Two days after Shaghayegh was released from Sydney’s Villawood detention centre, she began taking antidepressants.
It was something the 33-year-old Iranian had resisted during the four-and-a-half years she spent in offshore immigration detention on Christmas Island and Nauru, she says.
“I was so depressed, I cry a lot. When I came out [of Villawood] I feel I need something,” she told SBS News.
At the end of June 2017 she was transferred from Nauru to Sydney for a medical procedure not available on Nauru, and still lives in the city.
Shaghayegh was granted a temporary visa after being transferred to Australia for medical treatment. Source: SBS News
Shaghayegh described the medical treatment she received at a Sydney clinic as good, although says she felt as though she was treated like a criminal while being held at Villawood.
Medevac debate
This week, the Senate is expected to debate the government’s bid to repeal controversial medevac laws passed in February.
Described as “life-saving” by advocates but a threat to Australia’s borders by the government, the new laws give doctors more power to decide who is transferred from offshore detention to Australia for medical treatment.
The Morrison government has been ramping up its case against the laws in a bid to secure the deciding vote of Tasmanian Senator Jacqui Lambie, arguing the legislation has undermined national security.
Home Affairs Minister Peter Dutton has also accused refugees and asylum seekers of taking advantage of the new process to get to Australia, suggesting some are being "coached" to self-harm to make a case for transfer.
But for those that have already been medically transferred - most for mental health issues - it is far from a magic cure.
Shaghayegh is one of hundreds of refugees who have remained in Australia after being transferred for medical treatment.
Home Affairs Minister Peter Dutton flags isolated mining towns as locations for quarantine facilities. Source: AAP
While it may be an improvement from conditions in offshore immigration facilities, they must now live with uncertainty, few rights, and the threat of being returned to Nauru or Papua New Guinea. Manus Island’s asylum seeker facilities were closed last month.
More than two years since Shaghayegh came to Australia, she says she finds being in Sydney harder than being in offshore detention.
“They give me this freedom but it’s not real freedom because they show me everything but I’m not allowed to use it.
“Most of time I stay in bed, I didn’t do anything but I feel tired most of time.”
Academic and journalist Saba Vasefi has spoken to many women who have been transferred to Australia for medical treatment.
Even after they arrive in Australia, restrictions on what they can do mean “they struggle with a sense of stagnation and deadness”, she said.
“They are often unable to overcome the [lack of] self-worth that the detention regime instils. Poor rehabilitative services and deprivation from civil engagement are two major components which continue refugees' disempowerment.”
The government remains committed to enforcing its strict policy of not allowing anyone who arrived by boat after July 2013 to come to Australia, meaning there is little prospect of being able to stay permanently.
Shaghayegh says returning to the country she fled in 2013 is not an option. But asked if she wants to stay in Australia or try to be resettled in the United States, Shaghayegh says she prefers not to think about the future.
Shaghayegh prefers not to think about the future. Source: SBS News
“Because all the time I think about something, a little hope, they [the Australian government] break that. I'd rather just keep going, don’t think about future.”
Only a handful forced to return
One of the government’s chief complaints about the medevac legislation is that it lacks a mechanism to return patients and their relatives once they have recovered in Australia - something supporters of the bill dispute.
According to the Department of Home Affairs, only 282 out of more than 1,343 arrivals from Nauru and PNG between November 2012 and 31 July this year under the existing system have been sent back - the bulk of returns occurring before 2015.
Since the start of 2016, less than eight have been returned, leading to more living in Australia than remaining in offshore detention.
As of August, there were 320 matters before the courts involving 1,000 individuals in Australia for medical and associated purposes.
Home Affairs Secretary Michael Pezzullo explained to a Senate committee examining the medevac laws that about 500 of those cases were now considered to have an “effective barrier to their return”.
“It's anticipated that any attempts to return the remainder would result in the initiation of legal proceedings," he said.
Department of Home Affairs Secretary Mike Pezzullo said lawyers were the reason only a handful of refugees had been sent back to Nauru or PNG. Source: AAP
“What has commenced as medical transfer actions under various sections of the act has, over time, been transformed into legal blocking actions to keep these persons in Australia, irrespective of their medical status.”
More than 130 sick refugees and asylum seekers and accompanying relatives, deemed “transitory persons” by the government, have also been transferred this year under the new medevac process, with fewer than one in ten requiring hospital admission.
Advocates say the provisions in the existing medical transfer process still apply to the medevac laws, even if they are rarely used.
Shaghayegh is one of the lucky ones having now secured a six-month bridging visa enabling her to work. She says does not know how or why she was given one.
She has recently begun work as an administrative assistant.
Most of those transferred remain in community detention and are subject to curfews, restrictions on their movement and weekly reporting requirements.
'We thought we were out of jail'
Jalila* was reunited with her mother, brother and sister in Sydney last year after spending five years on Nauru.
The Hazara woman fled Afghanistan along with her family who had been shot at by the Taliban.
They were all taken to Nauru but two family members were transferred to Australia for medical treatment not long after.
Jalila was able to join them due to needing treatment for her persistent ear infections and mental health issues but says life isn't easy.
“We thought we are out of jail, we are out of limbo. But again here we are in a box, we can’t do anything.”
She lives with her family in community detention in a Sydney house and receives regular treatment for both her conditions.
She spends her days caring for her mother, who recently had an operation, and trying to study English, but says she wishes she could do more.
“We were really happy when we came here. But after a while we find we can’t do anything, we have to stay at home, we feel like sometimes, this sadness.”
She and her siblings also fear being sent back to Nauru.
“Two days ago, my sister called my caseworker and she say ‘you might get sent back to Nauru', then again we get depressed.”
Social connection crucial
Nicholas Procter, professor of mental health nursing at the University of South Australia, has been working with asylum seekers for 25 years and advises governments on health and suicide prevention programs for refugees.
Despite the uncertainty faced by those transferred to Australia, he says there are significant benefits.
“It’s been extremely beneficial for them in a range of areas. Certainly, to be able to receive contemporary, independent, well-resourced medical and mental health support in particular.
“Also, they’re in an environment which makes life much easier for them to be able to engage treatment, receive treatment and be able to flourish in a more positive way, certainly in terms of their mental health and wellbeing.”
The Home Affairs Department maintains transfer to Australia for medical purposes is intended to be temporary, but Professor Procter said long-term treatment was often required for the complex mental health problems suffered by asylum seekers and refugees who have spent lengthy periods in offshore immigration.
“It takes time for people, particularly who have been in some cases excruciating distress and despair, to be able to talk about that, to be able to bring about a calmer sense of self in all of that experience, that’s one of the real-world issues this at times fragile and vulnerable group are in need of.”
He suggested removing the threat of being returned to Nauru or PNG would help patients’ recovery.
“Many people are dealing with such tremendous amounts of uncertainty that is linked to excruciating states of distress.
“If you want to rock someone’s mental health, give them a dose of uncertainty and that will do it.”
The Home Affairs minister and the department declined to comment when contacted by SBS News, but have previously defended conditions for asylum seekers in community detention and temporary visas.
*Name has been changed
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