Tony Abbott has told us that his first task, if the Coalition is elected, will be "to pick up the phone to the President of Nauru" with a view, apparently, to re-establishing the Topside and State House detention centres on the island and transporting asylum seekers there. As one of the few Australian doctors who has worked on Nauru (in 2003, including in the Topside Camp), I believe this is a very bad idea. My main concern is the effect on the mental health of detainees, imprisoned indefinitely on a tiny and (for them) alien island more than 3000 kilometres from the eastern coastal cities of Australia. Topside was set up in 2001; by November 2002 Dr Martin Dormaar, the psychiatrist employed in the camp, had resigned in despair at the failure of the International Organisation for Migration and the Howard government to respond to his concerns at the level of psychiatric illness developing among detainees. After his departure the situation only grew worse: numerous organisations including Oxfam and the Australian and New Zealand College of Psychiatrists reported high levels of mental illness and the lack of mental health services for detainees on Nauru. I personally noted significant psychiatric symptoms among women I cared for. When Senator Amanda Vanstone finally closed the camp in 2005 it was because of the deteriorating mental health of remaining detainees. However for those among the Australian population unconcerned about the mental health of people locked up by our government, there are also multiple financial reasons for not reopening the Nauru camps. Nauru (population about 12,000, that is, half that of Broken Hill) is a dot in the Pacific some 21 kilometres square; 80% of this has been mined for phosphate and is uninhabitable. Topside was hastily built on a shadeless rubbish dump at the top of the island; only a few decayed dongas now remain. There is very little infrastructure on Nauru: everything must be brought at great cost from Australia to build and maintain a detention centre, feed, clothe and shelter the inmates. An unreliable water supply depends on one ageing desalination plant (run on diesel shipped from Australia) -- even water may need to be transported to the island for potential detainees. Australia has a responsibility to provide health care of a reasonable standard for refugees. In the absence of services in the ill-equipped Nauruan health system, most investigations must be done in Australia, all drugs must come from Australia, all patients requiring treatment for serious conditions must be sent to Australia. The costs, especially those for even a single medical transfer by air, are enormous. Nauruans are cash-strapped and understandably see the re-opening of the camps as providing needed jobs and income. They are also intelligent and humane -- they were personally very supportive of previous refugees although many privately questioned the ethics of the exercise.  And there was certainly resentment at higher quality medical care being provided to the camps’ inmates than they themselves received. Previous Nauruan Foreign Minister David Adeang expressed great concern at the prolonged detention of asylum seekers in what was supposed to be a processing centre; present Foreign Minister Kieren Keke (who is also an excellent practising anaesthetist) has hinted that if asked to re-open the camps, Nauruans would place some conditions on how they would be run. Australia has an obligation to assist Pacific neighbours, not least Nauru, but  re-opened detention camps, a huge expense for Australian taxpayers, will not have long-term benefits for Nauruans. Tony Abbott should think again.