In mid-2015, I received an email from International Health and Medical Services (IHMS), a contractor for the Department of Immigration and Border Protection. It was an invitation for an ophthalmologist to visit the detention centres on Nauru and Manus Island and provide eye care for detainees. It posed a moral dilemma, which I mulled over for a while.
As a migrant from Iran, it was easy to identify with people who sought refuge from danger or oppression. As an Australian citizen, I was upset by the appalling reports of how asylum seekers, including children, were being housed and treated. I was angered by our government’s punitive, rather than humanitarian response to a global refugee crisis—a crisis that we arguably helped foment through military support of the wars in Iraq and Afghanistan. Oddly or not, this treatment also reminded me of my work in Indigenous communities where the biggest buildings in town are often the police station and jailhouse. I imagined a national tagline to capture this panoptic treatment of the destitute:
AUSTRALIA: land grabbing since 1788, handcuffing those who plead a share.
Would a visit to Nauru or Manus constitute tacit acceptance of these policies? Would I be a pawn for Australian Border Force? If I didn’t accept, who’d provide the necessary eye care for detainees? How many Australian ophthalmologists spoke Farsi, had lived in Pakistan, and were familiar with Sri Lanka and the Middle East? Was it morally unacceptable to not go?
Since my visits to Nauru and Manus in 2015–16, things have changed. The centre on Manus was declared illegal by Papua New Guinea’s Supreme Court, and the fraught process of shutting it down continues. The Australian government agreed to our country’s largest human rights payout, tantamount to accepting the harm done to refugees. An undisclosed number of asylum seekers were granted resettlement in the US, but the Trump administration has stalled the process. Section 42 of the Australian Border Force Act 2015 was changed so that doctors, teachers and other workers are free from its secrecy provisions, making it safer for them to speak out without fear of legal reprisal. Previously, all employees and contractors risked being sacked, prosecuted and imprisoned if they disclosed information about detention centres to anyone. The coalition government announced an additional intake of twelve thousand Syrian refugees, but expressed a preference for Christians over Muslims, in spite of a non-discriminatory mandate. More recently, in the face of a global refugee crisis, Peter Dutton advocated fast-track visas for a select minority of immigrants—white South African farmers—in a shameless display of systemic, unprincipled bias towards white Christian migrants.
The passages that follow were written before the gag order was lifted. At the time, I faced the unsatisfactory choice between speaking out and facing possible prosecution, or remaining silent and returning to visit the detainees. I chose the latter and shelved the writing. However, in 2017 my offshore visits fell through, due to the frustrating bureaucracy of IHMS. Now that I can’t visit the detainees, I’m blowing my whistle alongside the dedicated others who have been doing likewise for years. At the time of writing, over fifteen hundred detainees remain in limbo, and they need witnesses, not handcuffs.
22nd August, 2015
At a dining table in the staff mess, the doctors gather for lunch. As a newcomer to their group, I join them to eat and chat, hoping to learn more about the centre. I listen as they discuss the difficulties of becoming accredited to work on Nauru, about hopes to emigrate from their homes in the Philippines, Poland and Zimbabwe, to Australia or the United States. They talk shop, compare the earnings of different specialists, contrasting their deployment here with facilities elsewhere: military bases in Iraq and Afghanistan, oil rigs in Nigeria. They speak about their rostered days off, cruising the island, visiting the Chinese eateries, checking out Anibare Bay.
Their tone is light, humorous, coloured with aspirations toward a better life.
Rarely do they speak about the detainees. When they do, they refer to them as ‘clients’, rather than ‘patients’ or ‘people’. Over a buffet of roast lamb and vegetables, detainees are mentioned with a roll of the eyes, a knowing look, a shift in tone. Scepticism moves in like a low cloud, undeclared but tangible. At times, the feeling verges on scorn.
What is implied, again and again, is that the detainees are not real patients, their conditions not real pathology. Their vague symptoms, such as headaches, non-specific pain or malaise, are difficult to diagnose or alleviate. Some have genuine afflictions, such as atopic dermatitis or upper respiratory tract infections. But their symptoms seem amplified, bordering on hysteria or the bizarre. Consequently, detainees are labelled malingerers: the scourge of doctors, feigning illness for personal gain.
My colleagues seem unaware or uninterested in the psychological impacts of detention. As a more sympa-thetic counsellor tells me, “Asylum seekers arrive here with post-traumatic stress disorder from the horrors of their home countries, develop anxiety about the welfare of family left behind, and fall into depression when we lock them up.” At our table, there seems to be little appetite to consider these more complex dynamics and how they may manifest as somatic symptoms among trapped and disempowered fugitives.
I peer around at the painted grey walls in the staff mess, the fluorescent tubes over stainless steel surfaces. I feel discomfited; I swear the aircon is dialled to Arctic. The mess, like the rest of the compound, is militarised and highly administered: monitored hand-hygiene stations, high-visibility vests, muscle men with buzz cuts. Last night, a security guard did me a kindness, permitting me a second orange after dinner by looking the other way. Even citrus can be contraband here.
23rd August, 2015
The eye conditions afflicting detainees on Nauru range from mysterious to tragic. Many suffer a form of allergic conjunctivitis, where the eyes become red, gritty and sore for weeks on end. I suspect it’s due to a local antigen, perhaps phosphate dust from the ubiquitous open-cut mines, or airborne fungal spores from mouldy accommodation. I see a three-year-old boy from Nepal with this condition. His eyelids are swollen and excoriated, and he has similar changes on the soft skin of his armpits and behind his knees. I prescribe anti-allergy eye drops and show his dad how to administer a steroid cream for him. But as long as he and the other detainees are exposed to the environmental toxins here, it all seems like band-aid medicine.
19th September, 2015
On Manus, I meet an Iraqi man who is blind in one eye from traumatic optic neuropathy. This is a case of ‘damaged wiring’ between the eye and brain, which occurs when the eye is struck so hard that a shock wave passes through the bony socket and shears the nerve fibres where they enter the skull. The nerve atrophies and the blind spot expands until eyesight is extinguished. The man tells me he sustained this when local Papua New Guinea (PNG) men stormed the centre and bashed his head in with a wooden bat. Another asylum seeker, 23-year-old Reza Barati, was beaten to death in the same riot.
I tell this man that his blindness is permanent and he slumps to weep in front of me. Has he not lost enough? What’s the price of his sight, to him and to us? On our government’s watch, his vision had been halved, his future prospects permanently diminished. Yet I doubt many Australians will ever hear his story. I trace the cause of his blindness back to the illegal invasion of his country by Western governments including ours, a spiral of dominoes fanning out to flatten the dignity of civilians.
This piece appears in full in The Lifted Brow #38. Get your copy here.
Hessom Razavi is a doctor and writer, born in Hamadan, Iran. He grew up in Tehran, Karachi and the UK, before his family moved to Perth. His poetry has been published in Australia and the UK, and his travel writing and videos are available online. He works as an ‘outreach eye doctor’ in remote communities in Australia and overseas.