In Melbourne, within 20km of our hospital, school-aged children were not enrolled in school, often for months. Schooling was unavailable or extremely limited for most children on Christmas Island for long periods. Almost half the children had interrupted education in detention. Protective systems were limited or absent.

Child protection issues were common – 19% required child protection notification and 8% were referred for sexual assault concerns in detention.

Two-thirds had a mental health problem (most commonly anxiety, depression and/or post-traumatic stress disorder) and 75% presented with developmental concerns. The trauma and deprivation of immigration detention had profound impact on children’s health. More than half the cohort had parents with mental illness, this reached 86% in the Nauru/PNG cohort, and 21% of these children had parents requiring psychiatric admission. One in five children were separated from a parent in detention, often for weeks or months, and young children were left alone in detention while their parents were hospitalised. They were exposed to self-harm, suicide attempts and violence – in unrelated adults and within their own families. They then experienced trauma in detention. They arrived with trauma – 62% had experienced major trauma before or during their journey to Australia, 8% had experienced the death of an immediate family member. The experience of these children was traumatic. Children sent to Nauru/PNG were detained for longer (typically three to five years) than those held in Australia (typically around one year), and many of this group remain in community detention.Ī total of 62% of the children in the study had experienced major trauma before or during their journey to Australia. The duration of locked detention ranged from a few months to more than five years. Most children had spent time in at least three different Australian detention facilities. There were 79 children from families who had been detained on Nauru/PNG, 47 children had been detained offshore. Our cohort of 277 patients comprised 239 children who had been detained, including 31 infants born in detention, and another 38 children born after release to families who experienced detention. Trauma, mental illness, lack of protection UK moves to copy Australia's cruel asylum-seeker policy – and it will have the same heavy human toll We have extensive experience in refugee health, forensic medicine and child development, but nothing prepared us for the complexity of looking after these children. Our team has been seeing refugee children for more than 20 years.

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