is simply not available locally. These facts in no way detract from the various good faith efforts of the Governments of Papua New Guinea and Nauru respectively, or the warmth and hospitality of their people.
Approximately 3,000 refugees and asylum-seekers have been forcibly transferred by Australia to so-called "offshore processing" facilities in Papua New Guinea and Nauru since the introduction of the current policy in 2013. Of these, some 800 remain in Nauru and 650 in Papua New Guinea.
Refugees and asylum-seekers were initially held in closed detention, before the transition of the Nauru Regional Processing Centre (in 2015) and Manus Island Regional Processing Centre (in 2016) to more open facilities. In April 2016, the Supreme Court of Papua New Guinea found that the detention arrangements on Manus Island violated the right to liberty under Papua New Guinea's Constitution.
Circumstances and conditions for refugees under Australia's "offshore processing" policy have had severely negative impacts on health, and particularly significantly mental health. During 2016, UNHCR medical experts found cumulative rates of depression, anxiety and PTSD among refugees forcibly transferred to Papua New Guinea and Nauru to be the highest recorded in the medical literature to date at over 80% in both locations. The wellbeing of refugees has been noted by various medical experts to have further deteriorated since that time.
The Government of Australia currently contracts International Health and Medical Services (IHMS) to provide limited healthcare services to refugees and asylum-seekers in Nauru, and Pacific International Hospital in Papua New Guinea. The respective local healthcare systems, on which most refugees are forced to rely after hours, are under-resourced and understaffed in both countries. Torture and trauma counselling services were discontinued on Manus Island following the withdrawal of the Government of Australia in October 2017. In Nauru, torture and trauma support is available only to those who experienced trauma prior to their arrival in Australia. MSF International ceased providing medical services to Nauruans and refugees alike on 6 October 2018, in accordance with an order received from the Government of Nauru. They have called for the immediate medical evacuation of all refugees and asylum-seekers from Nauru, noting at least 78 instances of attempted suicide, suicidal thoughts and self-harm among their patients in Nauru in the past 11 months.
The Government of Australia stated in May 2018 that 494 people had been returned for medical reasons from Papua New Guinea and Nauru to Australia as of 30 June 2017. Those brought back to Australia for medical treatment do not escape the ongoing negative impacts of "offshore processing". Some have been formally detained in onshore detention centres in Australia following their medical transfer, which is particularly damaging in cases of poor mental health. The current policy offers them no long-term solution in Australia, and leaves them vulnerable to being sent back to Nauru or Papua New Guinea in future. They live with the persistent threat of being returned to the place where they were detained for years, and where adequate support services and long-term solutions are lacking. UNHCR has strongly urged the Government of Australia to not return anyone to Papua New Guinea or Nauru.
Under a bilateral arrangement between Australia and the United States of America, announced in November 2016, 1,250 refugees are expected to be relocated from Nauru and Papua New Guinea to the United States. As of October 2018, a similar number of men, women and children remain with no appropriate solutions in sight.
UNHCR's briefing note of 12 October 2018 also available here.
Catherine Stubberfield, +61 424 545 569, [email protected]
 United Nations High Commissioner for Refugees, Submission to the Senate Legal and Constitutional Affairs Legislation Committee on the Migration Legislation Amendment (Regional Processing Cohort) Bill 2016, 16 November 2018, available at here.
 See: UN High Commissioner for Refugees (UNHCR), Submission by the Office of the United Nations High Commissioner for Refugees on the Inquiry into the Serious Allegations of Abuse, Self-harm and Neglect of Asylum-seekers in Relation to the Nauru Regional Processing Centre, and any like Allegations in Relation to the Manus Regional Processing Centre Referred to the Senate Legal and Constitutional Affairs Committee, 12 November 2016, available here.
 See Question on notice no. 142, Portfolio question number: AE18/147, 2017-18 Additional Estimates, Legal and Constitutional Affairs Committee, Home Affairs Portfolio, available here.