Public and private mechanisms of accountability for health care justice: Australia’s asylum seeker and refugee offshore health care program

Paula O’Brien1

1 Melbourne Law School, The University of Melbourne, 185 Pelham Street, Carlton, VIC, 3053,

The Australian Government retains foreign governments and private corporations to provide health care to asylum seekers in off-shore detention on Nauru and Manus Island. It also contracts to provide health care services to persons found to be refugees whom the Government refuses to settle in Australia and instead settles on Nauru and in Papua New Guinea. It is emerging that the health care needs of these vulnerable groups are being poorly served by the arrangements put in place by the Australian Government.

This paper analyses three accountability mechanisms which have been recently, or are presently being, used to scrutinize the Australian Government’s conduct in relation to the health care of asylum seekers and refugees: private litigation for harms suffered by individuals or groups of asylum seekers; freedom of information requests, in particular by the media; and an audit by the Australian National Audit Office into health care delivery in immigration detention.

In examining these three mechanisms, the paper asks the following questions: What do these different public and private accountability mechanisms offer in terms of health care justice for asylum seekers and refugees? What are the comparative strengths and weaknesses of these mechanisms? What other mechanisms might be usefully used to ensure that the Australian Government is meeting the health needs of asylum seekers and refugees in off-shore places in a fair manner? And in addressing these questions, the paper seeks to answer the urgent underlying question: what does health care justice look like for asylum seekers in off-shore detention and, very significantly, for those persons who have been found to be refugees but have sent to live permanently on Nauru and PNG, both being places with less than adequate health care systems by Australian standards?


Paula O’Brien is a Senior Lecturer at Melbourne Law School. She has a BA/ LLB from The University of Melbourne and an LLM from the University of Cambridge, specialising in international law. Paula’s research is focused on access to health care for marginalised groups, the legal regulation of dangerous commodities (in particular alcohol), and public interest lawyering.

About the Association

The Australasian Association of Bioethics and Health Law (AABHL) was formed in 2009.

It encourages open discussion and debate on a range of bioethical issues, providing a place where people can ask difficult questions about ideas and practices associated with health and illness, biomedical research and human values.

The AABHL seeks to foster a distinctive Australasian voice in bioethics, and provide opportunities for international engagement through its membership, journal and conferences.

Members come from all the contributing humanities, social science and science disciplines that make up contemporary bioethics.

Many members have cross-disciplinary interests and all seek to broaden the dialogues in which all members of the wider community ultimately have an interest.

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