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Paediatric Refugee Health Conference 2014

Red Cross work with people seeking Asylum and others impacted by migration with a focus on children and young people

Address by Robert Tickner to the Paediatric Refugee Health Conference, 16 May 2014

Good morning everyone, and thank you for inviting me to speak here today. My name is Robert Tickner and I am CEO of Australian Red Cross. Before I begin I would like to acknowledge the traditional owners of the land that we are meeting on today and pay my respects to their elders past and present.

Red Cross Movement
Australian Red Cross is part of the International Red Cross and Red Crescent Movement; the world's largest volunteer and humanitarian network. The Movement provides protection and assistance to vulnerable people including those affected by disasters, conflicts and migration.

With a mission to prevent and alleviate human suffering through the power of humanity, all parts of our movement focus on reaching vulnerable people through effective humanitarian action. The Movement also seeks to influence decision makers and opinion leaders, through Humanitarian Diplomacy, to act at all times in the interests of vulnerable people.

As an auxiliary to the public authorities in the humanitarian field this is an internationally recognised role for Red Cross and Red Crescent Societies.

We do this through the efforts of volunteers and staff all working in accordance with our fundamental principles (Humanity, Independence, Unity, Impartiality, Volunteer Service, Universality, Neutrality).

In Australia, addressing the Impact of Migration is one of the seven strategic priorities for the work of Red Cross, and we have a long standing commitment to this work, with this year being our centenary year of operations.

As many will know, our migration programs include significant Government-funded programs to support asylum seekers in the community, along with a range of other services that Red Cross directly supports. I will talk a little more about that later.

As a country, Australia has had a long commitment to the 1951 Refugee Convention and 1967 Protocol, and to a generous humanitarian and resettlement program. There is much for us to be proud of in our achievements.

However, asylum seekers arriving by boat has become an increasingly polarised issue over many years. At dispute is a clash of views about how government should respond to population movements, and most particularly to people seeking asylum.

Successive governments in Australia have responded through a range of measures that have ranged from mandatory immigration detention to offshore processing and temporary protection visas.

But there have also been other policy responses that have seen vulnerable asylum seekers transferred into community care arrangements, where Red Cross and other agencies have and continue to provide support to thousands of people awaiting an outcome of their claims for protection. While this option has clear humanitarian benefits for vulnerable people, it too is not without its consequences for the health and wellbeing of people awaiting decisions that will impact their futures. Prolonged uncertainty has serious consequences particularly for mental health and as our Inaugural Vulnerability Report demonstrated in 2013, many survive in the community without access to adequate support.

Red Cross Advocacy Positions
So what is the Red Cross position?

Our work is guided by the Australian Red Cross Policy on Advocacy: Persuasion through Humanitarian Diplomacy, a Board approved Policy on Migration and an internationally adopted policy on Migration.

These Policy Statements provide clear positions from which we base our work in this area. Our focus is not on government policy per se, but on the humanitarian impact of policy. We seek to use our own approach to advocacy, Humanitarian Diplomacy, to consistently raise humanitarian concerns, often in confidence with government. And we seek to provide assistance to people regardless of their legal status or mode of arrival. Our concern is with how people are treated while their protection applications are assessed.

Red Cross believes that people who are made vulnerable through the process of migration whose survival, dignity, physical or mental health are under threat, should receive the humanitarian support they need while their immigration status is being resolved. Assistance should be based on need regardless of mode of arrival or their stage in the visa determination process.

You may not often hear direct statements from Red Cross but do not mistake this for inaction in this area.

Mobile App
As a small aside, in 2012 a team from Australian Red Cross developed a mobile phone application that aims to educate the public regarding the refugee journey.

The app launched on the 29th November 2012 aimed to promote diversity, combat intolerance and discrimination, and highlight the journeys that people from refugee backgrounds must take to find safety for themselves and their families.

The app is a "choose your own adventure" experience, a game without winners. It is designed to give the user an immersive insight into the experiences of people fleeing war, violence and terror. The app "And then I was a refugeeā€¦" is free and supports both Apple and Android tablets and phones and is available for download at iTunes and Google Play.

To download the app or read more on this exciting innovation you can visit our website.

Red Cross Programs
Back to our Migration Support programs, our work in this area includes seven complex programs that are conducted nationally. The overall objective is to provide effective and responsive services to people who are vulnerable as a result of migration.

Three of these Programs are funded by Red Cross. The first is the Restoring Family Links program (more commonly known as the International Tracing Service), the second is the Immigration Detention Monitoring Program and the third is our Emergency Relief Program.

The remaining four programs are funded by the Australian Government and include the Support for Trafficked Persons Program, the Community Detention Program, Community Assistance Support Program, and the Asylum Seeker Assistance Scheme. The latter we have been operating for over 20 years.

Immigration Detention Programs
Red Cross undertakes monitoring of detention facilities across Australia through both staff and volunteer Humanitarian Observers.

Red Cross raises concerns directly with the authorities at each facility and escalates issues that remain unresolved on a quarterly basis. This is an example of our role as auxiliary to the public authorities in the humanitarian field.

While governments may determine that immigration detention is necessary for initial health and security checks, Red Cross believes it should only be used as a last resort and always for the shortest practicable time.

All people detained in immigration detention facilities are entitled to the maintenance of good health and wellbeing and to be treated with dignity and respect. It is imperative that all efforts be made to avoid and mitigate the negative impacts of detention.

People held in immigration detention are particularly vulnerable due to the trauma many have experienced in their home country and on their migration trail.

The evidence that long periods in immigration detention has profound and debilitating effects, which extend to one's health and well-being is well established in Australia and internationally. Detention is known to exacerbate the effects of other traumas experienced prior to arrival in Australia. This increases the level of self-harm in detention centres and prolongs psychological vulnerability after release, sometimes for life and especially for children and young people.

Australian Red Cross has Standards for monitoring Immigration Detention, based on the experience of the Red Cross movement, on international law and on the community standards we expect in Australia.

Some generally accepted standards include that:

  • Authorities are responsible for the provision of appropriate services and support to ensure the health and wellbeing of people in detention in line with Australian community standards
  • Children including unaccompanied minors, should not be detained in immigration detention facilities. Where detention has been deemed necessary in order, for example, to preserve the family unit, that detention environment should be community based
  • Facilities should be based, wherever practicable, in metropolitan centres with access to health and welfare services, a wide range of meaningful activities and excursions, appropriate community, cultural, religious and linguistic supports and access to a range of oversight and support agencies
  • Health care in detention should be based on community standards, but also needs to take into account the complex vulnerabilities of people in detention, and the ways in which detention can exacerbate physical and mental health vulnerabilities.

Red Cross for its part seeks to reinforce these standards in our detention monitoring work.

Restoring Family Links
Every year, countless families across the world are separated by conflict and disaster.

The Restoring Family Links Service in Australia is part of the International Red Cross Red Crescent global tracing network, which aims to re-establish contact between separated family members and clarify the fate of the missing.

Services are provided in the community and in detention facilities across the country. We have undertaken tracing work since 1915 and have helped reconnect thousands of families in this time.

Reconnection of families is critical to the health and wellbeing of people impacted by migration.

Support for Trafficked Persons
Through the Support to Trafficked persons program Red Cross has been able to support over 118 clients since March 2009 and has contributed to the development of policy and knowledge in this important area.

Red Cross has also developed and delivered a training package for community service providers to better understand the complex needs of trafficked people, and how to best support them, as well as building knowledge and links to raise awareness on labour exploitation.
The program's aim to develop community service provider knowledge of the issue of people trafficking in Australia.

The Training project has exceeded all targets and delivered a total of 64 workshops, consisting of 1063 participants from over 200 different organisations nationally.
Australian Red Cross has also developed Multilingual Program information and brochures to help migrant workers understand some of their rights while working in Australia, and to minimise the risk of unfair treatment in the form of poor working conditions, low wages or more serious forms of exploitation. These can now be downloaded from the Red Cross website.

DIBP Programs
Four of our programs focus specifically on people who require support in the community while their claims for protection are being assessed.

The Asylum Seeker Assistance Scheme (ASAS) provides vital support to eligible Asylum Seekers in the community experiencing financial hardship while awaiting an outcome on any protection visa application.

The Community Assistance Transitional (CAS TS) Support program provides integral orientation based support to clients during their first six weeks living in the community, upon release from immigration detention facilities.

The Community Assistance Support (CAS) ongoing program provides support to people with high needs in the community awaiting an outcome on their visa application. The program provides complex case work support, access to living allowance and rent assistance, and access to financial assistance for healthcare.

And the Community Detention (CD) program enables vulnerable people to live in the community, rather than in a detention facility, while waiting for the outcome of a protection visa application through the provision of living allowance, accommodation and casework support. Red Cross works with 20 partner agencies to support many families, vulnerable adults and unaccompanied minors to live in the community.

Data released by the Department of Immigration shows that there were 1,423 adults and and 1,490 children living in community detention arrangements at April 30 2014. There are a further 24,273 people, including 1,827 children, living in the community on Bridging Visas.

Red Cross in collaboration with our partner agencies are supporting in excess of 12,000 of these people. Thousands more have been assisted over recent and past years.

While a community-based model can avoid the worst effects of being held in immigration detention, as has been observed, care in the community is not void of potential serious health implications for young people.

Supporting the move of families, children and other vulnerable people out of immigration detention and into community care arrangements has been a significant achievement over recent years but much more needs to be done to address gaps that exist.

Emergency Relief
Red Cross attempts to address some of these gaps through our Emergency relief program, which focusses specifically on the provision of emergency relief and material aid to people seeking asylum experiencing serious hardship but not eligible for government funded assistance. This work has included support in the form of cash assistance, food security, housing security and household goods, health care, travel assistance and bicycles, youth holiday programs, and orientation support. Tens of thousands of highly vulnerable men, women and children have been assisted by these additional initiatives.

The number of volunteers and volunteer hours associated with all the support services are incalculable! Red Cross currently has over 600 volunteers registered and actively working within our Migration Support Programs. This is core to the work of Red Cross and one of our Fundamental Principles.

Specific Health Issues
Given the focus of this conference, I will now shift to make additional comments and observations on the health and wellbeing of people impacted by migration, most particularly children and to talk about some of the initiatives of Red Cross and partner agencies that seek to build on the strengths and resilience of those we work with.

Through service delivery across the country, Red Cross is able to observe trends and ongoing challenges that impact people's health and wellbeing.

We have worked closely with detention health providers to address issues with the exchange of health information, most particularly between a community and detention environment.
This is a challenge for all services working in this area, most particularly for those providing support to people being moved between detention and community care arrangements. While much has been done to address some of the earlier issues experienced, there remain some challenges that we need to continue to address that relate to privacy and release of information obstacles designed to protect clients but that may sometimes inadvertently work counter to their best interests.

But the issue I would like to focus most on today is the mental health of children and young people seeking asylum.

People seeking asylum often exist in a painful, protracted state of uncertainty. Long delays in processing and limited opportunities for meaningful participation in the Australian community both create and exacerbate mental distress.

Lack of purpose or focussed activity during the day does nothing to help the sleep of people seeking asylum. Nights for many are plagued by worry about the family, the future and experiences since arrival.

Worry over visa applications, stress and sadness worsens as the wait extends for a visa determination. Poor mental health rapidly spirals downwards in this scenario, and in some instances, acute distress can result in suicidal ideation.

Red Cross and many others in the community bear witness to the impacts of these types of stresses on people's mental health and on families.

The effects and subsequent behaviours of parents whose mental health is impacted are very often witnessed by children. This means that children can display feelings of hopelessness and lack of impulse control themselves.

Mental health issues for children and young people seeking asylum are, unsurprisingly, common place. Children are susceptible to the same stressors as adults and suffer from similar impacts to their mental health, which can be exacerbated by their environment (in detention), their living conditions (inadequate income) or the uncertainty of future (delayed processing). All of this is added to the effects of trauma often experienced prior to or even en route to Australia.

Children seeking asylum often present with signs of stress, depression, anxiety and frustration. Similar to their adult counterparts, the resultant self-harm among children in the community is of serious concern to Red Cross.

A wide range of services are available to people in the community such as a GP, a GP directed mental health plan, specialist referrals and Torture and Trauma counselling, which are in line with community standards.

While it is important that these supports are available, they can often only take a reactive approach to the various needs of children experiencing the impacts of their environment and plight.

Furthermore, studies have expressed concern, that, in spite of the mental health services made available to young asylum seekers, rates of contact with mental health services are substantially lower than expected. Studies report barriers such as, resettlement stresses on parents' ability to care for their children, low priority placed on mental health, poor mental health and service knowledge, distrust of services, stigma associated with psychosocial problems and various social and cultural factors. These barriers often result in low rates of utilisation of mental health services by young people seeking asylum, as well as high rates of early disengagement from mental health plans.

Red Cross Initiatives
So, in the face of these challenges, what is Red Cross doing to address these impacts?

In collaboration with our 20 partner agencies, Red Cross is driving and supporting several initiatives that support unaccompanied minors and young people to be more engaged in the community and society. This can be seen to improve mental and physical health outcomes through meaningful engagement and social connectedness. I would like to share some of these with you now.

Red Cross has developed guidelines to facilitate the smooth placement of clients presenting with complex needs, including clients living with physical disabilities that require additional support and case planning.

The guidelines provide a framework to support Red Cross staff to work closely with the Department of Immigration, IHMS, partner agencies and other relevant service providers, to ensure clients with disabilities or other complex needs are placed quickly and appropriately into the community. These guidelines were produced based on what has been learned from such placements and in line with feedback from the Department of Immigration in relation to their own processes.

In order to support the number of complex cases supported through CD, ASAS and CAS, Red Cross has also developed a Complex Case Framework. The complex case framework aims to provide greater guidance and structure to caseworkers and case coordinators who are managing complex cases, with the intention of providing improved support to care providers and clients. The complex case framework introduces an overarching guiding structure to support complex case management by formalising existing good practice around early identification and intervention, communication, monitoring and reporting, and follow up and review. The complex case framework outlines Red Cross expectations and minimum standards, for the management of clients and care supports when a complex case has been identified.

Red Cross in collaboration with our partners is working to highlight the benefits of social engagement for our clients' overall wellbeing, as well as helping to make volunteering and meaningful engagement opportunities more accessible.

Both the Victorian and NSW Red Cross offices have been collaborating with AFL to engage young people seeking asylum in a football training program. In Victoria, the program is commencing to take client referrals and training across three locations. The program is being delivered in collaboration with local police and Centre for Multicultural Youth. NSW is modelling their AFL program on Victoria's approach and is aiming to engage 12-18 year olds. Previous experience has shown the significant mental health and social benefits of team sport for young people. The opportunity for clients to engage with the police will also help break down existing barriers and stigmatisation associated with authority figures that clients bring with them from home or countries they have transited through.

Another sporting initiative developed followed detailed planning discussions with the Australian Sports Commission. The partnership in WA offered clients the opportunity to participate in a 2 day junior sports coaching program. To date, 19 clients have participated in this program. Clients have developed leadership skills such as managing conflict during a match and learning to provide guidance to young players regarding match rules.

Our QLD team has been able to promote a focus on youth leadership through the development and facilitation of the program "Young United Group". The program supports unaccompanied minors to develop skills in leadership, confidence, independent living as well as skills in contributing constructively to the planning and evaluation of activities for all UAMs in QLD. A meeting held late in 2013 attracted 15 young men. The group is facilitated by case workers from Red Cross, Partner agencies and Red Cross bilingual volunteers. This promotes the development of a sense of purpose and belonging and encourages young people to be leaders and ambassadors in their ethnic communities but also amongst people seeking asylum.

One of our NSW Partners, reported on the success of their Cultural Mentor Team. They noted that at the end of last year, they employed another two Senior Youth Worker-Cultural Mentors to enhance the effectiveness of the team. Two staff are of Middle Eastern background and one is of Sudanese background. The aim of the inclusion of this team in their care model is to ensure that clients receive the best possible support that is culturally appropriate.

A successful female focussed initiative provides for women only swimming classes. The swimming lessons were organised in partnership with client service providers, Royal Life Saving and Women's Health and Family Services. The classes were developed to address the gap of culturally appropriate environments for women and girls in their care, with learning how to swim being identified by most as an area of interest. The classes were held late last year and were reported as a great success due to promoting healthy lifestyles amongst clients.

Meaningful Engagement
Red Cross believes that it is fundamental for the health and well-being of all people made vulnerable by migration to be able to participate in the community in meaningful ways. This means that people seeking asylum should not be denied the opportunity to contribute to the economic, social and civic development of Australian society. It has been shown that resettled refugee communities in Australia contribute greatly to these spheres. It has been highlighted that this has supported the effective adjustment and development of their own ethnic communities, as well as the Australian community more broadly.

Unfortunately too many people are currently unable to engage in or contribute to the community in a meaningful way and we must do more to address this.

As I have outlined today, Red Cross aims to effect change in order to prevent and reduce the vulnerability of migrants, protect them against abuses, exploitation and denial of rights, through service delivery, innovative initiatives and Humanitarian Diplomacy.

We will continue to advocate for approaches that support the health and wellbeing of people impacted by migration, including the care of asylum seekers in the community, opportunities for meaningful engagement (including education for children), the timely resolution of immigration status and durable solutions for people needing protection.

We will also continue to recognise the inherent strengths and resilience of people we work with, to further strengthen the capacity of people impacted by migration to seek opportunities and sustainable solutions for themselves and their families.

Above all we seek to see the plight of asylum seekers and others impacted by migration as a humanitarian issue, one that can and must be addressed regardless of people's visa status or mode of arrival.

Thank you.