New research reveals how Australia’s offshore detention system placed health professionals in ethical conflict, discouraging patient advocacy and punishing those who spoke up, writes DrKim Elkovich.
AUSTRALIA REQUIRES doctors, nurses, psychologists and social workers to advocate for patients, protect human rights and speak up when care is unsafe.
Yet health professionals who worked in Australias offshore processing centre inNaurudescribed a system in which advocacy could cost them their jobs.
Newhealthcare systemsresearchexamining the healthcare ethics and ethical dilemmas ofAustralian health professionalsworking in Nauru’soffshoredetention system couldnot be timelier. Its findingscoincide with twosignificant developments: the United Nations’May 2026 recommendationson migration governanceand the AustralianSenate’sJuly 2026 Inquiry recommendationsinto offshoreprocessing.
Together, theypresent an opportunityfor open dialogue about whetherAustralia’s offshore detentionpolicies arecompatible with theethical practice expectedof its healthcareworkforce.
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Although the last refugee has left Australia’s much-criticised offshore detention centre on Nauru, the Federal Government has no plans to close the facility.
The UN recommendationsare particularly relevantbecausethey call ongovernments to protecthuman rights defendersand civil societyactors who assistmigrants affected bymigration externalisation; the practice ofshiftingresponsibility for asylumseekers beyond nationalborders.
At thesame time, refugeeadvocacy organisationshave criticised therecentSenate inquiry recommendationsfor failing to deliverthe accountability neededto address longstandinghuman rights concernsin Australia’s offshoredetention system.
Where health professionals come in
Health professionals occupya unique positionin this debate. Their professional responsibilityextends beyond providingtreatment. Australian health professional registration codesof ethics and conduct requirethem to advocatefor patients, protecthuman rights andspeak up whencare is compromised. Yettheir ability tomeet these obligationsdepends on thesystems in whichthey work.
Interviews with frontlineAustralian registered doctors, nurses, psychologists and social workersrevealwhat happens whenthose systems conflictwith their registration requirements.
Its a complex and comprehensive analysis, so by way of introduction, three primary interconnected findings will be highlighted here.
First, participantsdescribed a fundamentalconflict between thevalues underpinning Australianhealth professional practice and thoseof the healthcare delivery system operating within Nauru. Second, theyexperienced profound moraldistress when systemicbarriers prevented themfrom providing necessarycare. Third, theydescribed a psychologicallyunsafe workplace wherespeaking up forpatients could resultin some form of retribution, including being kickedoff the island.
Incomparable to Australia
In Nauru, the regulatory framework, central to achieving healthcare outcomes posited to be as near as possible comparable with Australian standards, was imbued with a double standard. Health contractors (employers) in Nauru were self-regulated; however, healthcare professionals remained bound to Australian health professional registration standards.
A system-level rule that contradicted their professional registration codes was the active discouragement of patient advocacy.
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One participant recalled
Health professionals needed to find a balance between fulfilling their duty of care and avoiding consequences such as being kicked off the island:
In Australia, workplace safety legislation protects employees who report safety issues from dismissal or discrimination. Yet in Nauru, several participants had contracts terminated for client advocacy and speaking up. These accountsalso sit uneasilyalongside the UN’srecommendation for governments to protect those defending therights of migrantsandasylum seekers.
Real-life repercussions
The powerlessness of being unable to effect change while watching ones clients health deteriorate resulted in significant moral distress for health professionals. Participants provided examples of deliberate indifference, where system-level roadblocks prevented necessary client care such as client transfers for urgent medical assistance, leading to further client deterioration.
One participant noted, with the increased deterioration of children with evasive refusal syndrome, And we knew from their parents that most of those children had already been referred to the OMR [Overseas Medical Referral Committee], and it wasnt working.
In this research, deliberate indifference extended beyond negligence or recklessness: health professionals examples suggested that authorities consciously chose to ignore the risk of serious harm and possible client death.
The infographic diagram depicts participant actions as they navigated ethical dilemmas attempting to find a balance between remaining in Nauru and losing their contract. Because if you were asked to leave, you could do less than if you were there.
(Image by Kim Elkovich)
What comes next?
Healthcare systems donot operate inisolation.They reflect politicalchoices and policypriorities. If governmentsexpect health professionalsto uphold Australianethical and professionalstandards, those professionalsmust besupported by systemsthat make ethicalpractice possible. Health professionals are ethically mandated to protect human rights and to do no harm.
The research highlighted a poor ethical climate, revealing a mismatch between the values underpinning Australian health professional practice and those underpinning the offshore detention system. As Australia continues to fund offshore detention amid ongoing scrutiny from the UN over the externalisation of migration governance, alongside multiple inquiries into offshore processing documenting human rights violations, Australian leaders, policy makers, regulators and the public face an important ethical question. What standards should govern Australias offshore detention arrangements?
If Australia expectshealth professionals touphold the ethicalstandards of ahealthcare system establishedfor Australia yetoperatingin another sovereignstate, reform mustextend beyond supportingindividual clinicians.It must alsoaddress the structuraland policy conditionsthat shapethe system inwhich they arerequired to practise.
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