Injustice in public health: asylum seekers and the case for political action. Paul McNeill. School of Public Health and Community Medicine. University of New ...
Injustice in public health: asylum seekers and the case for political action Paul McNeill School of Public Health and Community Medicine University of New South Wales Published in Helen Keleher and Gavin Mooney (eds.). 2002. Ethical Debates in Public Health, Curtin, ACT: Public Health Association of Australia; Series One: 27-41. Introduction As I arrived at the Scientia building at the University of New South Wales a large crowd outside the building, was already chanting: ‘Say it loud and say it clear: Refugees are welcome here. Say it loud and say it clear: Refugees are welcome here.’ We were ushered into the auditorium to await the Minister for Immigration, the Hon Philip Ruddock. There was no attempt to control the chanters or those carrying megaphones although the President of the local Students’ Association, tried to persuade us that we should ‘give him [Ruddock] a chance in the spirit of free speech and open debate.’ That brought on waves of another chant: ‘Free speech for refugees. Free speech for refugees.’ An academic colleague beside me shouted over the din: ‘Ruddock’s had his chance. The time for open debate is well past.’ Ruddock eventually arrived, was introduced, and the waves of chanting grew to a crescendo: ‘Shame Ruddock, shame. Shame Ruddock, shame.’ It felt to me as though I was in the centre of a violent storm – the energy in the room was electric. Ruddock stood at the microphone with a phalanx of seven security men and one woman alongside and in front of him – all facing the audience – none of them speaking. After some five minutes of stony facing-off, he spoke into a sound system powerful enough for him to be heard over the considerable volume of chanting. He outlined government policy on refugees: ‘It is based on a number of values: capacity to manage people across our own borders.’ ‘Shame Ruddock, shame. Shame Ruddock, shame.’ ‘We have changed laws to maintain protection of our borders. If we don’t, standards of living will deteriorate.’ ‘Lock up Ruddock. Free refugees. Lock up Ruddock. Free refugees.’ ‘Community support for immigration would evaporate.’ ‘Liar. Liar. Liar.’ A fight broke out at the front left of the auditorium and two of the uniformed policemen entered the fray. Television cameras, held head high only metres from the fracas, focussed in on it. The chant grew to a crescendo: ‘Ruddock’s a liar. Ruddock’s a liar.’ ‘Government must have the capacity. 19.7 million people are displaced world-wide.’ ‘Liar. Liar. Liar.’ The sheer magnitude of the problem means that governments have to make some hard choices.’ Ruddock’s a liar.’ ‘We have a limited capacity to assist.’
‘Lock up Ruddock. Free refugees. Lock up Ruddock. Free refugees.’ He left after suggesting that we, as members of a university audience, should reflect on our ‘willingness to allow free speech and open debate of ideas.’ What I reflected on was not our lack of willingness to allow free speech and open debate. Ruddock’s arguments have had a great deal of coverage. He has published those same views even in the Medical Journal of Australia. (Ruddock 2002a) Yet there is little evidence that he has been at all influenced by counter views. What I reflected on was the resilience of this man. The cold manner. Cadavic. Seemingly impervious to feeling. I reflected also on the staged performance for the cameras. He was expecting the reaction and played for it. It could be anticipated that the evening news would garner more support for Ruddock, his Government and their inhumane treatment of asylum seekers. As the promo for the Australian Story on Philip Ruddock stated: ‘There is no doubt about the electoral popularity of the current policies.’ (ABC Australian Story 16 September 2002) There can also be no doubt that this Government’s treatment of asylum seekers is inhumane. A Report commissioned by the United Nations High Commissioner for Human Rights, has damned the Australian Government’s treatment of asylum seekers. Justice P. N. Bhagwati, Regional Advisor for Asia and the Pacific of the United Nations High Commissioner for Human Rights, visited the facilities at Woomera, which had previously incarcerated the majority of asylum seekers.1 He found that the ‘human rights situation. . . in Woomera IRPC could, in many ways, be considered inhuman and degrading’ and contrary to both the International Covenant on Civil and Political Rights (Article 7) and the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. (Para. 37.) From the Report: ‘Justice Bhagwati was considerably distressed by what he saw and heard in Woomera IRPC. He met men, women and children who had been in detention for several months, some of them even for one or two years. They were prisoners without having committed any offence. Their only fault was that they had left their native home and sought to find refuge or a better life on the Australian soil. In virtual prison-like conditions in the detention centre, they lived initially in the hope that soon their incarceration will come to an end but with the passage of time, the hope gave way to despair. When Justice Bhagwati met the detainees, some of them broke down. He could see despair on their faces. He felt that he was in front of a great human tragedy. He saw young boys and girls, who instead of breathing the fresh air of freedom, were confined behind spiked iron bars with gates barred and locked preventing them from going out and playing and running in the open fields. He saw gloom on their faces instead of the joy of youth. These children were growing up in an environment, which affected their physical and mental growth and many of them were traumatized and led to harm themselves in utter despair.’ Para. 20. In particular he was concerned that: • a ‘number of individuals who had been in detention for several months, often exceeding 12 months, and sometimes considerably more.’ Para. 44. • the ‘extended and often seemingly open-ended detention appears to cause great distress and psychological trauma to several persons in detention in Woomera. Justice Bhagwati witnessed several persons who had committed acts of self-harm, such as slicing of wrists as well as stitching of lips.’ Para. 45. 1. According to Smith (2001), Woomera IRPC held 1383 inmates although the report relied on by Justice Bhagwati (2002) put the number at 216.
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that several ‘persons whose . . . application for a visa has been finally rejected, but who, for various - sometimes technical - reasons, cannot be returned to their country of origin . . . remain in detention.’ Para. 47. C. that ‘persons in immigration detention are unable to challenge the lawfulness of their detention under domestic law’ because of limitations on the power of judicial review. Para. 48. D. ‘Families in detention are sometimes separated.’ Para. 49. E. ‘the detention of children . . . is certainly contrary to international standards. But even from a practical point of view this would be undesirable as the children would be growing up in a detention centre enclosed by spiked iron bars in surroundings hardly conducive to the healthy growth of a child.’ Para. 52. ‘the policy of detaining unaccompanied minors also appears seriously flawed and must be regarded as totally unacceptable from a human rights perspective.’ Para. 53. G. ‘The lack of a proper independent monitoring and accountability mechanism is a matter of serious concern’. Para. 57. J. ‘In some instances, persons in immigration detention are detained in regular prisons [which is] contrary to Principle 8 of the Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment’. Para. 59. K.
From the Report: ‘In Woomera, Justice Bhagwati spoke to several children who had spent several months, sometimes years in detention. Most children appeared seriously traumatized, and severely affected by a culture of self-harm (e.g. slicing of wrists and suicide threats) out of a sense of desperation. With regard to education services, while children are in fact given access to education to some extent, it would appear that, at least in Woomera detention centre, the education services are at best wholly inadequate.’ Para. 52. Yet the Government was unmoved by this Report and issued a rebuttal that claimed (among other things) that: ‘Justice Bhagwati has clearly strayed from the mandate to consider whether Australia's system of immigration detention is consistent with Australia's human rights obligations. His report contains a number of emotive descriptions and assertions that have no foundation in the human rights instruments to which Australia is a party.’ (Ruddock 2002b) The rebuttal continued the Governments line by justifying Australia’s policy in terms of security, and dismissing the substantive moral issues by a disingenuous claim to be moral. It belittled both the Judge, and his moving account of his meetings in Woomera, by labelling his description of events as lacking in objectivity and ‘emotive.’ It ducked the human rights issues by resorting to the legalistic argument that Australia is not in breach of any ‘instruments to which Australia is a party.’ This Government does not take free speech and open debate seriously. Its response is frivolous, adolescent and silly. If the issues themselves and the consequences of this Government’s actions were not so serious, we could simply dismiss this Government as not worth talking to. Justice Marcus Enfield has described the actions of politicians as demonstrating ‘breathtaking arrogance’ and displaying ‘appalling ignorance’ and describes their behaviour as playing ‘shameful and unashamed politics.’ (Enfield 2001)
It is the substantive moral and humanitarian concerns that of are central concern in this paper. Justice Bhagwati’s Report is not on its own in pointing to the harmful consequences of Australia’s policy. A combined delegation of representatives of specialist medical colleges and the Australian Medical Association formed the ‘Professional Alliance for the Health of Asylum Seekers and their Children.’ This group has also condemned the Government’s policy and stated that: The Australian Government must follow the example of other Western countries with a more flexible and humane approach to dealing with asylum seekers and must abandon its current inappropriate long-term mandatory detention policy. (Royal Australasian College of Physicians 2002) There are numerous accounts of professionals who have witnessed the trauma experienced by incarcerated asylum seekers. Take for example the account of Lyn Bender, psychologist at Woomera Detention Centre, who reported that: During my six weeks at Woomera I spent on average of 50 to 60 hours per week, on duty. The greatest part of this time was spent listening to and assisting detainees with distress depression anxiety trauma. Suicidal ideation and acts of self-harm, were common and constant features of the detainees concerns. (Human Rights and Equal Opportunity Commission 2002) Nurse Moira-Jane spoke of the cruel treatment of inmates by guards. (Children out of Detention 2002) Numerous articles in academic journals have pointed to adverse health effects of the Government’s treatment of asylum seekers. Even before incarceration, these people are in need of assistance. Harris and Telfer (2001) found that asylum seekers are ‘likely to have psychological or musculoskeletal problems as a consequence of traumatic experiences in their own countries. Many require specialist treatment.’ Sultan and O’Sullivan (2001) found that the ‘prolonged detention of asylum seekers appears to cause serious psychological harm.’ Steel and Silove (2001) concluded that mental distress is ‘common in detained asylum seekers.’ These findings are supported by many other studies. (King and Vodicka 2001, Silove et al 2000, Burnett and Peel 2001) Role of the Public Health Professional The question I address in this paper is ‘what is the role of public health, of ethics, and of health professionals in response to the inhumanity of this Government?’ Smith (2001) took the view that ‘The medical profession can assist by reinforcing the principle of healthcare as a right, and opposing policies that contribute to poor health.’ Clearly the governmental policies need to be opposed. This is not a matter of party politics. Peoples’ wellbeing, psychological and physical, and their lives are at stake. In the face of an outright denial of the evidence, rejection of a damning United Nations Report, rejection of the opinion of the combined voice of specialist medical colleges and the Australian Medical Association – what kind of opposition might be justified? Mooney (2002) argues that our responsibility is to education and dissemination of knowledge to help create a more informed and autonomous citizenry. He also claims a legitimate role for passion in these debates, although he admits to ‘despair at the indecency of our Government and perhaps our people.’ I share the despair and wonder whether, in the absence of an ‘indecent’ stonewalling against valid argument and advocacy, some further action might be called for.
Public health as both moral and political Public health is an instrument for promoting and enhancing the health and well-being of individuals and their communities. This is a values position in that it gives priority to health and well-being ahead of other values, such as the economic abundance of a nation. It is also a moral position in that the implicit message is that we should value health and wellbeing highly. In its rationale for a ‘Public Health Code of Ethics’ the American Public Health Association acknowledged this dimension in stating: ‘The mandate to assure and protect the health of the public is an inherently moral one.’ (American Public Health Association 2002) In addition to its moral stance, public health is inherently political. It is political in a broad sense in being concerned with a group of interests within a community that may be competing with other interests. It is also political in the particular sense of being involved with power and authority, either in the exercise of authority or in reaction to those who exercise it, and thus engaged actively in issues of politics and government. Callahan and Jennings (2002) argue that, to achieve public health goals, ‘politics is a necessary component of public health.’ Moreover: given the governmental role of public health and its use of coercion for many purposes, politics is unavoidable and necessary. It is unavoidable because there is no way to stop the public from turning to legislatures or the courts to express their values and needs; nor should there be. The fact that power and politics are necessary to achieve public health goals should not in itself be alarming. The concern is not so much with politics but with the kind of politics. As Callahan and Jennings (2002) put it ‘there can be responsible and irresponsible politics.’ Public Health can function effectively as a vested interest, in a sense, in that it has an interest in the outcome. If it is to fulfill its role responsibly it will function by being ‘sensitive to community sentiments’ and by making available good data. It acts irresponsibly when it becomes no more than ‘one more self-serving, distant government bureaucracy.’ The test or whether or not it is acting responsibly, is its effectiveness in serving the public. When this is its primary motivation, public health can work politically to achieve its ends. Public Health is about the exercise of power. If power is to be used for the health of the public, then abuse of power is of concern, both in the sense of abuse of power in the exercise of public health coercive powers, and also in the sense of abuse of power by others in a way that has harmful consequences for the health of others. It is gratifying to see this acknowledged by the code put forward by the American Public Health Association that states that: [The public health mandate] carries with it an obligation to care for the well being of others and it implies the possession of an element of power in order to carry out the mandate. The need to exercise power to ensure health and at the same time to avoid the potential abuses of power are at the crux of public health ethics. (American Public Health Association 2002) Also at the crux of public health ethics is the ideal of equity. When the focus is on an individual, priority may well be given to values such as individual autonomy, care and compassion. Whilst public health is motivated by care and compassion for people, it is inevitable that its focus on the public, and on community, will tend to prioritise equity and justice. When programs are being considered for the good of the public it is more readily apparent that what is done for one person, ought also to be done for another in similar circumstances. A difference therefore, between ethics in the clinic and public health ethics is potentially a greater recognition of a need for fairness in its application. Public health is likely to be more sensitive therefore to issues of justice and injustice.
The inevitable conclusion must therefore be that political action is a part of public health and an appropriate response to cases of injustice and abuses of power. The treatment of asylum seekers by the Australian Government is a clear abuse of power and a paradigm case for taking political action. Ethical Analysis in Public health Public health requires both observation and action: observation to determine areas of need and action to address those needs. The student of public health typically spends a good deal of her time studying observational methods (including epidemiology) and action methods (such as governmental policy and health promotion). The typical public health curriculum gives little if any space to teaching ethics. Callahan (2002) notes that: The teaching of ethics is controversial primarily because the dominant ethos of most professions is empiricist, quantitative, and oriented toward precise, definitive solutions to discrete problems. This privileging of the technical over matters of value is not peculiar to public health. Jürgen Habermas (1971) argued persuasively that science (including social science) has attempted to eliminate subjectivity and has developed notions of objectivity and value neutrality that hide the human values and interests that are at the core of knowledge itself. As a consequence science serves the interests of technical exploitation, but is poorly equipped to deal with matters of value. In the face of inhumane treatment of asylum seekers, I am concerned that the empiricist and quantitative bias in public health is inhibiting public health professionals from acting effectively in response to political exploitation. The treatment of asylum seekers is a values issue. Getting the facts right is only a part of a sufficient response to official abuse. Habermas (1970) takes the view that it is only through an expansion of the public realm and an opening to genuine discourse, that matters of value and can be properly brought back into a consideration of science and technology. If this is true of science in general it is apparently more true in public health especially when health is taken to include well-being in more than a physical and objectively measured sense. The difficulty with this approach is that it depends on parties who are willing to engage in a genuine discourse. This Government is apparently not wishing to do so. Human Rights Callahan and Jennings (2002) note that ‘a growing international movement in support of human rights has exerted an important influence on public health’. Jonathan Mann (1997) in his article ‘Medicine and public health, ethics and human rights’ put the view that ethics has not been well elucidated in relation to public health. The language of medical ethics is ‘well adapted’ to medical care but ‘the contribution of medical ethics to . . . societal issues has been less powerful’. In part this is a problem that derives from public health itself in that there is insufficient ‘clarity about central issues, including its major role and responsibilities.’ In contrast however, Mann argued that the approach of human rights is suited to public health for several reasons: it helps address the discriminatory effect of population measures that may be prejudicial to some minority groups even though the measures may be popular with a majority. Secondly, human rights violations ‘have health impacts’ and the effect of abuse of rights needs to be recognised. Thirdly
human rights are not only instrumental in supporting healthy outcomes, they are themselves ‘social goods of pre-eminent importance.’ In responding to the plight of asylum seekers, human rights are accepted internationally and are well established. It is on the grounds of the human rights, identified in a number of international conventions, that Justice Bhagwati condemned the Australian government’s treatment of asylum seekers as ‘inhuman and degrading’. Public health ethics as political Callahan and Jennings (2002) in their article on ethics and public health, write of four types of ethical analysis. These are professional ethics, applied ethics, advocacy ethics and critical ethics. The code of public health ethics referred to above is a statement of professional ethics comparable to codes of ethics in other professions. It is a code, written by people within the field, that is designed to guide public health professionals in the exercise of authority. Applied ethics in Callahan and Jenning’s view draw on principles extrinsic to the profession. The paradigmatic example is bioethics – a field invented by philosophers and lawyers largely, that sought to guide medical practice and health professionals by applying principles (such as the principle of autonomy) that was not previously active in the practice of medicine. Business ethics is another example of ethics applied to business largely from the outside, as a way of influencing business toward more ethical conduct. Of the four types, advocacy ethics and critical ethics are of particular interest in the context of this article in that they address most directly the need for political action in response to perceived injustice. Critical Ethics Callahan and Jennings (2002) describe critical ethics as bringing: larger social values and historical trends to bear in its understanding of the current situation of public health and the moral problems faced. These problems are not only the result of the behavior of certain disease organisms or particular individuals. They are also the result of institutional arrangements and prevailing structures of cultural attitudes and social power. Critical ethics is part of a discourse that may well be conducted in academic journals, on television, and in the popular press, with the aim of analysing and laying bare the relationship between social conditions, inequities and poor health. In some situations this analysis itself may be sufficient to prompt action. In the debate about the treatment of asylum seekers in Australia, this has not been sufficient. Advocacy Ethics Callahan and Jennings (2002) describe advocacy ethics as having a ‘strong orientation toward equality and social justice.’ Whilst they include this as a field of ‘ethical analysis’ it is predominantly characterised by action rather than analysis. Advocacy is an obvious step to take when ‘prevailing structures of cultural attitudes and social power’ are implicated. Advocacy is that which follows from an analysis that shows ‘social deprivation, inequality, poverty, and powerlessness [that] are directly linked to poor health and the burden of disease.’ Where living conditions are demonstrably linked to poor health, there may well be a case for taking political action. In many situations an effective form of political action is advocacy. It is obviously not the only effective form of political action, but may be the only form available to someone drawing a salary from the public purse. As Callahan and Jennings (2002) put it:
While on occasion it can pose difficulties for civil servants, the ethical persuasion most lively in the field is a stance of advocacy for those social goals and reforms that public health professionals believe will enhance general health and well-being, especially among those least well off in society. Such advocacy is in keeping with the natural priorities of those who devote their careers to public health. The public health code of ethics refers to action although in a muted form by stating that ‘knowledge is not morally neutral and often demands action’. The forms of action include research, policy-making and ‘translat[ing] available information into timely action.’ Advocacy is also mentioned in the statement that ‘Public health should advocate and work for the empowerment of disenfranchised community members’. (American Public Health Association 2002) Public health bureaucrats may well act against staff in other arms of government, where it is clear that some action needs to be taken to overcome social conditions that lead to poor health. One can now argue, on the basis of this code of ethics, that it is a professional responsibility to do so. What action is justified? The case for political action is well established. What is not clear is the kind of political action that might be both justified and effective. The commentators are agreed that disseminating information and advocacy are legitimate activities in public health. The difficulty is that neither is enough. Prime Minister Howard and Immigration Minister Ruddock appear immune to information that reveals the harmful effects of their policies. They are immune even to extreme accounts of human suffering. Advocacy is far too tame for a Government that is willing to resort to the harshest of measures in dealing with the most vulnerable of people. It is worse than that. In his visit to the University of New South Wales campus (as on other occasions) Ruddock orchestrated an event to promote a violent reaction, knowing that this kind of publicity serves his cynical purpose of maintaining the coalition party in power. The red-necks like it. It appeals to their xenophobia. Rather than challenge ignorance, this Government is prepared to profit from it. It is an abuse of asylum seekers’ welfare and an abuse of the public realm by demeaning genuine discourse. Robertson et al (2002) discuss options available in hopeless situations. Their article focusses on humanitarian medical work during the recent civil war in the Balkans. In extreme situations the staff of Médicins Sans Frontières could do no more than witness and document suffering and violation of human rights. Even so, Robertson et al conclude that it ‘is a virtue or even a duty, a principled action we feel obligated to take, even if we believe such actions will be in vain.’ They state that: Many intended beneficiaries of aid, as well as participants in humanitarian medical intervention, place a high value on responding to suffering people simply by being with them, even in apparently hopeless situations. I agree with them. Even when nothing can be done, it is something to witness and share suffering. There are moving stories of people spending time with incarcerated asylum seekers. (Children out of Detention 2002) The circumstances in Australia however are different from civil war in the Balkans. In responding to the treatment of asylum seekers, I don’t believe we have exhausted all the options. The acceptable public health strategies of disseminating information and advocacy may not be enough. Something more is needed. Not violence – although our Government has resorted to it – for the obvious reason that in resorting to violence we become the perpetrators of harm ourselves. Reasoned advocacy may not be sufficient. Its time for a more passionate response. We should recognise, as my colleague said, that ‘Ruddock’s had his chance.
The time for open debate is well past.’ There are other options. None of them adequate. All of them worth a try. Public health professionals in open revolt. Passive resistance. Political satire. Street marches. Joining a lobby group. We should do all we can to bring an end to this heartless treatment of asylum seekers. References ABC Australian Story (16 September 2002), http://abc.net.au/austory/ (accessed 16th September, 2002). American Public Health Association. (2002). Writing a Public Health Code of Ethics. http://www.apha.org/codeofethics/background.html (accessed 8th September, 2002). Bhagwati P. N. (2002). Report of Justice P. N. Bhagwati, Regional Advisor for Asia and the Pacific of the United Nations High Commissioner for Human Rights, Mission to Australia 24 May to 2 June 2002. Report entitled: ‘Human Rights and Immigration Detention in Australia.’. http://www.smh.com.au/articles/2002/07/31/1027926913916.html (Accessed on 14 September, 2002). Burnett A, Peel M. (2001). Health needs of asylum seekers and refugees. BMJ; 322: 544-547. Callahan, D, Jennings, B. (2002). Ethics and Public Health: Forging a Strong Relationship. American Journal of Public Health, 92(2) February, pp 169-176. Children out of Detention (2002). http://www.chilout.org/index.htm (Accessed on 15 September, 2002). Also Transcript of speech by Nurse Moira-Jane, ChilOut Information Night, 3rd June 2002 http://www.chilout.org/53e.htm (Accessed on 15 September, 2002). Enfield, M. (2001) Wake up Australia, The New World Order: The Human Dimension, http://www.chilout.org/11e.htm (Accessed on 15 September, 2002). Harris MF, Telfer B. (2001). The health needs of asylum seekers living in the community. Med J Aust; 175: 589-592. Human Rights and Equal Opportunity Commission (2002), National Inquiry into Children in Immigration Detention http://www.humanrights.gov.au/media_releases/2002/59_02.html (Accessed on 15 September, 2002). King K, Vodicka P. (2001). Screening for conditions of public-health importance in people arriving by boat without authority. Med J Aust; 175: 600-602. Mann J. (1997). Medicine and Public Health, Ethics and Human Rights. The Hastings Center Report, May-June, 27(3): 6-13. Mooney G. (2002). Public health, political morality and compassion. Aust and NZ J of Pub Health. 26(3): 201-2. Robertson D, Beddell R, and Lavery J. (2002). What kind of evidence do we need to justify humanitarian medical aid? The Lancet, 360: 330-333. Royal Australasian College of Physicians (2002), Media Release - 6 May 2002: Professional Alliance for the Health of Asylum Seekers & Their Children, http://www.racp.edu.au/hpu/policy/asylumseekers/reform_mand.htm (Accessed on 15 September, 2002); and Professional Alliance for the Health of Asylum Seekers and their Children, http://www.racp.edu.au/hpu/policy/asylumseekers/alliance.htm (Accessed on 15 September, 2002). Ruddock P. (2002a). Asylum seekers and health care. Med J Aust; 176: 85. Ruddock P. (2002b). Minister for Immigration Philip Ruddock MP, Joint Media Release with Minister for Foreign Affairs, Alexander Downer, The Attorney-General, Daryl Williams. Government Rejects the Report of the UN Human Rights Commissioner's Envoy into Human Rights and Immigration Detention. http://www.minister.immi.gov.au/media_releases/media02/r02071.htm (Accessed on 14 September, 2002). Silove D, Steel Z, Watters C. (2000). Policies of deterrence and the mental health of asylum seekers. JAMA; 284: 604610. Smith, M. (2001). Asylum seekers in Australia. Med J Aust; 175: 587-589. Steel Z, Silove DM. (2001). The mental health implications of detaining asylum seekers. Med J Aust; 175: 596-599. Sultan A, O'Sullivan K. (2001). Psychological disturbances in asylum seekers held in long-term detention: a participant-observer account. Med J Aust; 175: 593-596.
