For three decades Australia has maintained a policy of mandatory, indefinite immigration detention and a range of related measures throughout the Asia-Pacific region. These policies have not come about by accident, their intent has long been made clear by the Australian government. The harm created and perpetuated by these policies has been engineered as a means to deter others who might otherwise seek Australiaâs assistance. In practice this means tens of thousands of men, women and children have been detained in squalid conditions and exposed to violence, riots, physical and sexual assaults, self-harm and suicidal behaviour as a means to achieve these ends. For those who are detained, the consequences of these policies are nothing short of devastating.
The healthcare community has had a close relationship with these policies. Healthcare has been provided within Australian immigration detention for decades. The near futility of doing so has been well documented. Outside of detention, healthcare professionals and healthcare bodies have advocated for change, with the healthcare community forming a small part of a larger chorus of criticism that has involved lawyers, artists, academics and concerned citizens.
Despite these controversies, despite the well-documented harms and despite rarely leaving the headlines for close to three decades, the Australian government has only hardened in its resolve to deter further arrivals, shutting down cooperative efforts, attacking those critical of these policies and attempting to cover up the despair within centres.
How should the healthcare community respond? This question is not new, and I am sure it has weighed heavily on many. In this book I want to challenge decades of thinking on this issue and argue that the healthcare community should incorporate non-violent resistance into future efforts that seek change. This approach recognizes that change will not come through consensus or collaboration alone but instead seeks to leverage the power of the healthcare community to demand change. Non-violent resistance could include a range of action, including strikes, whistleblowing and principled disobedience1; all aimed at expressing opposition to or undermining these policies. The broader argument I make in this book, which could also be applied elsewhere, is that when faced with major injustices such as human rights violations and when conventional avenues to pursue change have been shut down, the healthcare community should undermine and resist what creates and sustains these injustices.
This book which started off as PhD, originally sought to investigate the ethics of healthcare in Australian immigration detention. As you will see, discussions about the ethics of healthcare now occupy less than a chapter. I provide few answers on how individual healthcare professionals should act when working within immigration. This book also says little about consensus, mediation or negotiation. This book is focused on broader political change in how we approach the issue of refugees and asylum seekers in Australia. In doing so I cover some ground and despite being thorough I have had to make some trade-offs in what I discuss; many of the issues throughout this book are not settled, they deserve ongoing debate. A further trade-off that has weighed heavily was the need to tread a path between what was ideal and what was feasible. While debates about what is ideal should continue, this book was written knowing that many remain detained. It was written knowing that urgent, pragmatic solutions are needed. An overview of each chapter is discussed below.
In Chap. 2 I will outline Australiaâs policy of mandatory immigration detention and related regional measures aimed at denying and deterring boat arrivals. I outline a brief history of immigration detention, from its introduction in 1992 to the present day. While immigration detention could be criticized for a range of reasons, I will focus on two particularly important issues, the impact of these policies on health and wellbeing and on human rights.
In Chap. 3 I will provide an overview of the administrative and contractual arrangements related to healthcare delivery in detention centres. I will highlight testimony from healthcare professionals, refugees and asylum seekers and consider statements from professional healthcare bodies. In addition to providing an overview of the healthcare arrangements in detention I seek to do two things in this chapter. First, show that the delivery of healthcare in immigration detention is next to futile; and second, highlight disparity between testimony, the contractual arrangements and statements made by professional healthcare bodies. I will also consider some major controversies that have occurred and how the healthcare community have responded to these, outlining the action taken in response to the Border Force Act, the Medevac legislation and the case of Baby Asha.
While Chap. 3 inevitably began to touch on some of the ethical issues raised by the delivery of healthcare in detention, I will consider these issues in more depth in Chap. 4. I will first consider whether Australiaâs policy of mandatory immigration detention and the actions it has taken throughout the Asia-Pacific region can be justified. This is an important question as it will, at least to some degree, determine whether we can justify non-violent resistance as a response. I will argue that Australiaâs present policies are profoundly unjust. However, while drastic reform is needed and justified, some caution is warranted as we also need to carefully consider the regional implications of such reform. That is, in seeking reform domestically, changes to Australiaâs policies are likely to have repercussions throughout the Asia-Pacific region, which could again lead to asylum seeker boat arrivals, which could in turn lead to deaths at sea. I will conclude this chapter by outlining the literature that has considered the ethics of healthcare within immigration detention centres (IDCs), touching upon some key concepts and discussions in relation to the delivery of healthcare within centres.
In Chap. 5 I will sketch how we should begin to approach the issue of reform. First, I will outline an alternate approach to Australian immigration detention and ultimately what we should demand when engaging in action that seeks change. In proposing reform, I suggest a minimum standard needed to protect the health, wellbeing and rights of asylum seekers in Australia. I draw on human rights to do this and the recognition that health is dependent on human rights first being upheld and that human rights cannot be upheld in Australian immigration detention. I thus call for major systemic reform, consistent with the human rights instruments to which Australia is signatory. I will then consider the major constraints on achieving this reform or any type of reform for that matter. To do this I will start with Netheryâs (2010) thesis which argues that to understand why Australia persists with these policies, we need to consider a range of historical, social and political factors. I will also discuss a number of contemporary political constraints on reform. Finally, I will offer some reflections on why current approaches to immigration detention by the healthcare community are poorly equipped to challenge these constraints. This of course is not take away from those who have advocated for change for the last three decades. It is simply to say that we can and should do more, a case I will make in the next chapter.
In Chap. 6 I will make the case for a new way of thinking and acting in response to Australian immigration detention. As the title of this book has already given away, this approach employs a disruptive and adversarial non-violent action. I will first consider debates about the role of healthcare professionals in social and political change, arguing that the healthcare community should play a role in shaping social and political change more generally, particularly when faced with egregious injustices. Next, I will define what I mean by non-violent resistance. For the purposes of this book, non-violent resistance is a strategy that seeks to oppose, subvert and undermine Australian immigration detention (and related policies) through action that is often unorthodox, adversarial or disruptive. Such a strategy recognizes that change will not come through consensus or collaboration and instead leverages the power of the healthcare community to demand change. A range of action could be considered non-violent resistance, such as strikes, boycotts, whistleblowing and principled disobedience. While this book is also primarily concerned with âhowâ we should respond, in this chapter I will also deal with the question of âwhyâ the healthcare community should engage in non-violent resistance.
In the next three chapters I will consider three forms of action and question whether they are justified. In Chap. 7 I will consider whether strike action is justified. A strike is important to consider for two reasons. First, given the nature of the system and the almost futile delivery of healthcare within in, it would not be unreasonable to resign or decline to participate in the system. Second, unlike the other forms of action discussed in this book, a strike has already been debated amongst the healthcare communityâI hope to expand on these discussions here. I will start by outlining what I mean by a strike. I will then outline the discussions that have been had in relation to strike action in response to Australian immigration detention. Starting with a framework proposed by Selemogo (2013) I will then discuss the most important points when considering strike action. Amongst a number of other considerations I argue that the health and wellbeing of detainees should weigh heavily in any decision making and for this reason I donât believe a strike can be justified, nor would it be feasible. This of course does not mean we should accept the status quo or should dismiss a strike completely, it should be seen amongst a repertoire of other action. Furthermore, depending on s...