Médecins Sans Frontières (MSF) fieldworkers Virginie Thys and Dr Robyn Osrow share their reflections on providing mental health care to refugees and asylum seekers on Nauru, following the forced exit of MSF from the island.
“The human being seems to be totally forgotten at the expense of border policies”
Virginie Thys worked on Nauru for six months as Field Coordinator.
“In 10 years of field experience with MSF in highly critical contexts around the world, Nauru was the project that affected me the most: the project where I saw the highest level of desperation among our patients.
I could see the daily struggle of our mental health team trying to support the patients, to help them to not collapse, to give them some humanity. The main frustration of the team was seeing that most of our patients were not improving – the main reason being, they can start to recover only when they are resettled in a safe place, where the word ‘future’ can have meaning for them.
"Five years of punishment, isn’t it enough? "
In the case of asylum seekers and refugees on Nauru, the human being seems to be totally forgotten at the expense of border policies. Empathy does not exist anymore.
On Nauru, there is little understanding or recognition of what mental health means. People wonder why a person who has shelter and enough food should be mentally affected. The reasons are many, but the main ones are the total uncertainty about the future, the indefinite timeframe of ‘processing’ on Nauru and the lack of freedom. There is no therapeutic cure for a lack of freedom.
Now that MSF has been forced to leave Nauru, it is extremely worrying that asylum seekers and refugees will no longer have access to an independent mental health provider – at a time where they need it the most.
It took me a bit of time to understand the situation of the asylum seekers and refugees in Nauru, but the day I realised that the worst question I could ask them was, “How are you today?”, I realised how bad the situation really is.
Yes, five years in Nauru is enough!”
“It was the situation that needed treatment, not the person.”
Dr Robyn Osrow is a psychiatrist who worked as the Mental Health Activities Manager on Nauru.
“On my third visit to Nauru in September 2018, I witnessed a sharp decline in the mental health of the asylum seeker and refugee population. I saw increased severity of depression, increases in suicidality, and the emergence of a rare and extreme condition in children that I had never seen before, called traumatic withdrawal syndrome. This is where kids completely withdraw socially, and are unable to eat, drink or toilet themselves.
In September, almost every patient I spoke with was acutely and intensely suicidal. This was not the case when I was there four months earlier. But in the past months, it seemed that all hope the patients had held, hope for a life where they could feel safe and happy, had been completely destroyed.
Many patients had been separated from family members for some years, something that was too much to bear. Patients told me they felt “empty”; the resilience I had seen to some extent on my previous visits was gone. As the son of one of my patients said to me, “a broken person cannot fix anything”.
“Patients told me they felt ‘empty’; the resilience I had seen to some extent on my previous visits was gone. As the son of one of my patients said to me, ‘a broken person cannot fix anything.’”
Several patients told me they felt that dogs on Nauru were treated better than they were. Many compared being on Nauru to being in a prison, and to being tortured. They told me, “It is better if I die. We are customers for them [Nauru], they don’t want to lose customers.” Patients were starting to see suicide as the most rational choice they had in an intolerable situation.
The impossibility of treating people in this situation became clearer to me each day I was on Nauru. It was the situation that needed treatment and that needed to be changed, not the person. In my medical opinion, even the world’s best medications and most expert psychotherapy can, at this point, only have very limited effect while asylum seekers and refugees remain on Nauru. The only thing that will significantly improve their mental health condition is to leave the island and be brought to a safe and stable living situation.”