Ethics, human rights and refugees – what all nurses should know


A nurse who works with refugees untangles the facts from the fiction about ‘boat people’, asylum seekers (onshore and offshore) and nurses’ responsibilities under the Code of Ethics for Nurses in Australia.

Ruth Sheahan RN writes: I’m privileged to work as a registered nurse in the NSW Refugee Health Service. My working day is spent assisting ‘offshore’ arrivals settle into our health system. My role is to undertake a comprehensive health check, address any urgent medical problems, refer clients to appropriate area health clinics and give them an understanding of how our system operates. I follow complex cases and work closely with GPs and allied health. My team is encouraged to stay abreast of what’s happening in regard to current ‘onshore’ Immigration policy and to be aware of human rights in relation to our workplace and practice. We’re encouraged to engage in the conversation and act in support of related human rights issues.

I want to write about issues surrounding refugees in detention and the responsibility our profession has as a whole – indeed, nurses as individuals have – in regard to speaking out and advocating for people seeking asylum in Australia.

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Ruth (right) during a home visit to a Syrian refugee.

Almost every day we read in our newspapers, hear over the radio and witness on our TV screens the displacement of people from their homelands, people and families fleeing persecution and civil unrest. Visions of hopelessness and despair on the faces of our fellow human beings are broadcast, the aftermath of atrocities. Misery is plain to see. It seems to me that we as a prosperous and peaceful nation have a responsibility to protect and support such people. That is a basic human response.

Australia has resettled approximately 800,000 refugees since the end of World War II, building one of the world’s most vibrant multicultural societies. Most Australians are proud of this achievement, yet substantial prejudice exists in the Australian community toward refugees and asylum seekers, especially those who enter Australia by boat. Prominent members of the health profession and human rights lawyers have long argued that political rhetoric and distorted media representations continue to foster antagonistic sentiments towards asylum seekers.

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Brett Holmes of NSWNMA (2nd from right) and Ged Kearney, nurse President of the ACTU (4th from right) at a rally for refugees in Sydney.

Since 1996 the Australian government has maintained a Humanitarian Program, issuing around12,000 humanitarian visas per annum. During the Gillard years, the number rose to 20,000, but this degree of generosity was maintained only for a short period. Since the election of the present Coalition government, the number has more or less reverted to the previous level. Our current share of the world’s asylum applications is 2.2 percent, a small fraction of the total global number. Nonetheless, Australia ranks among the world’s top three resettlement countries, along with Canada and the United States.

Australia is a signatory to the United Nations Refugee Convention of 1951.  This means that under international and Australian law the protection of asylum seekers and refugees is sanctioned. Being a signatory to the 1951 Convention means Australia is obliged to process asylum seekers’ claims and offer refuge if their claims are verified. Within the convention document, a person seeking asylum is ‘an individual who has sought international protection and whose claim for refugee status has not yet been determined’. A refugee is a person whose protection has been deemed necessary by the UNHCR or a state which is a signatory to the Refugee Convention.


Our nation’s humanitarian program has two components, with onshore and offshore classifications. The onshore component concerns asylum seekers who apply for refugee status after arriving in Australia. As a signatory to the 1951 Convention the onshore component is a legal obligation, while Australia’s offshore program is a voluntary scheme.

Refugees who seek protection onshore are as legitimate as those who apply offshore.

For many years Australian Immigration authorities set a nominal quota of Protection visas, numbered at 2000 persons, issued to onshore arrivals. The processing of asylum claims applies to all those persons seeking protection upon arrival in our country regardless of how they arrive or whether they hold valid identity or travel documents. It’s worthwhile noting that most onshore arrivals enter Australia as visitors and students. Others arrive without authorisation, as passengers in unsafe fishing vessels. These boat entries are officially called ‘Illegal Maritime Arrivals’ by the Department of Immigration and Border Protection.

Refugees entering our country through the Australian Offshore Humanitarian Immigration Program are granted their visa before arriving in Australia.

This component of Australia’s humanitarian immigration program has a nominal quota of around 12,000 visas. Humanitarian entry visas are granted to people who are identified and selected by the Australian government for resettlement. They are displaced people who have been living in refugee camps or under UNHCR protection in countries where such opportunities exist. They have officially been recognised as refugees by the UNHCR and are in need of resettlement.


From my research, I’ve found that there are two misinterpretations of policy and fact surrounding asylum seekers in regard to queues. The first is that the onshore and offshore components of Australia’s refugee program are numerically linked. Every time an onshore applicant is granted a protection visa, a place is deducted from the offshore program. This policy blurs the distinction between Australia’s obligations as a signatory to the 1951 Convention and her voluntary contribution designed to share the world’s burden of resettling those refugees for whom no other enduring solution is available.

No other country in the world links onshore and offshore programs in this way.

In Australia those asylum seekers who arrive by sea have become known colloquially as ‘boat people’. A ‘boat person’ is generally perceived by the wider Australian community as a ‘queue jumper’, taking away a visa that would otherwise be allocated to a refugee who is believed to be patiently waiting offshore to be settled in Australia.

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Unions for Refugees at a rally.

I find this is not true, as Australia has a standing obligation to provide protection to onshore arrivals, whereas the resettlement of the offshore person is a voluntary commitment.

The second misconception surrounding queues is the idea that there are orderly lines in Australian diplomatic outposts situated in faraway places, where displaced people patiently wait their turn for a visa to be issued. This is not true, as these queues simply do not exist.

While the mainstream media broadcast and print biased material in regard to ‘queue jumping refugees’ and ‘boat people’, the government of the day does nothing to remedy the situation. Quite the contrary, it actively fuels the debate by using the same provocative language when referring to asylum seekers arriving by sea and being held in detention centres.

The present Government’s naming of the vessels that ‘people smugglers’ use to ferry asylum seekers onto our mainland as ‘illegal arrivals’ might be fair, but it’s my understanding according to the 1951 Convention that the term ‘illegal’ should not apply to the people aboard these boats who arrive seeking asylum.

Over the years governments may not have coined the labels ‘queue jumpers’ and ‘illegals’, but they have done little to quash attitudes. The deliberate release of mis-information, for example during the ‘children overboard’ incident during the Howard years, served to inflame public opinion. I find these actions impossible to reconcile with our international humanitarian obligations according to the 1951 Convention.

According to the 1951 Convention, detention is permissible and may be deemed necessary for public health, security and identification reasons. Australia is one of the few countries, signatory to the 1951 Convention, which places asylum seekers in mandatory detention for the entire length of time it takes for their claims to be processed.

The conditions and treatment of people in immigration detention must comply with Australia’s international human rights obligations. The Australian Human Rights Commission and others have long raised concerns about the detention of people, especially children, for long periods of time.

Recently the Australian Human Rights Commission has raised concerns about conditions in Australian on and offshore immigration detention centres, especially on Nauru and Manus Island, finding they are not appropriate places in which to hold people, especially for prolonged periods of time. Australia’s then Immigration Minister stated in 2014 that he will never allow people who come to our country illegally by boat to settle permanently in Australia.

There have been repeated concerns voiced regarding the effects of prolonged detention on mental health. Studies have found detrimental effects on psychological wellbeing, with these refugees reporting persistent sadness, hopelessness, psychological reactivity, intrusive memories and attacks of anger and self-harm. Often the severity of these effects relate to length of time a person is detained.

In January 2013 the UNHCR Mission on Manus Island sent to review conditions within the detention centre found that basic conditions and standards were lacking, particularly in regard to freedom of movement and access to an appropriate legal framework, and that asylum seekers were detained on mandatory and indefinite bases. The United Nations 1998 Convention on the Rights of the Child (CRC) requires that a child should only be detained as a measure of last resort and for the shortest appropriate period of time. It also requires that those children who come into a country as refugees are given the same rights as children born in that country. In 2004 the report on the National Inquiry into Children in Immigration Detention found that Australia’s system of mandatory immigration regarding the detention of children was inconsistent with Australia’s obligations. Subsequently children and their families were placed in community detention.

After recent changes in immigration policy all this has changed and once again children are being detained.

The 2014 National Inquiry into Children in Immigration Detention has exposed disturbing revelations made by government-contracted health professionals. Some were the confiscation of hearing aids, a prosthetic limb being removed from a disabled boy, medication withdrawn from a three year old girl who suffered seizures and then subsequent delays in getting adequate medication as her seizures continued and that children are routinely identified by their boat number instead of their names.

For the nursing profession as a whole, in regard to refugees and asylum seekers in Australia, within the framework of our code of ethics and professional conduct we are provided with clear guidelines surrounding the support of human rights.

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The nurse-led refugee health program team.

The Code of Ethics for Nurses in Australia states: ’The nursing profession recognises the universal human rights of people and the moral responsibility to safeguard the inherent dignity and equal worth of everyone, this includes recognising, respecting and where possible protecting the wide range of civil, cultural, economic, political and social rights that apply to all human beings’ .

Our Code of Professional Conduct for Nurses in Australia expects that nurses set exemplary standards of conduct and that we should consider the ethical interests of the nursing profession and the community when exercising our right to freedom of speech and participating in public, political and academic debate, including publication. Furthermore, nurses should promote and protect the interests of people in their care and when making professional judgements in relation to a person’s interests and rights and that nurses do not contravene the law or breach the human rights of any person, including those deemed stateless, such as refugees and asylum seekers.

The National Professional Competency Standards for the Australian Registered Nurse requires that we practice in a way that acknowledges the dignity, culture, values, beliefs and rights of individuals and groups. That where it is appropriate we advocate for individuals or groups when rights are overlooked or compromised.

It is clear that Australian nurses have a professional responsibility to uphold the expectations of our national codes and standards and it is comforting to find that information regarding the need for ‘whistleblowing’ – to disclose information relating to any misconduct, illegal and unethical practices that we may encounter in our professional lives – is discussed within these documents.

Australia’s nurses as a professional body should be well versed concerning the various UNHCR conventions, understanding their role in respect to human rights and social justice, and they should be prepared to uphold the standards and ethical obligations pertaining to our profession, especially when it concerns refugees and asylum seekers.

Some health professionals who have been contracted to work in Australia’s detention centres have broken strict workplace confidentiality agreements, speaking out about the treatment of asylum seekers, describing appalling practices and conditions – but it seems for a while now these voices have been silent.

Popular discourse has affected the health of people seeking asylum in our country. Upon election, the present Coalition government proclaimed that the Australian people had handed them a mandate to use whatever methods it deemed necessary to ‘stop the boats’. The ensuing misery inflicted on some of the most vulnerable people on our planet is unprecedented in Australian history.

International law surrounding the 1951 UNHCR Refugee Convention and the Rights of the Child appear helpless as people who have sought asylum in our country languish impounded in appalling conditions on Manus Island and Nauru.

I encourage Australian nurses to take every opportunity to lobby government at all levels and get out on the streets whenever a peaceful opportunity arises to support human rights issues, especially when it concerns refugees and asylum seekers. The voices of many can make a difference. If we are to be called a civilised society, then Australia’s immigration policy must change. History supports the fact that most of these asylum seekers will one day become Australian citizens and the lasting psychological damage caused from mandatory detention will eventually affect every Australian citizen or resident in one way or another.

Also on Nurse Uncut: Nurses lead the way on refugee health



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