Opinion piece: Refugee health programs

This opinion piece originally appeared in the November 2014 issue of the Council to Homeless Person’s Parity magazine


Community health services in Victoria have been front line providers of health and support services to refugees and asylums seekers for many years and among these, cohealth (and its founding organisations Doutta Galla Community Health, North Yarra Community Health and Western Region Health Centre) has been a leader.

Our refugee health programs and the Statewide Refugee Nurse Facilitator role we support have played a key role in shaping Victoria’s refugee and asylum seeker response, which is articulated in the recently released Victorian Refugee and Asylum Seeker Health Action Plan 2014-18 (1) and was commended by the Victorian Auditor General’s Office in its 2014 report Access to Services for Migrants, Refugees and Asylum Seekers. (2)

Victoria’s response shows national leadership, but it is constrained by a health and immigration policy environment that is complex, volatile, and frequently buffeted by the winds of political expediency and populism.

Thousands of refugees and asylum seekers living in our communities are subject to a vast range of immigration vagaries. Some are humanitarian entrants who qualify for a range of supports. Others are asylum seekers on bridging visas. Depending on when they arrived, they may or may not have work rights or access to Centrelink supports. Then there are those whose bridging visas have expired and who have no clear legal status at all.

More recently, temporary protection visas have been re-introduced. These visas provide a maximum stay of three years in Australia, access to Medicare, Centrelink and work rights, but no settlement support, no family reunion and no re- entry to Australia.

Along with this increasing administrative complexity, legal assistance to help asylum seekers make sense of and advocate for their United Nations protected rights have been tightened. In place of legal advice, many asylum seekers are now required to sign a lengthy English-language code of conduct setting out the conditions of their stay in Australia.

The stories and the lives of people who have often fled circumstances of unspeakable horror are harrowing. Shamefully, we have added to their burden by creating systems and barriers they must attempt to navigate in a foreign place with an unfamiliar language, far from family and community. This inevitably compounds the long-lasting and crippling effects of their trauma and continuing isolation.

It is hardly surprising, then, that unstable housing and homelessness are commonly experienced by refugees and asylum seekers. Here are some of their stories:

Abdul is a single 20 year old man who arrived in early 2014 as a tourist from Palestine and claimed asylum. He has no family or friends in Melbourne and minimal English. His visa provides access to Medicare, work rights and assistance from settlement services. Initially, things looked good for Abdul. However, when he became ill he lost his casual job and house, and was soon sleeping rough or couch surfing when he could. Abdul is currently in emergency housing but increasingly anxious about his health, his future and the fate of his family at home.

Wako is a 34 year old Ethiopian man who arrived in Australia in late 2013 as a humanitarian entrant. He has minimal English. Initially Wako was living in a share house with other men from a similar background to him, but tensions emerged when his housemates learned he was being treated for latent (non-infectious) TB. He was soon ostracised and turned to couch surfing in the homes of people he met at his English classes. Wako’s previous experiences of torture have left him anxious at the prospect of sharing accommodation with strangers, but with the majority of his Centrelink payment going back to Ethiopia to support his elderly mother, private rental is too expensive and options through community providers are limited. Wako is on the public housing waitlist and continues to couch surf and sleep rough.

Habte is a 26 year Eritrean man who arrived in Australia in late 2013 as a humanitarian entrant, via the UNHCR in Cairo. Habte has a history of significant trauma and torture, false imprisonment and human trafficking. In addition to significant mental health issues, he is being treated for severe psoriasis with a drug that is expensive and compromises his immune system. Ostracised from his original settlement household due to his appearance, Habte has been homeless for several months. He often sleeps rough around Flinders Street Station and other public locations, which is causing his mental health to further deteriorate.

Salar is a 36 year old Hazara man from Pakistan with limited English. Salar arrived in Australia by boat and following a long period of onshore detention was released into the community on a bridging visa. His visa expired in July 2014, along with his Medicare card. Salar accesses multiple services for depression and anxiety that cause poor sleep, panic attacks, poor motivation, reduced concentration, social withdrawal, nihilism and suicidal ideation. When he is profoundly depressed Salar presents as catatonic and is heavily reliant on his housemates who are also asylum seekers. The administrative confusion associated with Salar’s immigration status is causing his mental health to further deteriorate, placing his accommodation in jeopardy.

These stories are remarkable because they are so common. Distressingly, these are some of the happier stories because they relate to people with some access to work rights, English classes and temporary accommodation and other services.

Many people do not have access to the services and supports vital for their settlement and recovery beyond a post-arrival period of a few weeks. After that, they are largely left to fend for themselves.

Of course the commitment of staff in many services like ours and within pockets of the community make a practical difference to individual refugees and asylum seekers, and go some way to challenging the dominant political narratives that demonise this vulnerable group. But there seems little doubt that the unnecessary complexity and administrative hurdles cruelly placed in the lives of refugees and asylums seekers are doing significant damage to them and our community fabric that will take years to repair.

Practically we must be able to do better. Legally, ethically, morally we are obliged to.


Endnotes

  1. http://www.health.vic.gov.au/diversity/refugee.htm
  2. http://www.audit.vic.gov.au/publications/20140529-Migrants-Services/20140529-Migrants-Services.pdf

Citation: Rostant, J. (2014). Opinion. Parity, Vol. 27, No. 10, Nov 2014: 36-37.

 

 

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