Humanitarian medicine: up the garden path and down the slippery slope
http://www.100md.com
《英国医生杂志》
1 Geneva, 1203 Switzerland harding@bluewin.ch
Doctors dealing with asylum seekers need clearer direction on how to manage human rights issues and avoid being drawn into abuses
Introduction
Dr Maarten Dormaar left after four months working for the IOM. He was employed as a psychiatrist to work on the Pacific island of Nauru, where hundreds of asylum seekers (men, women, and children) had been detained since September 2001—condemned to idleness and constantly guarded by more than 100 security guards. Some of the asylum seekers had been rescued at sea by the Norwegian ship Tampa; others had tried to enter Australia.3 They were kept on Nauru as part of the Australian government's "Pacific solution," designed to prevent asylum seekers reaching its territory. Dr Dormaar witnessed worsening mental health problems, including depression and acute stress reactions, and claims that IOM did not act on his reports.4
Doctors are under pressure to help prevent people from seeking asylum in rich countries
Credit: AAP/PA
Since his return Dr Dormaar has tried to mobilise public opinion in the Netherlands and Australia (with some success). In December 2002 riots broke out in a Nauru camp. IOM staff, including nurses and doctors, were threatened by asylum seekers, who could no longer tolerate indeterminate detention and constant pressure to return to their countries of origin, which included Iraq, Afghanistan, and Iran.
The Australian government finances the whole Nauru operation. IOM is the main contractor. Thus even a well established organisation like IOM, which has repeatedly proved its value in difficult situations, becomes compromised as the de facto detaining authority. Its medical staff thus face ethical dilemmas for which they do not receive clear guidance. An internet advertisement for an obstetrician and gynaecologist to be contracted by IOM reads, "Working in Nauru will give you a flavour for the `Pacific Way.' You will be able to experience the relaxed lifestyle and savour some of what the Pacific has to offer with the sea, sand and smiling faces."5 It does not mention the complex human rights and ethical issues facing doctors who have to deal with refugees who have become prisoners.
Vigilance to abuse
British Medical Association. Medicine betrayed. London: Zed Books, 1992.
Collectif Contre Les Expulsions. Centre fermé de Vottem: un médecin démissionne et accuse. http://ccle.collectifs.net/article39.html (accessed 22 Jul 2004).
Zinn C. Australia accused of blocking doctors' visits to asylum seekers. BMJ 2004;328: 186.
Fickler D. Australia "as bad as Taliban" say hunger strikers. Observer 2003 Dec 21. http://observer.guardian.co.uk/international/story/0,,1111167,00.html (accessed 22 Jul 2004).
Royal Australian and New Zealand College of Obstetricians and Gynaecologists Asia and Oceania Affairs Committee. Volunteer e-News 2002;1:4. www.ranzcog.edu.au/Open/asia-oceania/pdfs/volunteers-emewsmay2002.pdf (accessed 5 April 2004).(Deborah Harding-Pink, for)
Doctors dealing with asylum seekers need clearer direction on how to manage human rights issues and avoid being drawn into abuses
Introduction
Dr Maarten Dormaar left after four months working for the IOM. He was employed as a psychiatrist to work on the Pacific island of Nauru, where hundreds of asylum seekers (men, women, and children) had been detained since September 2001—condemned to idleness and constantly guarded by more than 100 security guards. Some of the asylum seekers had been rescued at sea by the Norwegian ship Tampa; others had tried to enter Australia.3 They were kept on Nauru as part of the Australian government's "Pacific solution," designed to prevent asylum seekers reaching its territory. Dr Dormaar witnessed worsening mental health problems, including depression and acute stress reactions, and claims that IOM did not act on his reports.4
Doctors are under pressure to help prevent people from seeking asylum in rich countries
Credit: AAP/PA
Since his return Dr Dormaar has tried to mobilise public opinion in the Netherlands and Australia (with some success). In December 2002 riots broke out in a Nauru camp. IOM staff, including nurses and doctors, were threatened by asylum seekers, who could no longer tolerate indeterminate detention and constant pressure to return to their countries of origin, which included Iraq, Afghanistan, and Iran.
The Australian government finances the whole Nauru operation. IOM is the main contractor. Thus even a well established organisation like IOM, which has repeatedly proved its value in difficult situations, becomes compromised as the de facto detaining authority. Its medical staff thus face ethical dilemmas for which they do not receive clear guidance. An internet advertisement for an obstetrician and gynaecologist to be contracted by IOM reads, "Working in Nauru will give you a flavour for the `Pacific Way.' You will be able to experience the relaxed lifestyle and savour some of what the Pacific has to offer with the sea, sand and smiling faces."5 It does not mention the complex human rights and ethical issues facing doctors who have to deal with refugees who have become prisoners.
Vigilance to abuse
British Medical Association. Medicine betrayed. London: Zed Books, 1992.
Collectif Contre Les Expulsions. Centre fermé de Vottem: un médecin démissionne et accuse. http://ccle.collectifs.net/article39.html (accessed 22 Jul 2004).
Zinn C. Australia accused of blocking doctors' visits to asylum seekers. BMJ 2004;328: 186.
Fickler D. Australia "as bad as Taliban" say hunger strikers. Observer 2003 Dec 21. http://observer.guardian.co.uk/international/story/0,,1111167,00.html (accessed 22 Jul 2004).
Royal Australian and New Zealand College of Obstetricians and Gynaecologists Asia and Oceania Affairs Committee. Volunteer e-News 2002;1:4. www.ranzcog.edu.au/Open/asia-oceania/pdfs/volunteers-emewsmay2002.pdf (accessed 5 April 2004).(Deborah Harding-Pink, for)