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By now most Australians are aware of the rapidly deteriorating scenario on Manus Island. Hundreds of refugees who have been kept in the Australian-sponsored offshore detention centre at Lombrum Naval Base are being forced out to new accommodation untested and unprepared for their arrival.

These men, who have survived for two weeks since the Australian and PNG governments cut off food, water, electricity, security and medical supplies to the camp, have endured extraordinary, escalating circumstances. Yet they remain, for the most part, resilient – even as PNG police and military prepare to enter the camp and forcibly remove them.

Kon Karapanagiotidis, CEO of the Asylum Seeker Resource Centre, said he has been on the phone with the men at Manus, “hearing men starving, malnourished, dehydrated, without hope, some struggling even to breathe, others forced to go dangerously cold turkey from medications for their mental health and heart, men fearing they are going to die”.

The situation is desperate, and Karapanagiotidis has hit on one particularly disturbing feature of the government’s’ torturous treatment of these detainees: blocking their access to psychiatric medications and forcing them into withdrawal.

“What [the men] would be experiencing is both physical and mental symptoms, which would be very acute – like, within hours,” consultant psychiatrist Dr Helen Schultz explains. “Terrible physical symptoms like dizziness, nausea, headaches, confusion could happen, and lots of psychiatric problems.”

Many of the men on Manus (as well as refugees imprisoned in other Australian-run centres) suffer from a range of mental health conditions, including depression, anxiety, post-traumatic stress disorder, schizophrenia and psychosis.

For a large portion of these detainees, their conditions are directly linked to their internment – what the United Nations High Commissioner for Refugees calls “predictable mental health deterioration” as a consequence of their open-ended mandatory detention and the lack of adequate services there. So some detainees are issued medication in detention to help manage psychiatric symptoms.

Dr Barri Phatarfod, the President of Doctors For Refugees, told Crikey, “Last month, those in Manus [Regional Processing Centre] were handed four weeks’ worth of medications, which have now started to run out. They have been told they will not get medical treatment until they leave the RPC, which many believe is unsafe.”

“We also had significant concerns about the men being handed a month’s work of medications at one time,” Dr Phatarfod says. “These men have been institutionalised for four years, so every day for four years they have had to line up for each dose, sometimes multiple times a day. To suddenly be told they are self-managing, when many are on medications they don’t know or understand and almost all have English as a second or third language at best is not the equivalent of patients in the general community.”

“Anyone can foresee that there will be mistakes at best; intentional overdoses or non-compliance at worst.”

For detainees who are already starving and dehydrated in a tropical climate, they must bear this additional and torturous burden.

Dr Louise Newman, Director of the Centre for Women’s Mental Health at the Royal Women’s Hospital and Professor of Psychiatry at University of Melbourne, tells Crikey that “drugs don’t have a very big role to play” in the conditions in detention, especially now.

“Drugs do not make up for violations of human rights, and lack of freedom. So at the most these medications have maybe given some people dramatic relief – but it’s not a cure. It never has been a cure. The cure for this situation is restoration of human rights.”

However, the damage is done. And these cruel conditions are not just uncomfortable, they’re also potentially dangerous.

“I think the other important thing to make sense of is that [the detainees] would have disruption to their cognitive functioning and their ability to make executive decisions,” Schultz explains. “Judgement, reasoning, planning could all be impaired. So their ability in a horrific moment in their life to actually make decisions around their own safety and the wellbeing of others would be impaired.”

For a government to choose psychiatric horror over the compassionate evacuation and assistance of men on Manus feels like a precise kind of evil.

“It’s just an unnecessary cruelty,” said Newman. “Just the general principle of it is that people are on these drugs for good reasons and they should be maintained and monitored.”

Dr Phatarfod agrees. “This is a cruel, grossly negligent policy by the Australian government that seem indifferent to the potential and likely loss of lives.”

Peter Fray

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