This post was originally published on ABC’s The Drum.
International health and human rights lawyer Alexandra Phelan argues that by exposing asylum seekers to the risk of malaria on Manus Island, the Government could be violating human rights conventions.
When the Australian officials head to Port Moresby this week to discuss the reopening of the Manus Island detention centre, their risk of contracting malaria on a short-term visit to Port Moresby (according to the Government’s own Smart Traveller website) is relatively low.
However, if the officials make their way to Manus Island, located north of Papua New Guinea to inspect the detention centre site, their health professionals would likely advise that they take prophylactic antimalarial drugs.
Given this visit is part of a government-related mission, the cost of these antimalarials would most likely, and rightly so, be covered by tax-payer funding.
Malaria is contracted by the bite of a mosquito infected with one of the five species of Plasmodium parasite. The parasite travels to your liver, where it multiplies and then ruptures liver cells, spreading to your red blood cells and then throughout your body. This process causes fever, shivering, headache, and vomiting. In the case of Plasmodium falciparum (the cause of 90 per cent of Papua New Guinea malaria cases), if not treated within 24 hours, the infection proceeds to severe malaria resulting in coma and death, especially in young children and pregnant women. In malaria endemic areas, local populations may develop partial immunity, meaning that individuals who have not grown up in the endemic area are at greatest risk.
There is currently no vaccine for malaria – prevention is through the use of antimalarials, which require important medical consideration of each patient’s age, weight, pregnancy status, underlying illnesses, the risk of side-effects and the increasing prevalence of the parasite’s antimalarial resistance.
Papua New Guinea is a malaria endemic country; in the World Health Organization’s (WHO)2011 World Malaria Report, the WHO concluded that 94 per cent of Papua New Guinea’s population is at high risk of malaria infection, with the remaining 6 per cent of the population at low risk. No person in Papua New Guinea is deemed by the WHO to be risk-free of malaria. In 2010, there were 1.4 million suspected malaria cases in Papua New Guinea, out of a total population of 6.9 million. In 2010, there were 616 reported deaths attributed to malaria, six times more than any other country in the Western Pacific Region.
Papua New Guinea is clearly the highest risk country in the entire Western Pacific Region for malaria. But to make matters worse, the WHO categorises Manus Island, where the Government proposes to send asylum seekers, as having the highest numbers of probable and confirmed malaria cases in all of Papua New Guinea.
The Manus Island detention centre was initially established in 2001 under the Howard government’s Pacific Solution policy. In February 2002, an outbreak of malaria affected at least 15 asylum seekers detained at Manus Island, a claim denied by then-minister Philip Ruddock, but supported by local doctors on Manus Island.
In response to the outbreak, the Royal Australasian College of Physicians (RACP) called for asylum seekers detained at Manus Island to be immediately removed. Then-president of the RACP, Richard Larkins, said that:
“[G]iven the medical evidence about the prevalence of malaria, in particular the chloroquine [an anti-malarial] resistant strains, on Manus Island, the responsible course of action is to immediately evacuate the detention centre. This is the only truly effective way people at risk can be protected, especially pregnant women and children, but also any others with low immunity.”
The Manus Island detention centre was closed in mid-2004, after asylum was granted to Aladdin Sisalem, who had been the sole detainee at the centre for the previous 10 months.
If plans to re-establish Manus Island are followed through, Australia will most definitely risk violating a number of the asylum seekers’ human rights and protections under international law, in particular, the asylum seekers’ right to health under article 12 of the International Covenant on Economic, Social and Cultural Rights, and possibly, their right to life.
The right to health provides that everyone has the right to a standard of living adequate for the health and wellbeing of themselves and their family. It imposes obligations on countries to take steps to prevent, treat and control disease. The principle of non-regression prevents countries from “going-backwards” in the realisation of the right to health. It is also arguable that by sending individuals to a country where their health is knowingly at risk so substantially as to risk their lives, the protections of their right to life under the International Covenant on Civil and Political Rights could be engaged.
These rights are universal, regardless of an individual’s status under a piece of Australian legislation. Even more so, due to their circumstances, asylum seekers are especially vulnerable and at risk of having their rights violated. Sending asylum seekers offshore to Manus Island where malaria is endemic, and present in its most deadly strain (Plasmodium falciparum), risks violation of the asylum seekers’ rights and contravention of Australia’s obligations under international law.
There are only two ethical options left for the Australian Government. The first option is to invest Australian tax payers’ money in improving the facilities on Manus Island, providing mosquito nets, and supplying universal medical prophylaxis and healthcare with informed consent to detainees (which may be impossible with pregnant women, children and those most vulnerable to malaria). The second option is to immediately abandon any plans the Government has to send asylum seekers to Manus Island.
When Australian Government officials on Manus Island this week take their medically-assessed and freely consented to antimalarials, don their long shirts and pants, spray their insect repellent, and don’t have to worry about closing their mosquito nets securely around their hotel beds thanks to the air-con, perhaps they can take a moment to consider whether it would be conscionable for the Australian Government to expose persons in its custody and care to the conditions on Manus Island.
Alexandra Phelan is an Australian international health and human rights lawyer, and was involved in writing a book chapter on a human rights based approach to malaria at the World Health Organization, to be released later this year. View her full profile here.