Australian authorities were repeatedly warned over a lack of health services on Christmas Island to deal with a disaster in the mould of yesterday’s boat tragedy, which has claimed the lives of at least 28 people.

Two reports were submitted by the Australian Human Rights Commission to Canberra, one in 2008 and one in 2009, highlighting black holes in health and mental health resources in relation to immigration detention and offshore processing on the remote refugee outpost.

Rescuers continued their search for survivors this morning, after an Indonesian fishing vessel broke up as it crashed into the cliffs at Christmas Island in rough seas. Customs told Crikey that 44 survivors have been rescued, while the immigration department told Crikey this morning that the Christmas Island hospital was “effectively managing” the crisis.

According to an immigration department spokesperson, the AFP, Customs and NGOs are assisting in search and rescue operations. International Health and Medical Services, the organisation contracted to oversee health services on the island, have also flown in extra doctors and nurses for support.

It is still unclear whether the survivors will be flown to the mainland for specialist care. Stephen Langford, Royal Flying Doctor Service medical director, said today that some of the survivors at Christmas Island could require extra medical care in Perth. So far the Perth Royal Flying Doctor Service has flown two women to Royal Perth Hospital for extra treatment.

“They [Christmas Island] don’t have a surgical capacity,” Langford told ABC Television, noting that “half a dozen” patients had “minor traumatic” injuries. A spokesperson for the immigration department said that the Flying Doctors were being deployed on an “as needed basis”.

But refugee advocates have questioned the ability for Christmas Island to deal with the tragedy. Pamela Curr from the Asylum Seeker Resource Centre and Christmas Island asylum seeker advocate Kaye Bernard raised concerns this morning about the island’s ability to offer mental health care to the survivors of the crash.

“There’s some talk that people are to be brought to the mainland, I don’t think that there is any facility that could hold these people,” Bernard told Crikey. “Not just for the physical trauma, but for the mental trauma. It’s just not going to be enough, they need to be brought to the mainland.”

This is not the first time that issues have been raised about the availability of health and mental services on Christmas Island.

In 2009, a Australian Human Rights Commission report into the conditions on Christmas Island entitled Immigration detention and offshore processing on Christmas Island found that health and mental health services were insufficient for the number of detainees being held on the island.

At the time, health services consisted of a hospital manager, four nurses, two doctors on rotation, a psychologist and four mental health nurses, while the ambulance service was run by volunteers. The Forum of Australian Services for Survivors of Torture and Trauma is also contracted by the immigration department to offer counselling. These staff were also responsible for serving the detention centre.

The Australian Human Rights Commission had “serious concerns” about the appropriateness of holding asylum seekers on Christmas Island, “particularly asylum seekers who might have a background of torture…”

The Commission also noted that should an emergency medical situation occur in one of the detention facilities on the island, it could take an hour or two for an ambulance to arrive:

“If the Australian Government intends to continue using Christmas Island for immigration detention purposes, DIAC should ensure that detainees on the island are provided with access to appropriate health and mental health care services. These should be no less than the services available to detainees on the mainland.”

Mental health services were of particular worry, according to the report. They noted that there was “virtually no local capacity” to meet the mental health care needs of immigration detainees and that there are restrictions on the availability of interpreters, transport and escorts:

“These concerns contribute to the Commission’s view that Christmas Island is not an appropriate location in which to hold people in immigration detention.

“However, if the government intends to continue this practice, DIAC will need to ensure that detainees on the island are provided with access to adequate health and mental health care services – both by providing additional services on the island, and by bringing detainees to the mainland when services are not available on the island.”

At the time the immigration department responded by saying detainees on Christmas Island are provided with a “commensurate level of health care services as those accommodated in mainland immigration facilities”.

Another issue being raised is how the boat managed to make it all the way to Christmas Island without being picked up by border control.

According to Tony Kevin, author of the book A Certain Maritime Incident: the sinking of SIEV X (the incident claimed the lives of 353 asylum seekers), boats that enter Australian waters are typically picked up well before they make it to shore. Customs relies on the Jindalee Operational Radar Network (JORN), Kevin explained, which is an over-the-horizon radar network which monitors air and sea movements for intelligence on boats to Australia’s north.

Wooden boats are picked up because they have metal engines and, as those boats are generally moving towards Christmas Island or Ashmore Reef, said Kevin, border control waits until they are a safe distance and that moves out to intercept the boat.

CORRECTION: The Australian Customs and Border Protection Service and the Royal Australian Navy intercept boats approaching Christmas Island and Ashmore Reef, not the immigration department.