In November 2016, Martin put up his hand to work on Nauru. He is a permanent resident in Australia and lives in regional NSW with his wife and children.
It was a decision driven partly by duty. He has spent much of his life serving in the wars that created asylum seekers and refugees. This was an opportunity for him to serve them.
“I went into the job wanting to do my best as a doctor," he said.
But it was also a personal decision.
During World War II Martin’s grandfather Bernard Quin was stationed on Nauru while the Japanese were bombing the island. He was one of a handful of Western physicians who stayed during the raids to tend to local civilians after the Japanese invaded.
“He was beheaded by the Japanese in 1943,” Martin said. “He is revered in Nauru.” Some Nauruans are named Quin in his honour.
“They still hold him in high regard,” Martin said. “So it was good to be able to go to Nauru just as a way of, in some way of honouring his memory.”
The Pacific island of Nauru is 4,190km from the Australian mainland. While it was at one point one of the richest nations per capita in the world from a phosphate mining boom, by the 1990s Nauru’s tropical flora and blossoming economy had been ravaged.
Its economy was saved by Australia. But now, it balanced its chequebook not by shipping minerals offshore, but by shipping people onshore.
The country signed on to Australia’s “Pacific Solution” in 2012, which was designed to deter asylum seekers from arriving by boat to Australia. Any asylum seeker who attempted to arrive on Australian shores by boat would be sent to a detention centre on Nauru or Papua New Guinea.
When he arrived on Nauru Martin was confronted with the same sight that hundreds of Australian staff at the detention centre saw: a tiny island of just 21 square kilometres. Smaller than some airports.
Australia has privatised the management of the Nauru and Manus Island detention centres. Martin's employer IHMS is a subsidiary of for-profit healthcare giant International SOS.
Martin's first impressions were of a rundown, almost derelict island nation. Skeletons of buildings, the ghosts of old phosphate mines, dotted the dusty roads of the island. Occasionally, ordnance from World War II would be dug out of the ground.
He was toured through the three detention facilities that house asylum seekers on the island and a fourth, Fly Camp, in which some refugees also stay.
Accommodation varies from air conditioned buildings to run down tents with mould on the walls. The facilities have been designated “open detention” since 2015, which means asylum seekers may come and go during the day.
He was put in charge of a small clinic with a team of medical staff to deliver healthcare for asylum seekers. He described it as “a souped-up sick bay”. Yet in a country with rudimentary healthcare services, it surpassed anything the local hospitals could deliver.
Martin would frequently see wealthy Nauruans and senior members of the government when they needed treatment.
He found the detention centre’s set-up similar to the army camp he had worked in during his 16 years in the military.
“It ran on essentially military lines with mess halls, lots of rules and regulations that you had to abide by, which I found fairly easy to fit in with,” he said.
When Martin arrived the community quickly learnt of his family connection. He was greeted by the president of Nauru, Baron Waqa.
The government’s own bulletin sets out that Martin was the “chief and honoured guest” at the November 2016 Remembrance Day ceremony.
Martin threw himself into working on Nauru. But he quickly discovered that there were hidden rules in Australia's immigration centres.
The first rule Martin learnt was that advocacy is a dirty word on Nauru.
“I was basically told ‘absolutely don’t contact the press, don’t talk out of turn, don’t be an advocate, just look after the patients and don’t complain too much’,” Martin said.
During the first few months he was energetic and hopeful. He treated asylum seekers and refugees with a host of health issues. But gradually he grew troubled with the responses he received from Australian officials about the more serious cases he dealt with.
"I kept going back for repeated tours, and each time you’d flag up your concerns to your bosses and you’d be told, 'yep, yep we hear what you’re saying'," he said. "And each time you’d go back the same patients would still be there.
"In the end I got more and more cynical, and realised that no matter how much I jumped up and down, or tried to make noise about it via the official channels, nothing was going to happen."
He recorded his frustrations in a diary on Nauru. One entry Martin wrote read:
“I think it was about four months until it suddenly dawned on me; learned helplessness didn’t just apply to the patients. It affected the staff too. You could see it on the faces of those who didn’t look indignant when their failure to speak up, their lack of comment at another poor decision, their complicity in propping up this inhumane system was pointed out. They had ceased to care they too had been reduced to automata, ticking boxes furiously to satisfy an administrator in Sydney or Canberra and ignoring the simple fact that these people were dying in front of us.”
Under Australia’s harsh detention secrecy laws at the time, just keeping this record could have landed him in jail.
Legally, Australia is responsible for the care of asylum seekers on the island.
But Nauru’s hospital is ill-equipped to deal with complex cases, and Martin’s own facility wasn’t set up to handle complicated medical procedures. So when asylum seekers need urgent medical treatment, they have to be transported overseas.
While Australia would be the easiest and safest destination, the country will only transfer asylum seekers and refugees who need medical care “in exceptional circumstances”,
according to government documents . The documents say this is due to concerns over asylum seekers taking legal action to prevent their return to Nauru.
In 2015 the government publicly stated asylum seekers would no longer be flown to Australia for medical treatment, except
in the most extreme cases. The theory was that this arrangement was comparable to how long it would take to treat people in regional Australia.
“It should have been fairly straightforward, we were working to set guidelines which were broadly equivalent to Australian standards,” Martin said.
But it was far from the reality. Martin and the staff at IHMS would make medical recommendations using a “request for medical movement” form. They would describe the patients’ conditions and give medical deadlines by which to fly the patients out. But frequently Australian officials would fail to action these recommendations, and patients were often in constant pain as their conditions worsened.
“They would reach and breach those guidelines and when we would say, ‘Look, the patient is still here, what is happening?’, we would not get a satisfactory answer,” he said. “Patients were languishing on these waiting lists for months and months and sometimes years still with their conditions but with no satisfactory answer.”
Supplied
Nick Martin at his desk on Nauru.
Martin says he raised these concerns with ABF officials. He says the responses were, at best, unhelpful. Sometimes, there was no response.
“If you are a doctor your primary role is to do the best for your patients,” he said. “You should be striving to do that all the time, it is what we do. That is what you sign up for. That is widely understood. When I did see what I felt were huge delays in these patients getting the care they needed, I felt obliged from a medical, ethical, social, moral responsibility to flag this up and the responses I got were dismissive at best.”
BuzzFeed News and the ABC have obtained several medical request forms that disclose shocking conditions for patients in urgent need of medical transfers. They include female asylum seekers with breast lumps being denied required biopsies. They also show patients with nerve, back and kidney conditions unable to be properly diagnosed.
The delays in their treatment appeared to make their ailments worse. In one case, medical removal documents reveal a delay of a full year for a patient suffering from kidney stones, an extremely painful condition that gets worse over time and can eventually cause death.
“If [redacted] is not treated, he is at risk of developing permanent damage to his kidneys and renal failure due to progressive obstructive uropathy," his treating medical doctor wrote in 2017. The patient "is also at risk of increased urinary tract infections which can cause general sepsis, acute renal impairment and chronic kidney damage. The client is also at significant risk of his mental health further deteriorating.”
Martin had several patients with obstructing kidney stones on high doses of painkillers waiting for treatment.
The allegations Martin raises are at considerable odds with the Australian government’s recent representations that it has improved medical care for asylum seekers.
In 2014 an asylum seeker on Manus Island died from a foot infection. His death is subject to an ongoing coronial inquiry.
Paul Douglas, who was previously the Australian immigration department’s chief medical officer,
told a February 2017 inquest hearing that his report into the case found that “ambiguous and deficient” policies for emergency evacuations contributed to the events. “I think the fact that we’ve made some clear changes in process showed that they could be improved,” he said.
And in April 2017 , a cross party parliamentary inquiry recommended that Australia review medical transfer procedures “as a matter of urgency”.
BuzzFeed News asked the Australian immigration department whether such a review had occurred, and how processes had changed since 2014. It also put detailed questions about Martin's allegations medical delays to the department.
The department did not respond to specific questions, but a spokesman said in a statement: "Health care in regional processing countries is the responsibility of the governments of PNG and Nauru.
"All transferees in regional processing countries have access to clinically recommended care. Refugees settled in the community have access to local health care services.
"Where required health services cannot be provided to transferees and refugees on Manus or Nauru they will be temporarily transferred to Port Moresby, PNG, for the required services."
"Decisions about medical transfers are made on a case by case basis according to clinical need, in consultation with the contracted health services provider and the government of Nauru or PNG."
The single wish of many biding their time on Nauru is to be granted refugee status. The acceptance of their asylum claims is the gateway to the dream of resettlement in the United States, however slim that chance may be.
But refugee status can also have dire consequences on Nauru. Once an asylum seeker is found to be a refugee, Australia considers them to be Nauru’s responsibility and foists them onto Nauru’s social, housing and medical system.
There are now 1,052 refugees on Nauru, close to 10% of Nauru’s population. Even with the massive injection of Australian funding, the country’s support systems are struggling to cope.
Healthcare is the most pressing part of this struggle. The Nauruan hospital is run down, antiquated and poorly staffed.
“My staff found it incredibly difficult because we were effectively picking up the pieces that the hospital could not provide,” Martin said.
One of the worst cases Martin saw was a refugee who had been in a scooter accident. He was in extreme pain, and could barely walk.
At the hospital the man "had been sent away with a couple of Panadol and no imaging, no treatment, no proper investigations, nothing,” Martin said. When the refugee was scanned at Martin's clinic they discovered he had four unstable fractures in his back.
Martin quickly found the tiny island nation and its bureaucrats held a lot of power when it came to the health of his refugee patients. A powerful Nauruan panel called the “Overseas Medical Referral” (OMR) committee is now the gatekeeper for refugees getting the treatment they need abroad, in conjunction with the ABF officials who organise transfers.
Martin recommended that the refugee in the scooter accident be urgently transferred off the island and into a specialist neurosurgical unit via the referral process.
“We were told, ‘Nope, he is a refugee and he is under the care of the government of Nauru, therefore leave him there at the hospital’,” he said.
Martin told ABF officials the man would become a paraplegic if he wasn’t transferred to another country.
The patient "finally got to Sydney and spent four months in a cast after having had surgery and being unable to walk. He is walking but he is still deeply traumatised by what happened to him.”
In the past four years a number of refugees on Nauru fell pregnant. Some had children, but others chose to have abortions. However
abortions are illegal on Nauru . Previously, they could be flown to Australia for the procedure. Martin said they are now subject to the same restrictions that others are facing for medical conditions.
“In the past whether you were a refugee or an asylum seeker, because terminations are illegal in Nauru, patients would be taken to Australia to have their terminations,” he said.
“That was insane asking the doctors in Nauru, who were deeply religious and conservative, to basically break the law and approve a procedure that was not legal.”
Martin said the change in policy had denied women refugees the right to choose.
“They had got pregnant often in far from optimal circumstances and then were being told you had to have the baby,” he said.
“To do that with no discussion and, in fact, in the face of the strongest possible advice from the doctors here on Nauru and from Border Force officials … I found that unbelievable.”
In August 2017 Martin returned to Australia from Nauru. It would be his last rotation to the island. He had been vocal on the island in raising his concerns. He said his employer IHMS told him it could no longer guarantee his safety on the island and said he couldn’t return to Nauru.
“At some point I just couldn’t walk past it,” Martin said. “What I was seeing was wrong. Morally, ethically, wrong. Medically, absolutely wrong. I cannot look myself in the mirror and let this happen and not tell someone else about it.”
Soon afterwards Martin made the decision to speak with BuzzFeed News and the ABC about his experiences. He is an unlikely whistleblower. He has little interest in Australian politics. He accepts that offshore detention has bipartisan support.
“I agree you need to protect your borders,” he said. “I agree that you need to choose who comes into your country, I see nothing wrong with that, but using these couple of thousand people as human pawns is just unbelievable and it is just cruel. It is completely un-Australian.
“The things I saw in my military career were pretty horrific at times but there was always an option to try and do something about it, you didn’t feel completely helpless. But the level of helplessness I felt in trying to get the best medical care for these patients that I was unable to give them because of the setup that had been put in place by the Australians was very confronting and distressing.”
Australia’s decision to wind back part of its secrecy laws around the immigration detention system under the Australian Border Force Act may embolden more doctors to speak out.
BuzzFeed News also put questions to Australia’s immigration minister Peter Dutton. He declined to respond. His department's response said that healthcare is a matter for the government of Nauru.
Martin anticipated the government would say that refugees are Nauru's responsibility. He views it with great skepticism, given the enormous power Australia wields over the tiny island nation.
"The argument that they use saying, 'that’s a question for the government of Nauru', is completely specious," he said. "It’s just not right."
Martin may never return to Nauru again. Its government does not view whistleblowers favourably. But the experiences will always stay with him.
And he hopes that his decision to speak out will encourage others to do the same.
“At some point the story will come out," Martin said. "And I think this will be a shameful episode in Australia’s history.”
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