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Speech: Medevac Repeal Bill

I rise to speak to the Machiavellian named Migration Amendment (Repairing Medical Transfers) Bill 2019. We should actually call it the 'Denying people medical treatment bill', the 'Die somewhere else bill' or the 'Australia has lost the last shreds of its humanity bill'. I have said previously when we have discussed this that it boggles my mind that there are people sitting in this parliament who want to repeal a law that allows sick and injured people to receive the medical attention that they need. I've asked how full of hatred must your heart be to say someone should be denied the medical treatment that they desperately need, simply because they are a refugee or an asylum seeker? Well, it appears we have the answer. Shame on the government for bringing on this bill and shame on those who will vote for it to remove medical care from people.

Australian governments, both Labor and Liberal, put people seeking asylum into the prison camps on Manus and Nauru against their will. What we should be doing is closing down those island prisons, where refugees have been trapped in a state of terror and are fearful and vulnerable. Close the camps, bring them here and let them stay.

At the very least, Australia has an obligation to provide them with adequate medical care. The medevac bill is already watertight. It includes a whole range of conditions before someone can be brought to Australia for medical assistance. The medical transfer provisions require that, before a person can be transferred, two treating doctors for the person must give an opinion that a patient requires medical or psychiatric assessment or treatment, that they are not receiving such treatment in the relevant regional processing country and that it is necessary for them to be transferred to Australia for such assessment or treatment. All of these conditions have to be met. The minister can refuse the transfer if they reasonably believe it is not necessary to remove the person from the regional processing country for appropriate medical or psychiatric assessment or treatment, if they suspect that the transfer would be prejudicial to security or if the person has a substantial criminal record.

At a public hearing of the Legal and Constitutional Affairs Legislation Committee on 26 August 2019, the department provided data on the operation of medical transfer provisions. That data said that, since March 2019, 167 valid notifications have been received, 112 people have been transferred to Australia, 18 applications have been refused, 19 applications have been approved with transfer pending, and a number of submissions are still being drafted. They also showed figures on cases that had been referred to the Independent Health Advice Panel following the minister's refusal to approve transfer on medical or psychiatric grounds. It was reported that the IHAP considered 28 applications, of which 10 were recommended for transfer, and the minister's decision to refuse transfer was upheld in 18 cases. In relation to those 18 cases, nine applicants subsequently reapplied and eight of those have been approved. The system is working. It is clear that this legislation is working on every level, and to provide health care for those people who need it.

But it is a thorn in the side of Minister Dutton, who is stopping at nothing to take full control of as many parts of government as possible, aided and abetted by a weak Prime Minister. The government claims that the premedevac medical transfer policy was adequate. What an absolute sick farce. Every step of the way the government has fought attempts to get asylum seekers the medical care they need. Dr Tony Bartone, the Australian Medical Association president, described the government's premedevac process as 'torturous' and 'involving long periods of delay', without any appropriate oversight. The Australian Human Rights Commission previously said that under the previous provisions transfer decisions 'often did not occur in a timely manner' or in line with medical advice and had to be escalated to the Federal Court, which determined that processes for assessing individuals for medical transfer from Nauru or PNG were neither adequate nor sufficiently quick. Imagine having to go through a federal court for the right to receive medical care. What a diabolical system.

We know that, for some in here, some lives matter a lot less than others or perhaps not at all. If we revert back to the old ways, people will suffer immensely. The National Justice Project talked of a case where a young man waited two years before these medevac laws came in. It was only after they were passed that he was sent to Australia for treatment, although he will never regain the full use of his hand, because of the delay. Do we really trust Minister Dutton having the power of life or death? This is a man who said pregnant rape victims on Nauru were trying it on by seeking abortions in Australia. This is a man who tried to smear the medical profession and those doctors who are working to provide health care to refugees and asylum seekers. He's a man who was happy to spend $180 million of taxpayers money to reopen the Christmas Island detention centre in a political stunt before the election. As I understand it, the only people in that centre are Priya, Nadesalingam and their children, Kopika and Tharunicaa, whom the Australian government is cruelly imprisoning there.

Numerous stakeholders have said what a terrible idea this bill is. The Royal Australian and New Zealand College of Psychiatrists representative, Dr Kim Jenkins, has said:

The RANZCP is also concerned that the new bill allows for the removal of a person before medical treatment may be completed or may be adequate. We feel that decisions such as this should always be medical decisions, not ministerial ones.

The Australian Association of Social Workers has said that repealing the medevac law is tantamount to state-sanctioned torture and is in direct breach of our human rights obligations. Who exactly wants the medevac bill to be repealed? No-one. No-one but the power-hungry Minister Dutton, whose appetite for cruelty knows no bounds.

At the end of the day, this debate on the medevac bill is symptomatic of the sickness this country has in the way it treats refugees and asylum seekers. It is a sickness that has destroyed countless lives of the world's most vulnerable people. Like all systems that have lost a moral compass, it intensifies in its cruelty. It is the kind of warped reality that has members of the Liberal-National government—the government that is locking up children and people fleeing the brutal regimes in Myanmar, Sri Lanka and Iran—thinking they are the good ones.

I want to commend my Greens colleague Senator Nick McKim for his excellent work in being an advocate for humanity in a parliament largely so devoid of it. Alex Reilly, director of the Public Law and Policy Research Unit at the Adelaide Law School, writing in The Conversation, put it very clearly:

These people are under Australia's care. It is Australia that pays the governments of Nauru and PNG to house offshore detention centres to create the disincentive for others to travel by boat to Australia. It is Australia that pays the security companies to keep them detained. And so it is Australia that is responsible for the dramatic decline in their mental and physical health.

It is the narrowest of concessions to offer emergency medical treatment in Australia to people we have so mistreated.

Our country is crying out for some humanity in these dark times. Retaining laws which provide some semblance of medical assistance for people we wrongly lock up surely is the least we can do.

I want to spend the next few minutes by reading onto the public record the Australian Greens dissenting statement to the Legal and Constitutional Affairs Legislation Committee report on the migration amendment, and some of the other statements that different people have made. I also want to acknowledge and thank Labor and Centre Alliance for their dissenting statements to this report. The Greens dissenting statement covered several significant areas, including the right of people to seek asylum in Australia, Australia's duty of care to asylum seekers, the failed system of medical transfers pre-medevac and the need to depoliticise medical care. It concludes:

The medevac legislation has saved lives, and delivered people health care they had previously been deliberately deprived.

The government's refusal to transfer sick people from offshore detention to Australia under previous arrangements caused death, mental anguish and untold suffering among refugees and people seeking asylum.

The medevac repeal Bill shows that the government puts political imperatives ahead of people's medical needs.

They have made the crass calculation that some lives are worth sacrificing for broader political outcomes, despite their legal and moral obligations.

This calculation should be intolerable in a liberal democracy like Australia.

Decisions about medical care should be made by medical experts, not politicians or bureaucrats.

I think there are also some who made submissions to the inquiry whose voices need to be acknowledged here. The United Nations High Commissioner for Refugees states:

UNHCR considers that these measures enhance transparency and predictability in the provision of healthcare in critical situations. In particular, it is appropriate that Australian law contain safeguards for the protection of the refugees and asylum-seekers subject to the offshore transfer arrangements, reflecting the position that cooperative bilateral and/or multilateral arrangements should enhance the capacity of the States concerned to provide protection to refugees, and should not represent an attempt of any State to divest itself of responsibility or limit jurisdiction and responsibility under international law. Measures of the kind established by the medical provisions are all the more necessary in light of UNHCR's observations of the shortfalls in protection standards in respect of both Papua New Guinea and Nauru. The resulting conditions have led to the deterioration of the health of refugees and asylum-seekers throughout the life of the offshore transfer policy, and this deterioration can be expected to continue until long-term solutions are achieved. UNHCR recommends that the Bill not be passed.

These comments should not be taken lightly. It is worth noting that the UNHCR provided these comments as the agency entrusted by the United Nations General Assembly with responsibility for providing international protection to refugees and other and other persons within its mandate, and for assisting governments in seeking permanent solutions to the problem of refugees.

As set out in its statute, the UNHCR fulfils its international protection mandate by promoting the conclusion and ratification of international conventions for the protection of refugees, supervising their application and proposing amendments there too. The UNHCR's supervisory responsibility under its statute is reiterated in article 35 of the 1951 Convention relating to the status of refugees, according to which state parties undertake to 'cooperate with the Office of the United Nations High Commissioner for Refugees … in the exercise of its functions, and shall in particular facilitate its duty of supervising the application of the provisions of the convention'. The same commitment is included in article 2 of the 1967 protocol relating to the status of refugees. Australia is a party to the 1951 convention relating to the status of refugees and its 1967 protocol relating to the status of refugees, also known as the refugee convention. We are signatories of that convention, which this government often forgets. They go on to say:

The physical transfer of asylum seekers from Australia to Papua New Guinea and Nauru does not extinguish Australia's legal responsibility for their protection. Australia is jointly responsible (with Nauru and Papua New Guinea, respectively) for ensuring that the treatment of all asylum-seekers and refugees transferred to those countries is compatible with each state's respective obligations under the Refugee Convention and other applicable human rights instruments. While international law does not prohibit bilateral transfer arrangements involving asylum-seekers where relevant standards under international law are met, the primary responsibility for providing protection rests with the State from which asylum is sought.

They then conclude:

The Bill would explicitly authorise the forcible return (to Nauru or Papua New Guinea, and to countries of origin) of refugees and asylum-seekers who have been transferred to Australia under the medical provisions, irrespective of whether the purpose of their transfer to Australia has been achieved.

Australia clearly has international legal obligations in respect of these refugees and asylum seekers. UNHCR continues to urge that asylum seekers and refugees presently in Australia should not be returned to Nauru or Papua New Guinea.

The legislative framework for Australia's offshore transfer policy contains few safeguards for the protection of the people to whom it applies. The Bill would abolish two of the most significant of these safeguards. The health of the refugees and asylum-seekers in Nauru and Papua New Guinea will continue to deteriorate in the absence of a long-term solution to their situation of forced displacement. Until durable solutions are found outside those countries, both regular monitoring of health services and timely access to necessary medical care are safeguards that enhance confidence in efforts to address the health needs of those who remain. Accordingly, UNHCR recommends that the Bill not be passed.

The Australian Medical Association is the peak professional organisation representing medical practitioners in Australia. This body surely would have the most impartial view of what is required for medical care. In their submission, they state:

The AMA advises the Committee that we affirm our position that those who are in the care of the Australian government and who are seeking, or who have been granted, asylum within Australia have the right to receive appropriate medical care without discrimination, regardless of citizenship, visa status, or ability to pay. Like all people seeking health care, asylum seekers and refugees in Australia, or under the protection of the Australian Government, should be treated with compassion, respect, and dignity.

The AMA views refugees, asylum seekers and individuals in detention facilities or detailed in offshore in Nauru and Papua New Guinea (PNG) to be under the protection of the Australian Government.

…   …   …

1. In addition to suffering the same health problems as the general population, asylum seekers and refugees are at particular risk from a range of conditions including psychological disorders such as post-traumatic stress disorder, anxiety, depression, and the physical effects of persecution and torture. They may also suffer the effects of poor dental hygiene, poor nutrition and diet, and infectious diseases such as tuberculosis, which may be more common in their countries of origin.

2. To determine their specific health needs, all asylum seekers and refugees need to undergo comprehensive and timely health assessments in a culturally appropriate manner by suitably trained medical practitioners as part of a primary health care team. This assessment should be used to establish ongoing care with appropriate and descriptive records of asylum seekers' health being recorded on a regular basis to enable multidisciplinary teams and healthcare providers to give effective ongoing care.

3. All asylum seekers and refugees should have access to the same level of health care as all Australian citizens.

4. All asylum seekers and refugees, independent of their citizenship or visa status, should have universal access to basic health care.

5. Immigration policies that restrict the basic human rights of disadvantaged groups of people, such as asylum seekers and refugees, can have adverse impacts on their health and wellbeing.

They conclude:

The AMA supports a body of clinical experts, independent of government, with the power to investigate and advise on the health and welfare of asylum seekers and refugees.

We maintain that health and medical services in immigration detention centres should only be provided by organisations, in facilities accredited to Australian standards, that have the full capacity to provide an appropriate range of health and medical care to all detainees as needed, and according to best practice standards in health care delivery (as would apply in the general community).

Adherence to these standards should be guaranteed through a process of ongoing monitoring of detainees' health by an independent statutory body of clinical experts with powers to acquire information and investigate conditions in centres as it determines.

It is essential that the assessment and provision of medical care to asylum seekers in detention must be undertaken by medical practitioners.

In the absence of any other alternative independent medical panel that is demonstrably superior, the AMA affirms its support for the IHAP, in assessing the needs of asylum seekers and refugees for transfers for medical and psychiatric assessment and treatment.

So many of these submissions are against the repeal of medevac. So many groups from so many walks of life from across the country—from here in Canberra to the Illawarra, northern Victoria and East Gippsland; from Bega, Yass, Brisbane, Darwin, Melbourne, Sydney and the Blue Mountains.

I conclude by repeating again: our country is crying out for some humanity in these dark times. Retaining laws which provide some semblance of medical assistance for people we wrongly lock up is surely the least we can do.


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