By Ebony Birchall.

Healthcare professionals engaged in Australian immigration detention have publicly advocated against the use of detention for over three decades. The Australian Government’s policy of mandatory and prolonged detention is designed to deter asylum seekers from coming to Australia by boat. However, this policy is controversial as prolonged detention of asylum seekers has been repeatedly proven to cause increased risk of mental harm.

My journey into this topic began in 2014 when Hamid Khazaei, a young and fit Iranian detainee, died after contracting an infection in Australia’s offshore detention system. Hamid sought medical attention but several delays, including Government interference in medical processes, led to his death. At the time I worked as a medical negligence lawyer in Australia and studied Hamid’s case closely. The Government asserts that detainees receive healthcare ‘broadly comparable’ to that available in the Australian community, but, drawing from my experience working in medical law, I could see clear problems with the detention health system. Coronial findings published in 2018 confirmed Hamid’s death was preventable and caused by compounding, systemic failings in the detention health system.

My research seeks to interrogate the experience of professionals providing healthcare in detention. I aim to expose the layers of complexity facing these professionals to inform policy making and ultimately to improve patient outcomes.

My recently published paper is one aspect of a larger body of research. This particular paper focuses on explaining the underlying cause of the conflicts experienced by professionals working in detention. The conflict is caused by contextual forces which shape the detention environment, primarily the Government’s deterrence ideology, which conflicts with the ideology (ie, the values, ethics and beliefs) expressed by the profession. Deterrence ideology is communicated through messaging and use of terms such as ‘stop the boats’ or ‘illegal entrants’. It is used by wealthy nations to justify harsh border policies and cruel treatment of people seeking asylum.

I argue professionals view deterrence ideology as incompatible with their ideology and ethics. The first conflict stems from the profession’s belief that all patients should be treated equally without regard to race or creed. The second conflict stems from the profession’s duty to do no harm. The third conflict stems from the profession’s desire for transparency and an ability to advocate for their patients. Professionals view deterrence not just as conflicting with their own ethics, but as dangerous to society, with some professionals going as far as likening Government policy to abuse or torture.

In dual loyalty situations such as this, if healthcare professionals have an opposing ideology to the entity running the system, then they will also face a power struggle: if they attempt to work under their own ideological principles when institutional structures are working against them, they will struggle against institutional exertions of power. I argue that the profession in this context face several struggles of power. They face an inability to provide proper healthcare, an inability to influence and prevent the harms caused by the system, and an inability to advocate effectively for their patients and influence society, as deterrence ideology has become mainstream in Australia. Finally, the profession experiences a struggle of power internally, that is, within the profession itself. Professionals advocating against the system raised several examples of discriminatory ideology influencing the attitudes and ethics of some healthcare professionals working in the system. This internal struggle compounds the profession’s struggle to maintain professional values and provide acceptable healthcare in the system.

Given that the tensions healthcare professionals experience in detention are driven by systemic causes, through ideological conflicts and power struggles, systemic solutions and supports are required. It is impossible for individual healthcare professionals operating within the system to overcome systemic struggles on their own. Without such support and training, individual professionals are at risk of adopting the narratives surrounding people seeking asylum promoted by the government’s deterrence ideology. Dehumanising ideology can lead to discriminatory attitudes and values, which can ultimately impact the quality of healthcare provided and patient outcomes.

Paper title: Dual loyalty conflict in Australian immigration detention: a struggle of ideology and power

Author: Ebony Birchall

Affiliations: Macquarie University, Sydney, Australia

Competing interests: The research was conducted with the support of an Australian Government Research Training Program Scholarship.

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