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Offshore detention: cross-sectional analysis of the health of children and young people seeking asylum in Australia
  1. Lahiru Amarasena1,2,
  2. Nora Samir1,
  3. Louise Sealy2,
  4. Nan Hu1,
  5. Mohammad Reza Rostami3,
  6. David Isaacs4,5,
  7. Hasantha Gunasekera4,5,
  8. Helen Young6,7,
  9. Rishi Agrawal8,
  10. David Levitt9,10,
  11. Joshua R Francis11,12,
  12. Jacinta Coleman13,
  13. Sarah Mares3,
  14. Penny Larcombe14,
  15. Sarah Cherian15,16,17,
  16. Shanti Raman1,18,
  17. Raghu Lingam1,2,
  18. Karen Zwi1,2
  1. 1School of Women's and Children's Health, University of New South Wales – Randwick Campus, Sydney, New South Wales, Australia
  2. 2Community Child Health, Sydney Children's Hospital Randwick – Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
  3. 3School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
  4. 4The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
  5. 5The Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  6. 6Paediatrics, Royal North Shore Hospital, Sydney, New South Wales, Australia
  7. 7Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
  8. 8Paediatric Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
  9. 9Mater Refugee Complex Care Clinic, Mater Misericordiae Health Services, Brisbane, Queensland, Australia
  10. 10Paediatrics, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
  11. 11Global and Tropical Health Division, Menzies School of Health Research – Charles Darwin University, Darwin, Northern Territory, Australia
  12. 12Paediatric Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
  13. 13Adolescent Medicine, Monash Children's Hospital, Melbourne, Victoria, Australia
  14. 14Paediatrics, Gold Coast University Hospital, Gold Coast, Queensland, Australia
  15. 15Refugee Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
  16. 16Discipline of Paediatrics, University of Western Australia, Perth, Western Australia, Australia
  17. 17Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
  18. 18Community Paediatrics, South Western Sydney Local Health District, Sydney, New South Wales, Australia
  1. Correspondence to Dr Lahiru Amarasena, School of Women's and Children's Health, University of New South Wales – Randwick Campus, Sydney, NSW 2031, Australia; l.amarasena{at}unsw.edu.au

Abstract

Objective To describe the health and well-being of children and young people (CYP) seeking asylum subjected to Australia’s immigration policy of indefinite mandatory detention on Nauru.

Design Cross-sectional analysis of a cohort of CYP seeking asylum.

Setting Australian paediatric clinicians from 10 health services completed detailed health assessments around the time of transfer from Nauru, mostly to Australia.

Participants Sixty-two CYP who were ≤18 years on entry into offshore immigration detention on Nauru between 2013 and 2019. Mean age at health assessment was 9 years.

Main measures Health outcomes were categorised as physical, mental or neurodevelopmental concerns/conditions. Risk and protective factor data were collected using the adverse childhood experiences and refugee-specific adverse childhood experiences tools.

Results Over half of the CYP (n=32, 52%) were held on Nauru for ≥4 years. The vast majority of CYP had physical health (n=55, 89%) and mental health (n=49, 79%) concerns including self-harm or suicidal ideation/attempt (n=28, 45%). Mental health concerns were more likely in CYP who were school-aged (p=0.001), had been held on Nauru for ≥1 year (p=0.01); originated from the Eastern Mediterranean region (p<0.05); witnessed trauma (p<0.05) or had exposure to ≥4 refugee-specific adverse childhood experiences (p<0.05). Neurodevelopmental concerns were seen in eight children (13%).

Conclusions This study highlights the almost universal physical and mental health difficulties in a sample of CYP who experienced forced migration and were subjected to Australia’s offshore immigration detention policy. Immigration detention in recipient countries, a known adverse childhood experience, may contribute to or exacerbate harmful outcomes in CYP seeking asylum.

  • adolescent health
  • child health
  • child welfare
  • global health
  • mental health

Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Footnotes

  • RL and KZ are joint senior authors.

  • Collaborators Australian Refugee Child Health (ARCH) Network: Hasantha Gunasekera, David Isaacs, Helen Young, Philip N Britton, Jennifer Anderson, Merran Mackenzie, Alanna Maycock, Llewella Butland, Shanti Raman, Karen Zwi, Louise Sealy, Christy Norwood, Lahiru Amarasena, Rishi Agrawal, Scott Sypek, Jon Jureidini, David Levitt, Sarah Cherian, Gemma Hanes, Raewyn Mutch, Tom Volkman, Joshua R Francis, Paul Bauert, Laura Francis, Penny Larcombe, Jacinta Coleman, Philipa Lewis, Murray Webber, Georgia Paxton, Shidan Tosif. University of New South Wales Population Child Health Research Group: Lahiru Amarasena, Nora Samir, Nan Hu, Yalemzewod Gelaw, Karen Zwi, Raghu Lingam.

  • Contributors LA was responsible for ethics applications, development of the study instrument, coordination of the study, recruitment, data entry, data analysis and write up of the paper. NS was responsible for ethics applications and coordination of the study. LS contributed to the design of the study, recruitment, data entry and development of the paper. MRR contributed to the design of the study. DI, HG, HY, PB, LB, CN, DL, JC, PL, SM, SC, RA, JF and LF contributed to recruitment and data entry. SM and SC also contributed to editing of the paper. NH contributed to development of the study instrument. NH and YG provided advice regarding statistical analyses. SR and RL were responsible for development of the paper. KZ was the guarantor for the study and was responsible for ethics applications, design and management of the study, selection of the study instruments and final editing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.