Whilst we have previously noted our opposition to the detention of children in Nauru, the Guardian’s publication today of leaked incident reports highlights the true horrors experienced by these children. For more on the background on detention then take a look here.
Today, the Guardian has published over 2000 leaked incident reports from Nauru. 51.3% (1086 reports) involve children. They include physical and sexual abuse, degrading and inhumane treatment.
In 2015 alone, there were 57 incident reports of assault of a minor, 189 reports of self-harm or threatened self-harm, and 7 reports of sexual assault on children. A full breakdown of all the incident reports can be found here.
The physical assault incidents include guards pulling children’s hair, slapping them across the face and pushing them to the ground. The sexual assault incidents include a child indicating that another asylum seeker had cut her vagina; while another young child asked adults to insert their fingers into her vagina. There are multiple reports of children displaying worrying behaviour include anxiety attacks, uncontrollable screaming and self-harm. There are reports of children being denied basic sanitation with one report of a young child being refused permission to use the toilet and being made to squat instead; and another child had their request to spend 4 minutes in the shower rather than 2 minutes accepted in exchange for sexual favours.
It makes awful reading, but it’s important for us, as healthcare professionals to read it, because it’s happening right under our noses.
As medics, we know that incident reports actually only reflect the tip of the iceberg. In hospitals, so many ‘near misses’ go unreported, and hospital incident reports show just a snapshot of the problems that hospitals face. How often have you ‘almost’ made a medication prescribing error, but it was picked up before the patient received the dose? Similarly, we can assume that the incident reports from Nauru just scratch the surface.
But also, and perhaps more importantly, the point of incident reports in hospitals is to make systems changes. They aren’t about blame, but they are about identification of issues. Root cause analysis (RCAs) and clinical investigations are a robust process in place within the public hospital system. They involve multidisciplinary investigation teams interviewing, analysing, recreating, and researching what went wrong. Then the team makes recommendations. These recommendations are reported back to a hospital committee and then will be reported to the hospital Executive. Serious incidents will be escalated to the Executive more quickly. It is not just that we have systems in place to respond to incidents, but the whole incident reporting system is transparent and freely available. It is this clear governance process that makes our hospitals run better, and our staff perform better. Because our aim is to deliver the best patient care we can.
The whole system of reporting in Nauru is closed and secretive, and we are having to rely only on leaked reports for this information. What was being done with these incident reports in Nauru? Was there a similar review and investigation process? Was the government aware of these incidents? Were any changes implemented in response to these incidents? The Guardian suggests that rather than decreasing, the number of reports increased over the last few years – we need to know if this was due to increased reporting awareness, or a lack of effective leadership to improve the abuse that happened so regularly in Nauru.
As paediatricians we need to be clear that this is unacceptable. Children are disproportionately represented in these leaked reports – making up 51% of the reports but only accounting for 18% of the Nauru detainee population. It goes without saying that no child should endure this sort of abuse, in these sort of living conditions. The long-term impact on their development, mental health, and physical well-being must surely be significant. The Government must respond.