Organisational Study<\/p>\n
Order Description<\/p>\n
Assessment 1 gives you an opportunity to demonstrate the application of knowledge in organisation theory on a specific organisational setting. To allow for uniformity in assessment, this assignment will be based on a common case \u2013 the organisations involved in the detention of asylum seekers as portrayed in the following article:
\nBriskman, L., Zion, D., & Loff, B. (2012). Care or collusion in asylum seeker detention, Ethics and Social Welfare, 6(1), 37-55.<\/p>\n
Assignment 1 is in two parts. Use the headings below.<\/p>\n
Part A: Profile of the Organisations [Use half the words allocated]
\nUsing clues that can be gleaned from the accounts of workers’ experiences in the article, provide a profile of the human service organisations in terms of:<\/p>\n
1,How recipients of services are conceptualised
\n2.How workers are conceptualised
\n3.Governance and decision making structures<\/p>\n
Part B: Influence of the External Environment [Use half the words allocated]<\/p>\n
Critically consider the role of the external environment – particularly the societal politics behind the issue and the funding relationships these organisations have – in shaping the development of the culture within those organisation represented by how recipients of services and workers are conceptualised and the governance and decision making structures.<\/p>\n
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\nCare or Collusion in Asylum Seeker
\nDetention
\nLinda Briskman, Deborah Zion & Bebe Loff
\nVersion of record first published: 13 Jul 2011
\nTo cite this article: Linda Briskman, Deborah Zion & Bebe Loff (2012): Care or Collusion in Asylum
\nSeeker Detention, Ethics and Social Welfare, 6:1, 37-55
\nTo link to this article: http:\/\/dx.doi.org\/10.1080\/17496535.2011.575383
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\nCare or Collusion in Asylum Seeker
\nDetention
\nLinda Briskman, Deborah Zion and Bebe Loff
\nThis paper explores ethical questions arising from the work of health practitioners
\nin immigration detention centres in Australia. It raises questions about
\nthe roles of professional disciplines and the ways in which they confront dual
\nloyalty issues. The exploration is guided by interviews conducted with health
\nprofessionals who have worked in asylum seeker detention and an examination
\nof the outsider advocacy role undertaken by the social work profession. The
\npaper discusses the stance taken by individuals and professional associations on
\nparticipation in controlled settings, including as participant, bystander and
\nadvocate, and asks when the provision of care becomes collusion with
\noppression.
\nKeywords Immigration Detention; Health Provision; Dual Loyalty; Ethical
\nDilemmas
\nWhen it comes to health and human rights more often than not asylum seekers do
\nnot count. (Correa-Velez & Gifford 2007, p. 278)
\nIntroduction
\nProfessional practice can be undermined in sites where services are dispensed
\nin controlled settings. This article discusses the ethical issues that arise in
\nprofessional practice with asylum seekers in immigration detention centres in
\nAustralia. Discussion is based on interviews conducted with health service
\nproviders, and an analysis of the advocacy of refugee advocates with health
\nISSN 1749-6535 print\/1749-6543 online\/12\/010037-19
\n# 2012 Taylor & Francis
\nhttp:\/\/dx.doi.org\/10.1080\/17496535.2011.575383
\nLinda Briskman is a social worker and Chair of Human Rights Education at Curtin University, Australia.
\nShe conducts research, advocates and writes on asylum seeker issues in Australia. Deborah Zion
\nteaches medical ethics at Monash University, and has published widely on issues related to the health
\nof asylum seekers, clinical research and issues related to HIV\/AIDS. She led the project ( help with nursing paper writing from experts with MSN & DNP degrees) \u2018\u2018Caring for
\nAsylum Seekers. Human Rights and Bioethics,\u2019\u2019 which was funded by the Australian research council.
\nBebe Loff is a lawyer and Director of the Michael Kirby Centre for Public Health and Human Rights in
\nthe School of Public Health and Preventive Medicine at Monash University, Australia. Correspondence
\nto: Deborah Zion, International Public Health Unit, School of Public Health & Preventive Medicine,
\nMonash University, 3rd Floor Burnet Building, Alfred Hospital, Melbourne 3004, Australia; Email:
\ndeborah.zion@med.monash.edu.au
\nETHICS AND SOCIAL WELFARE VOLUME 6 NUMBER 1 (MARCH 2012)
\nDownloaded by [ ] at 21:14 30 June 2012
\nand human services backgrounds, drawing on literature that contributes to an
\nexplanation of the ethical terrain. To provide context, the article presents an
\noverview of immigration detention in Australia, a synopsis of the research and
\nproject ( help with nursing paper writing from experts with MSN & DNP degrees) methodologies and findings, followed by discussion of the debates on the
\ndelivery of services in environments of social control.
\nAsylum Seeker Well-being
\nAsylum seeking is a global phenomenon. War, violence and persecution have
\nresulted in people fleeing their home countries to seek safe haven. Australia has
\nstood out as one of the harshest regimes in the industrialised world in its
\ntreatment of asylum seekers. The focal point of the attempt to make Australia an
\nimpenetrable fortress is mandatory detention, the relevant legislation introduced
\nby a Labor government in 1992. With mandatory detention:
\n. . . refugees have been criminalised through their incarceration in prison-like
\ninstitutions, where the daily imperatives of control and management systematically
\nundermine detainees\u2019 decision making capacity; their ability to engage in
\nthe wider polity; and their access to proper legal advice, care and protection.
\n(Grewcock 2009, p. 196)
\nAs the asylum seeker flow increased from 1999, particularly from Afghanistan,
\nIraq and Iran, increasingly harsh measures were put in place including the now
\ndefunct Temporary Protection Visa (TPV) that created uncertainty and barred
\nfamily reunion, and the \u2018Pacific Solution\u2019 which saw asylum seekers placed in
\ndetention camps on Nauru and Manus Island (Papua New Guinea). Under the
\nconservative government of Prime Minister John Howard (19962007), the main
\nsites of detention in Australia itself were remote locations in Western Australia,
\nSouth Australia and Christmas Island, with many people languishing for years in
\nthe facilities. In each site concerns arose about the quality of health care, and
\nthe role of healthcare professionals. Although overall responsibility for the
\npolicies and practices rested with the Immigration Department (now known as
\nthe Department of Immigration and Citizenship*DIAC), a changeable and
\ncomplex web of privatisation of detention and the services within detention
\nfacilities resulted in limited accountability and transparency, posing additional
\nbarriers to the creation of an environment conducive to acceptable health
\npractice. Despite the evidence that many practitioners working within immigration
\ndetention centres colluded with processes amounting to inhuman and
\ndegrading treatment, including participating in force feeding and chemically
\nconstraining people for deportation (Briskman et al. 2010b), we acknowledge the
\ncourage of those who stood up against these practices and spoke out about what
\nthey witnessed.
\nThe findings documented in this article refer mainly to the period up to mid-
\n2008, after which the Labor government that came to power in November of the
\n38 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\npreceding year introduced a range of reforms based on its newly devised
\nDetention Values, including abolishing the Pacific Solution. Despite some changes
\nat this time, once the boats started arriving more regularly from 2009, the
\ngovernment became increasingly tough in its border protection measures,
\nincluding immigration detention. The concerns outlined in this paper have
\nchanged only minimally since the research was conducted.
\nThe following two case studies illustrate the nature of health concerns which
\nled to the professional advocacy in Australia that is profiled in this paper. The
\nfirst relates to the death of a woman detained on remote Christmas Island and
\nthe second refers to the consequences of detaining a child in immigration
\ndetention.
\nCase Study One: Fatima Erfani
\nThe folly of maintaining detention in a remote location has had serious
\nconsequences. In 2003, Fatima Erfani, an Afghan asylum seeker and mother of
\nthree young children, was detained on Christmas Island. Ms Erfani was diagnosed
\nwith high blood pressure that increased rapidly. After several days of blinding
\nheadaches she was taken to the Christmas Island Hospital where she was
\ndiagnosed with migraine. Upon returning to the hospital when her condition
\nbecame worse, she collapsed and did not regain consciousness. By the time she
\nwas flown to Perth, 2,600 kilometres away, she was brain-dead and her life
\nsupport was switched off in the presence of her traumatised husband.
\nCase Study Two: Shayan Badraei
\nThe case of five-year-old Shayan Badraei, despite exposing the damage that
\ncould be inflicted on children, did not influence policy change. Shayan had
\nbecome increasingly withdrawn in detention and developed a range of disturbing
\nsymptoms including refusal to eat, night terrors and inability to speak. Although
\nhospitalised many times, he was continually returned to an immigration
\ndetention centre. Following his eventual release from detention and the
\nrelentless advocacy of his supporters, he and his family received an out-of-court
\nsettlement that recognised the harms that had been inflicted.
\nIn time, tragic scenarios began to receive attention in the media and also
\ncaptured the concern of advocates, including health professionals, particularly in
\nthe sphere of mental health. The main question that arose for us as researchers
\nand advocates was how health and mental health practitioners working within
\nthe restrictive detention environments articulated their ethical obligations. This
\nled to the research project ( help with nursing paper writing from experts with MSN & DNP degrees) titled \u2018Caring for Asylum Seekers in Australia:
\nBioethics and Human Rights\u2019. An Australian Research Council grant enabled the
\nconduct of interviews with health professionals who had worked in immigration
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 39
\nDownloaded by [ ] at 21:14 30 June 2012
\ndetention facilities during the time of Prime Minister John Howard\u2019s government.
\nThe semi-structured interviews focused on ethical dilemmas of working in a
\nsecuritised detention environment and were conducted with nurses (the majority
\nof respondents), psychologists, psychiatrists and general practitioners who had
\nworked mainly in immigration detention centres between 2000 and 2006. A total
\nof 40 interviews took place Australia-wide. The people who agreed to speak out
\nwere those who found the environment problematic and we are aware that there
\nare others who were able to fulfil the duties required of them by the government
\nand private security companies. An unknown number of people who could not
\ncope silently relinquished their employment, choosing not to go public with their
\nconcerns. Using grounded theory and thematic analysis, the overall findings
\ncentred on the concepts of human rights, dual loyalty and professional ethics.
\nThe interview narratives that follow illustrate the interconnected themes arising
\nfrom the broad concepts: the decision to take positions, coping mechanisms,
\ndehumanisation, standards of care and securitisation. Some of the interviewees
\nhad previously aired their concerns publicly, in open forums or with the media,
\nbut there were others who had not previously spoken out. Respondents were
\nchosen either because of our knowledge of their public advocacy or through a
\nsnowballing approach.
\nThe second project ( help with nursing paper writing from experts with MSN & DNP degrees) that will be discussed is the People\u2019s Inquiry into
\nDetention, which was a response by academic social workers who had previously
\nraised their disquiet with immigration officials, but to no avail. Although not a
\nprofession that was specifically involved in immigration detention settings, the
\nAustralian Council of Heads of Schools of Social Work (ACHSSW) saw itself as
\nhaving a professional obligation to expose injustices in immigration detention.
\nTaking a different slant to the bioethics research, the People\u2019s Inquiry is
\ndiscussed not through a focus on the ethics of working in detention but
\narticulates how the social work academics enacted an ethical mandate to expose
\nthe policies and practice that constituted human rights violations. The stimulus
\nfor the Inquiry was the following case scenario.
\nCase Study Three: Cornelia Rau
\nThe People\u2019s Inquiry arose in response to the cruelty shown to one woman,
\nCornelia Rau.
\nIn February 2005, a mentally ill Australian was \u2018discovered\u2019 inside the highsecurity
\nBaxter Immigration Detention Centre in rural South Australia. She was
\ninitially identified as a German named \u2018Anna\u2019 before her true identity was
\nestablished. Prior to her incarceration in Baxter, Rau had been held in a
\nQueensland jail after found wandering in a disturbed manner (Briskman &
\nGoddard 2007). Two social work academics (Goddard & Liddell 2005) wrote that
\nwhat happened to her \u2018exposed the darkest corners of our lives\u2019. Although the
\ngovernment ran an inquiry into the circumstances of her detention, it refused,
\n40 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\ndespite pressure from detainees and refugee advocates, to widen its terms of
\nreference to inquire into the treatment of all detainees. Prominent QC and
\nrefugee advocate Julian Burnside (2005) asked: \u2018Why is it acceptable to treat
\nasylum seekers this way, but shocking when it is done to one of us\u2019
\nThe ACHSSW conducted the People\u2019s Inquiry into Detention. The Inquiry had a
\ndual role to influence policies and to place the stories of immigration detention
\non the public record for the future of the nation. Professional responsibility arose
\nfrom social work ethics and from the knowledge base and experience of social
\nworkers, which fostered a positioning as practice ethnographers (Briskman 2010)
\nthrough understanding the harms that arise through institutional racism and
\nmalevolent policies. In these ways the ACHSSW adopted the stance described by
\nFraser and Briskman (2005) that social work cannot be apolitical or neutral but is
\na profession engaged with the political context. An advantage of an academic
\ngroup taking the lead was the existence of academic freedom, as universities:
\n. . . are essential for producing educated, informed and questioning citizens with
\nsome capacity to scrutinise government decisions. The academics who staff
\nthese institutions require a high level of academic freedom to pursue research
\nthat may, at times, challenge a government\u2019s values and agenda. (Hamilton &
\nMadison 2007, p. 13)
\nThe methods of inquiry included holding 10 public hearings in urban and regional
\nareas and inviting written submissions. With very little financial backing, the
\nInquiry attracted volunteers from all walks of life. More than 200 people gave
\nverbal evidence, including health professionals, faith groups, lawyers and
\nmigration agents and asylum seeker advocates and activists. Almost one-third
\nof those testifying had been previously incarcerated in immigration detention
\nfacilities. Another 200 organisations and individuals presented written submissions.
\nThe evidence received was supported by formal documents including court
\nhearings and parliamentary debates. The Inquiry was joined by volunteers who
\nHelped in every facet of the organising including media activity, panel
\nmembership, transcription, promotion of the Inquiry and liaison with witnesses.
\nBoth project ( help with nursing paper writing from experts with MSN & DNP degrees)s had at their core concerns about the detention of men, women
\nand children, particularly how human rights violations inflicted harm on people
\nexercising their right to seek asylum. In the absence of comprehensive official
\ndata which were not officially collected, the project ( help with nursing paper writing from experts with MSN & DNP degrees)s made a contribution to
\nasylum seeker advocacy by rigorously exposing issues and in highlighting
\nprofessional responses which had been absent from the wider literature on the
\ntopic (sample nursing essay examples by the best nursing assignment writing service). By gathering a substantial number of testimonies, the systemic and
\ninstitutionalised nature of the human rights violations was exposed.
\nWe now turn to outline the findings of the bioethics and human rights project ( help with nursing paper writing from experts with MSN & DNP degrees)
\nprior to examining in more detail the ethical issues that arise from the provision
\nof services in sites of control.
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 41
\nDownloaded by [ ] at 21:14 30 June 2012
\nFindings: Bioethics and Human Rights Research
\nOne of the first questions that confronted some of those we interviewed was the
\nquestion of the ethics of working in an immigration setting. \u2018Hannah\u2019, a
\npsychologist, stated: \u2018The biggest ethical dilemma was being an employee in
\nthere. Taking a pay.\u2019 \u2018Max\u2019, a nurse, although stating he was \u2018on the side of the
\ndetainees\u2019 put it simply, stating that he worked in detention as it paid well and
\nhe wanted a different experience. \u2018Susan\u2019, another nurse, raised the further
\nquestion of showing people kindness, posing the question: \u2018Shouldn\u2019t I stay and
\ncontinue to do that And what about hope One person said to me, and it sticks in
\nmy mind absolutely clearly: \u2018\u2018Are you just a kind lady or can you really help us\u2019\u2019
\nSusan responded with: \u2018I don\u2019t know that I can help you any more than how I\u2019ve
\nhelped you here, but I will keep trying to help you. That I promise you, I will.\u2019
\n\u2018Louise\u2019 discussed how she responded to hostility about working as a nurse \u2018in a
\nplace like that\u2019:
\nOn the inside there\u2019s nobody who\u2019s on their side so I saw myself as a person who
\nwas privileged to sit in their room, privileged to hear their stories because that\u2019s
\nwhat people on the outside, no matter how well intentioned, were not able to
\ndo. Sometimes I was able to facilitate their linking with the outside world. I just
\nfelt there was a role for us there, as long as I tried to be true to myself. I suppose
\ntoo, guards learnt very quickly there was no point hanging shit on detainees in
\nfront of me because I would argue with them or say \u2018that\u2019s not on, you can\u2019t say
\nthat, that\u2019s illegal, I can report you\u2019.
\n\u2018John\u2019, a psychiatrist, saw the situation somewhat differently in relation to
\nmedical personnel and presented the way he saw the problem of enacting
\nmedical practice in isolated conditions:
\nBut my concern is every doctor in Australia has the opportunity of peer review of
\nsome sort or another, except them. That lack of peer review plus the nature of
\nthe way those doctors get employed in the first place, they tend to see people
\nthat work in the prison system, who are perhaps a little bit out of mainstream
\nmedicine as they may not see the ethical issues in the same way we would. And I
\ncan see that there is an issue. They would just say \u2018Look, I\u2019m a doctor and I\u2019m
\ndoing my best when I see the patient, and that\u2019s that\u2019. I know they\u2019re reasonable
\ndoctors and I know that they\u2019re trying to do a good job for these patients but they
\ndon\u2019t have a broader perspective of where they\u2019re in the system that they\u2019re in.
\nThey haven\u2019t got the contact with the outside medical world to see what they\u2019re
\nmissing.
\nNonetheless there were others who stayed within the system not just to be \u2018good\u2019
\nhealth practitioners, but to also be advocates. Advocacy was important for
\n\u2018William\u2019, a psychiatrist, and he described as nonsense the idea expressed by some
\nof his peers that medical care and advocacy could not be enacted simultaneously.
\nRespondents spoke further about how they coped with working in detention,
\nparticular maintaining their ethical stance and enacting a duty of care. A common
\ntheme arising was the idea that being somewhat subversive and adjusting the rules
\n42 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\nwas an appropriate response, a phenomena that Bill Jordan (1990) refers to as
\n\u2018isolated acts of banditry\u2019. In her nursing role, \u2018Susan\u2019 explained that to survive
\nand be effective in that environment required both adaptive and subversive
\nbehaviour when acting from humanity rather than inappropriate rules:
\nI needed to be surreptitious about what I was doing which to the organisation was
\nprobably quite subversive and not being open about what I was doing with the
\ndetainees.
\nUsing a specific example, \u2018Max\u2019 said he ignored the rules when he felt it was in
\nthe interests of the detainees, including the dispensing of the morning drugs. He
\nexplained he felt sorry for the refugees as they had to queue up outside a hut and
\nwait for their medications. \u2018We were asked to check them off to make sure they
\nwere taking their tablets, the thing that I didn\u2019t agree with and didn\u2019t do.\u2019
\nThe theme of dehumanisation has been a recurring one in immigration
\ndetention regimes and one of the main responses in the research was concern
\nabout the use of identification numbers rather than names. \u2018Max\u2019 spoke about
\nthe number system and said that this had an impact on the keeping of medical
\nnotes:
\nYou see the problem was they weren\u2019t given names; as they got off the boat they
\nwere given three letters and three numbers.
\n\u2018Simone\u2019, a nurse, discussed how the dehumanised environment became normalised:
\nWe would actually refer to people by their number rather than by their names . . .
\nI wasn\u2019t conscious of it. And eventually I must say I think it was much easier as it
\nturned out, and people themselves actually identified by that number.
\nThe dehumanisation process of using identity numbers continues today. The
\nAustralian Human Rights Commission (2010) states that its members observed the
\npractices of calling people by numbers in the detention centre on Christmas
\nIsland, and, as one detainee told the visiting representatives, it made people feel
\nlike a flock of sheep (AHRC 2010). One of the authors also witnessed this practice
\n(Briskman et al. 2010a), commenting in a report to the immigration authorities
\nthat the practice breaches DIAC\u2019s Detention Values which specify that the
\nconditions of detention will ensure the inherent dignity of the human person.
\nA further anomaly for those used to providing health care on an equitable basis
\nwas that lesser services were provided than for people outside the detention
\nenvironment; poor and discriminatory quality of care was a recurring theme in
\nthe interviews. This included some comments about comparisons with other
\nenvironments of social control such as prisons where there was more equitable
\nhealthcare provision than in immigration detention. \u2018Simone\u2019 referred to one
\nmedical practitioner who stood out by challenging the expectation of low-level
\nhealth care:
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 43
\nDownloaded by [ ] at 21:14 30 June 2012
\nShe said to me that she got hauled over the coals because she ordered an
\nultrasound to test the person for kidney stones. And see again, because it\u2019s a
\ndetention situation, you never ever do the ultrasound. The ultrasound would
\nhave involved a transport from Woomera to Port August, 180 kilometres each
\nway. It would take two prison guards out of circulation, plus of course the costs.
\nOvernight costs maybe for the person, for the two guards. So viewed in that
\ncontext, it really does escalate the costs. And so the doctor then got into trouble
\nfor ordering too many ultrasounds. \u2018Why do you order more than the other doctor
\ndoes\u2019 And she said \u2018I like to treat my patients all the same regardless of where
\nthey\u2019re coming from.\u2019
\n\u2018Anna\u2019, a psychiatrist, explained that working in the public system where
\ndetainees were sent for treatment, she was told not to refer to matters like
\nimmigration and visas. However, she made it clear that she would not
\nrecommend that people return to detention. Her community discharge plans
\nwere rejected by the authorities. She said:
\nPolitics came into play. People could be sent back to detention against
\nprofessional judgment. That was the real crunch for me.
\n\u2018Max\u2019 spoke of the shock of seeing the health centre when he first arrived,
\ndescribing it as \u2018disgraceful\u2019:
\nThere was no opportunity for sterilising things. It was all done with hot water.
\nThe clinic was, because we were in the desert, always dirty. Babies\u2019 bottles were
\nwashed at the same sink where urine was tested. It was horrible.
\n\u2018Louise\u2019 spoke of inadequate access to the one medical doctor in the Curtin
\ndetention centre in remote Western Australia and a rotating system by compound,
\nwhich meant that it was less than a day a week that access was possible. This rule
\nwas applied even when people needed immediate medical treatment.
\nDespite relentless criticisms that continue into both physical and mental
\nhealth care in immigration detention facilities (see Briskman et al. 2008), the
\nAustralian government maintains that:
\nAll people in immigration detention are provided access to health care at a
\nstandard generally comparable to the health care available to the Australian
\ncommunity. Health care services are provided by qualified health professionals
\nand take into account the diverse and potentially complex health care needs of
\npeople in immigration detention. (DIAC n.d., p. 1)
\n\u2018John\u2019s\u2019 response spans the issue of equity of health provision and dehumanisation.
\nHe described one visit to a detainee:
\nFor example, when I went to see my first patient, they were expecting me, I
\ndidn\u2019t have too much trouble getting in the door, and I was offered the file to
\nreview before I went to see the patient. The patient was brought in handcuffs
\ninto a room and the room I was given was the size of this room (about 5 2 m
\nwide) it had light-blue walls which were just painted large concrete blocks with
\n44 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\nbright lights at the top and that\u2019s it (and a carpet). There was no table no chair,
\nno examination couch, no nothing. He and I are sitting on the floor, having a chat
\nand I\u2019m trying to examine the patient on the floor. Although . . . there were no
\nnasty words said by the guards to the detainee, there was nothing like \u2018You stupid
\nbastard go in there\u2019, there was nothing like that at all. It was \u2018these are the rules,
\nthis is the room that you\u2019ve got, that\u2019s it\u2019. It struck me as the most depersonalised
\nsystem I could possibly imagine.
\nAlthough under-explored in the immigration detention literature, healthcare and
\ntherapeutic relationships have been severely compromised by security considerations.
\nAs asylum seekers are not \u2018criminals\u2019 but still held in what are
\neffectively private prisons, abuses can occur through the employment of security
\npersonnel who may engage in practices that clash with those who uphold ethical
\ncare as the main imperative. Yet without the accountability and peer review
\nreferred to by \u2018John\u2019 that are the norm in most healthcare settings (Zion et al.
\n2009), ethical concerns for service providers continually emerged, as told to us
\nby interview participants.
\nAs with John, \u2018William\u2019 told of people coming to appointments in handcuffs
\nwith guards, which he tried to dispute. \u2018Susan\u2019 spoke of her difficulties as a nurse
\nin dispensing strong medication in the medical centre with guards present. When
\nshe raised her concerns it was suggested that she should leave. To survive and be
\neffective in that environment required acting from humanity rather than
\ninappropriate rules. She spoke further about the ethical dilemmas:
\nOne of the biggest problems was that the guards decided that they would become
\nthe triage nurse, so they would determine who got through the gate and who
\ndidn\u2019t. So they\u2019d ask what the problem was and if the person said: \u2018I\u2019ve got a
\nheadache\u2019, well the guard would say that\u2019s not a good enough excuse to see the
\nnurse. I had to say to some of the refugees: \u2018If you want to get through the gate,
\ntell them you\u2019ve got chest pain and they have a duty of care to let you through.\u2019
\n\u2018Max\u2019 spent time reprimanding the guards for their behaviour towards the
\nrefugees; some of the things they did were \u2018quite abominable, it was appalling\u2019:
\nI would hear guards talk about how \u2018I gave LOC46 a good thumping today, a good
\nsmack in the mouth, he spoke back at me\u2019 or something like that. The guards
\nwould totally abuse their power.
\n\u2018Max\u2019 tried to speak out within the system and wrote official reports and even to
\nthe Minister but he did not get responses:
\nThe dilemma was that I was supposed to report to the supervisors, the guards,
\nACM,1 anyone who was suicidal, they\u2019d be on 24 hour watch and deprived of all
\nliberties. The problem is that they would be punished if they were deemed to be
\nsuicidal . . . in actual fact the consequences of being suicidal made them more suicidal.
\n1. Australian Correctional Management was the private detention provider until 2004, followed by
\nG4S and now Serco.
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 45
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\nTo deal with this \u2018Max\u2019 told them that he would not tell anyone but asked them to
\npromise not to hurt themselves because of the consequences and said he would
\nreview them the next day.
\nProfessional Issues in Detention Health
\nWhat do these research data suggest about traversing the complex terrain that
\nsurrounds health care in immigration detention settings Robust sociological
\ncritiques directed at the helping professions argue that they generate an ideology
\nthat perpetuates the dominant power of the professionals over groups they are
\nostensibly helping (Fook 1993, pp. 56). Themes of social control have
\ncharacterised appraisals of professionalism, particularly where practitioners
\nmay be expected to provide the contradictory roles of care agent and control
\nagent. The social work literature is one body of knowledge that has grappled with
\nthis conundrum, pointing out that practitioners must balance the competing
\ndemands of a society that wants both to help and to control the disadvantaged,
\nusually at the same time (Ife 1997). Critics from within social work argue that
\nthere are unresolvable dilemmas between the values of casework practice and
\nthose of the society in which it is practised (Fook 1993, p. 6). Once we
\nunderstand the core of the tensions underpinning working within an immigration
\ndetention environment there is the prospect of grappling with what Fook sees as
\nintractable. One explanation is the issue of dual loyalty.
\nDual loyalty issues arise where the loyalty of a health or welfare professional
\nto the patient\/client is compromised by obligation to the employing body, which
\nmay represent the interests of the state. Historically, the ethical obligations of
\nhealth and welfare professionals have privileged the need for loyalty to patients
\nand clients. Increasingly, however, health professionals may be in settings where
\nthey are asked to weigh their devotion to patients against their obligations to
\ngovernment employers or third-party employers acting on behalf of government
\n(London et al. 2006, pp. 38182). As employees, those within the care
\nprofessions are expected to follow agency rules and policies (Carniol 1990, p.
\n61), and these rules may be both explicit and tacit. In the case of immigration
\ndetention, dual loyalty considerations may create potential for the violation of
\nhuman rights through collaboration which can be either active or passive (Gready
\n2007, p. 417). It is not always clear as to the extent to which health professionals
\nin these contexts are bound by employment, bureaucratic, political and
\neconomic constraints (Fook 1993, p. 30) and part of the problem may lie outside
\nthe employment contract, with health professionals colluding with the dominant
\ndiscourse in their societies, which may be unevenly challenged by their training
\ninstitutions or their professional bodies. This means that beyond day-to-day
\npractice there is a danger that professional groups may contribute to the social
\ncontrol function by abiding with a dominant and repressive order. This is nowhere
\nclearer than in the case of asylum seekers, where governments have successfully
\n46 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\nconvinced the wider populace of the risks associated with receiving strangers
\nwho arrive \u2018uninvited\u2019. Here an imagined threat has a potency that was
\nexacerbated after the attacks in New York on 11 September 2001. As Tascon
\n(2010, p. 289) asserts:
\nFear of the outside, fear of \u2018the other\u2019 that is outside, of invasion by that other,
\nwho pervades the unknown outside is consistently present in Australia as an
\nisland because the way to breach the physical border is by boat. The boat
\nbecomes an iconic symbol that represents the possibility of such an invasion most
\npatently and hence became deeply central in the easy acceptance by the wider
\npopulation of the border protection measures taken after 2001.
\nDisturbingly, those working within detention are no more immune to the
\npolitical and media attack against boatpeople2 than health and social workers
\nwere under National Socialism in Germany (Georges & Benedict 2006), the
\napartheid regime in South Africa (Gready 2007) or those involved in torture in
\nGuantanamo Bay (Woolf 2007). Ahmed (2004, p. 1) speaks of how narratives arise
\nthat espouse that the \u2018other\u2019 or those who are \u2018not us\u2019 are seen as endangering
\nwhat is \u2018ours\u2019. Health professionals may become socialised to environments that
\npermit abuse. By failing to confront abusive acts they may sustain those
\nenvironments. This is enacted through both their silence and the failure to use
\ntheir professional authority in defence of patient well-being (Allen et al. 2006).
\nConsistent with the views of interview participants about normalisation of
\npractices within detention, journalist Sushi Das writes:
\nSo, how do you attract people to run camps, such as Baxter, where a detainee\u2019s
\nhuman rights are abused through indefinite incarceration; where the disciplinary
\nprocess, which includes solitary confinement, appears to be arbitrary; and where
\ndemoralised and depressed detainees resort to aggression, roof-top protest,
\nbarricades and hunger strikes in anguished pleas for help One way to do it, is to
\nmake everything look normal. Corporate, bureaucratic or technical language is
\noften employed to provide a normalising effect.
\nShe notes that when cruelty is organised, systematic and routine, it starts to
\nappear normal. There is also the misleading propaganda of the immigration
\nauthorities that states that detention is not about punishment but about duty of
\ncare, good order and safety (Das 2005).
\nHealth professionals may witness severe abuses that have enormous health
\nconsequences (International Dual Loyalty Working Group 2002, p. 48). They
\nmay well believe they are powerless to do anything; others believe that
\nspeaking out is not their professional concern. They may be contractually
\nprohibited from speaking out, and their supervisors are likely to be nonmedical
\nadministrators with duties unrelated to health care (International Dual
\nLoyalty Working Group 2002, pp. 47, 48) and with little understanding of the
\n2. The term \u2018boatpeople\u2019 has entered the Australian lexicon to describe asylum seekers who arrive by
\nsea without travel documents.
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 47
\nDownloaded by [ ] at 21:14 30 June 2012
\nprofessional requirements of health practice. In Australian immigration
\ndetention, nurses were one front-line group who often found themselves
\ndirectly confronted with dual loyalty conflicts, where legal obligations to their
\nemployers could subsume their professional obligations (Zion et al. 2009). This
\nfrequently resulted in their having to work against the interests of their
\npatients.
\nDespite the constraints, many health professionals tried to provide extra care
\nbeyond that mandated by the authorities in places of detention. This could be
\nsimple acts of the giving of appropriate food, humane ways of administering
\nmedicine or offering the hand of friendship (Zion et al. 2009). In this way the
\nhealth professionals embraced an ethics of care, a morality based upon empathy.
\nHowever, neither such mild acts of benevolent defiance nor empathic care served
\nto challenge the conditions of detention. What was largely absent was the act of
\nspeaking out and a political analysis framed by advocacy. For this group, caring
\nand relationships were preferred to confronting questions of justice and rights
\n(Zion et al. 2009). Well-known American community organiser Saul Alinsky
\ndistinguishes between those who are prepared to fight for the rights of the
\n\u2018under-dog\u2019 and those who are morally indignant but not prepared to act on their
\nconcern. He argues that without active opposition, we perpetuate existing
\nunequal social and political relations (cited in Kenny 1999, p. 21), an argument
\nthat echoes the troubling collusion that pervaded much professional activity in
\nimmigration detention settings.
\nThe People\u2019s Inquiry project ( help with nursing paper writing from experts with MSN & DNP degrees) did not confront the question of collusion as it
\nwas undertaken through an \u2018outsider\u2019 role. In undertaking this form of advocacy,
\nthe social work academic group avoided taking on a \u2018bystander\u2019 position to act
\nbeyond the moral indignation approach criticised by Alinsky. Before examining
\nthe ethics that guided the project ( help with nursing paper writing from experts with MSN & DNP degrees), an overview of some of the findings is
\npresented to reveal the abuses that the People\u2019s Inquiry uncovered. Those
\nhighlighted are by no means unique, and a major strength of the Inquiry was that
\nthrough a rigorous collection of narratives, the systemic institutional abuses were
\nexposed.
\nFindings: The People\u2019s Inquiry into Detention
\nThe People\u2019s Inquiry into Detention documented testimony that revealed the
\ninjustices and harms created by the asylum seeker system in Australia across four
\nthematic areas: journeys into detention, the processing of claims, life inside
\ndetention facilities and the aftermath of detention. Although all four areas
\nrevealed serious abuse by a range of actors working within the asylum and
\nimmigration detention system, among the most compelling of the evidence
\npresented were the testimonies and written submissions that told of the
\nmalevolent practices within the detention centres. Evidence was collected
\n48 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\nfrom professional groups outside the health and welfare domain, such as lawyers,
\nmigration agents and faith group representatives. Health concerns featured
\nprominently in both the verbal evidence and submissions from health providers,
\nformer immigration detainees and advocates focusing on physical and mental
\nhealth issues. One mental health professional stated:
\nYou could have the Rolls-Royce of mental health services in Baxter and I don\u2019t
\nthink it would make a scrap of difference, because the environment is so toxic
\nthat you can\u2019t treat anything meaningfully. I think that half a dozen of the most
\ndamaged people that I\u2019ve ever seen are the adults I\u2019ve seen in Baxter and
\nWoomera detention centres, both parents and single men.
\nAn early childhood worker told about witnessing the treatment of children in
\ndetention:
\nIf I saw the same level of abuse, neglect and distress in the children in the
\nservice in which I work, and I failed to make a mandatory notification, I could
\nbe prosecuted. Yet, I have made mandatory notifications on so many children in
\ndetention and they have gone nowhere. I will never, ever forgive them for what
\nthey have done. There have been children emotionally murdered in detention.
\nA visitor to detention said:
\nWe . . . do our best but nothing bloody well changes. And while we do our best, we
\nwatch people get very, very, very sick trying to kill themselves and wish they
\nwere dead.
\nFormer detainees raised issues of the unhealthy conditions in immigration
\ndetention centres. On Nauru, part of the now defunct \u2018Pacific Solution\u2019, a
\nwitness told the People\u2019s Inquiry:
\nI have never seen such a place in my entire life. It was scorching hot; you couldn\u2019t
\neven see trees. There wasn\u2019t enough drinking water and the water itself was
\ncompletely sour. The windows were covered by plastic, no electricity, not enough
\nfood and we couldn\u2019t see anything except stone.
\nA detention worker from a remote rural detention centre told of how:
\nEighteen hundred detainees arrived in a couple of weeks. We had to allocate
\nthem places to live. Bessa block buildings fit for one person and on many
\noccasions there would be six people in one. There was no air conditioning, the
\ntemperature would range from easily high 40s and my shirt would be covered
\nhead to toe with flies. There were scorpions, snakes, lizards. There were eight
\ntoilets for 1800 people. There were two taps in the compound.
\nAlthough the People\u2019s Inquiry did not delve into the ethics of health provider
\ncollusion, it documented clear breaches to the right to health, particularly
\nexclusion from the provision afforded to those designated as \u2018citizens\u2019. This is
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 49
\nDownloaded by [ ] at 21:14 30 June 2012
\nby no means exclusive to Australia, for as the group Medical Justice (2007) has
\nstated in the United Kingdom, unmet health needs are a major problem among
\nimmigration detainees and detention itself is frequently damaging to the
\nhealth of detainees, and sometimes profoundly so. Other commentators argue
\nthat privatisation is a key problem, for once granted entry into this state function
\nthe endeavour of contractors to maximise their profits can lead to abuses in
\ndetention sites (Flynn & Cannon 2009). One group of psychiatrists explicate the
\ndilemmas faced by practitioners once they enter the detention environment (Steel
\net al. 2004):
\nWhen we enter the world of detention . . . we enter a zone where usual
\nconceptions of human rights and obligations to others do not apply . . . The role
\nof doctor and clinical advocate is altered by \u2018crossing over\u2019 . . . the social
\ncontract, as we usually experience it, does not apply here.
\nResponses into the Future
\nThere are a number of avenues open for professional action. Professional
\nadvocacy is one pathway to respond to the harms of immigration detention.
\nAlthough social work academics have ceased their role in convening the People\u2019s
\nInquiry, the findings that were documented in Human Rights Overboard: Seeking
\nAsylum in Australia came to public prominence with the awarding of the
\nAustralian Human Rights Commission award for literature in 2008. Furthermore,
\nsocial work academics are among those who continue to work as advocates,
\ncommentators and researchers in the field of immigration detention.
\nThe immigration detention authorities in Australia have now adopted a \u2018case
\nmanagement\u2019 role for people in immigration detention facilities and some
\nemployed are social workers. Up until now there has been silence from the
\ncase managers, but their observations may become apparent in the years ahead
\nas it is likely that some may draw on their experiences to advocate for change.
\nBut professional advocacy is by no means the norm, and the perplexing
\nquestion remains as to how professionals can withstand the pressure to
\nparticipate in organisational dictates that are antithetical to their professional
\nidentification, values and norms. Amanda Sinclair (1996) discusses the significance
\nof whistle-blowing when the organisational ethos conflicts with conscience,
\nleading individuals to reject organisational norms despite the pressure
\nplaced on them. It is important, she argues, to maintain a personal sense of what
\nis right. In relation to health and welfare, Soldatic and Fiske (2009) point to the
\nmedical discourse, which carries with it a claimed \u2018objective\u2019 knowledge and
\n\u2018scientific truth\u2019. They posit that the use of a medical discourse needs to be read
\nalongside the ideological aims of the speakers, as evident in the statement by the
\nimmigration authorities on health equity within detention.
\nIn encouraging more robust professional responses it is important not to diminish
\nthe difficulty confronting practitioners for it takes courage and determination to
\n50 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\nengage in resistance or to speak out in the name of a profession. Ministers of religion
\nhave been told to stick to the pulpit and not lurch into politics; health professionals
\nhave been told that their role is to dispense direct care and not to be advocates; and
\nthe legal profession has smeared activist lawyers.
\nProfessional organisations have a role. Although some professional bodies have
\nmade statements against detention, they have stopped short of making recommendations
\nabout whether their members should work in immigration detention
\nenvironments. The Royal Australian and New Zealand College of Psychiatrists
\n(RANZCP) issued a statement on the provision of mental health services to asylum
\nseekers. Although it expressed concern about the plight of asylum seekers and
\ncalled for the full provision of mental health services and research (RANZCP n.d.),
\nan advocacy approach was not suggested. A position statement of the Australian
\nMedical Association (AMA 2005) affirms that those seeking asylum within Australia
\nhave the right to receive appropriate medical care without discrimination,
\nregardless of citizenship, visa status, or ability to pay. Like all seeking health
\ncare, those seeking asylum in Australia, says the AMA, should be treated with
\ncompassion, respect, and dignity. The statement adds:
\nAustralia must find an alternative solution to prolonged, indeterminate detention
\nas a matter of urgency.
\nThe Australian Association of Social Workers (order custom written ‘academized’ nursing papers) (AASW) supported the People\u2019s
\nInquiry into Detention. Its Code of Ethics (AASW 1999) calls upon social
\nworkers to strive to challenge policies and practices that are oppressive. The
\nAASW Code emphasises that the social work professions subscribe to the values
\nand aspiration of the 1948 Universal Declaration of Human Rights, a directive
\nthat can be a sound basis for asylum seeker advocacy. Organisational
\nconstraints against speaking out against perceived abuse beset social work as
\nmuch as other professions. Although it is not known how many social workers
\nhave been employed in any capacity within detention, those on the outside
\nalso face advocacy difficulties if working in government or publicly funded
\norganisations.
\nChild psychiatrist Sarah Mares (2007, p. 222) reflects on her professional role,
\narguing that moral indifference fast becomes complicity. This raises the question
\nof how professions refute a climate where, in relation to asylum seekers, service
\ndelivery has reached a point where it is almost accepted without question that
\nexisting arrangements are satisfactory and where the professions are uncritical
\nand complicit (Hayes 2005, p. 191). South African social worker Tiamelo Mmatli
\n(2008, p. 306) provides some leads for the professions, telling us that it is a dereliction
\nof professional duty not to comply with what Canadian academic Bob Mullaly (1997)
\nrefers to as the promotion of political will to develop a humanised society.
\nProfessional groups, particular social workers who work with the most
\nvulnerable people, can invoke their practice wisdom as experience in a range
\nof fields of practice demonstrates the harm of policies that are antithetical to
\nour common humanity. The knowledge base of the professions can open our
\nCARE OR COLLUSION IN ASYLUM SEEKER DETENTION 51
\nDownloaded by [ ] at 21:14 30 June 2012
\neyes to the impact of subjugation, oppression, racism and structural
\ndisadvantage. Beyond direct health and welfare practice we can propose an
\nethics of responsibility where we locate ourselves in relation to others,
\nincluding strangers (Stratton & McCann 2002) and challenge the pervasive fear
\nof asylum seekers that permeates Western societies.
\nAnother pathway to Helping practitioners in resolving the dilemmas is by
\nensuring that health and welfare education has a strong ethical component that
\ngoes beyond direct and individual practice to an understanding of the political
\ndomain. This remains unfinished business in the competition for curriculum space
\nthat confronts many disciplines, but without such foundations the quest for
\njustice in the care professions will be more difficult.
\nPostscript
\nThe final comments in this paper reflect a degree of pessimism as developments
\nwithin immigration detention in Australia continue apace. At the time of writing
\nin late 2010 there are more than 5,000 people detained in immigration detention
\nsites in Australia, including 900 children. The case of Christmas Island illuminates
\nthe ongoing problem.
\nIn late 2008, the Labor government opened a maximum-security immigration
\ndetention facility on Christmas Island to house single male asylum seekers. There
\nare now more than 2,000 asylum seekers on the island, including families and
\nchildren who are housed in an alternative detention facility known as Construction
\nCamp, as it was designed as temporary accommodation for the workers who
\nbuilt the maximum security centre. Christmas Island is 2,600 miles from the
\nAustralian mainland state of Perth, with the detention industry supported by flyin,
\nfly-out service contractors. As the numbers of asylum seekers expand on the
\nisland, access to health and mental health services diminishes. The island cannot
\ncope effectively with medical emergencies or the level of distress within the
\ndetention facilities. In 2010 an anonymous source working within Christmas Island
\nhealth services said \u2018there\u2019s better medical treatment available in Indonesia than
\nthere is on Christmas Island . . . Christmas Island does not have the facilities to
\ncope with complicated medical conditions, with no surgeons or anaesthetists on
\nhand\u2019 (cited in Collerton 2010). This assertion was confirmed in December 2010
\nwhen an asylum seeker boat arriving on Christmas Island smashed against rocks,
\nkilling up to 50 people. This tragedy was exacerbated by the need to fly out
\nseriously injured survivors and to fly in trauma counsellors to deal with the grief.
\nConcern extends beyond the remote sites. In the last three months of 2010,
\nthere were three suicides of detainees in Sydney\u2019s Villawood detention centre
\ndespite the constant advocacy by mental health providers and other advocates
\nwho express concerns about the level of despair and desperation created by
\ndetention. As psychiatrist Derrick Silove (2005, p. 29) states:
\n52 BRISKMAN ET AL.
\nDownloaded by [ ] at 21:14 30 June 2012
\nThe evidence that prolonged detention under harsh conditions damages the
\nmental health of previously traumatised refugees places a heavy burden on all of
\nus. It confronts us with a stark reality that the social policies, we, as citizens,
\nentrust in policy-makers will determine whether traumatised refugees become
\nhealthy, productive citizens or, conversely, chronically mentally disturbed
\npersons with mounting disabilities.
\nThe People\u2019s Inquiry into Detention made three broad recommendations: to
\nremove racism, restore human rights and reinstate accountability. Such principles
\nare the gateway not just for governments but for morally active
\npractitioners to be freed from the tyranny of organisational practice in cruel
\nand unjust settings. These cannot be seen as the responsibility of governments
\nalone but arguably the health and care professions have a role in both ensuring
\ntheir practitioners adhere to such principles and that they challenge human rights
\nviolations as individuals and collectively through professional advocacy.
\nWhen accepting the prestigious award of Australian of the Year granted by
\nPrime Minister Kevin Rudd in 2010, psychiatrist Patrick McGorry demonstrated the
\ntype of leadership that is a model for the professions. He used the occasion to
\ndescribe detention centres for asylum seekers as factories for producing mental
\nillness and said he would lobby the prime minister to process asylum seeker
\nclaims while they were residing in the community instead of detention (cited in
\nOverington 2010). The quest for justice for asylum seekers continues with health
\n(and other) advocates continuing to strive to influence change. The words of UK
\nPrison Ombudsman Stephen Shaw, which resonate with the Australian experience,
\nconclude this work.
\nThe strength of a liberal democracy is measured not by how it treats the majority
\nbut by how it cares for minorities and those on the margins of society. The best
\ntests for humanity and decency are conducted in prisons, psychiatric hospitals,
\nand in institutions for failed asylum-seekers and other migrants. (Cited in Medical
\nJustice 2007)
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