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Submission to the National Inquiry into Children in Immigration Detention from
The Dietitians Association of Australia (DAA)
Food and Nutrition Issues Associated with Mandatory Detention of Children
Executive Summary
Refugees are a group at high nutrition risk. There is a strong duty of adequate nutritional care for institutionalised persons. The Dietitians Association of Australia (DAA) is the largest member organisation for nutrition professionals in Australia. It is notable that DAA has been unable to identify significant input by nutrition professionals into the planning or provision of care for asylum seekers in Australia.
Sources available to DAA raise questions in respect to the standards of nutritional care and management of children in detention. It is of real concern that the authorities may not even be aware of the extent of the nutritional disadvantage of these people due to the lack of adequate assessment and monitoring. If, as is feared, current conditions do not meet international standards, government policy should be reviewed to enable asylum seekers to better access government and non-government support in the community.
Introduction
DAA is a national body representing over 2000 dietitians throughout Australia. Dietitians are the experts in food and nutrition and provide practical advice based on scientific evidence. DAA strives to advocate for better food, better health, better living for all. It is from this perspective that the Association strongly supports the inquiry by the Australian Human Rights and Equal Opportunity Commission into the conditions of children in immigration detention.
The Australian Commonwealth Government has agreed to international standards sanctioned by the United Nations Committee on Economic, Social and Cultural Rights on the right to health under Article 12, ICESCR. Six core obligations under this convention include:
- Access to health facilities
- Nutritionally adequate and safe food
- Basic shelter, sanitation and safe drinking water
- Essential drugs
- Equitable distribution of all health facilities
- A public health strategy and plan of action
This submission outlines some of the key considerations in the determination of whether Australian Detention Centres are reaching our obligations of supporting children through meeting their food and nutritional needs at a critical time in their physical and mental development.
The lack of access to first hand information is a key, and rather telling issue for health professionals concerned about the welfare of asylum seekers in the care of the Australian Government. The only information available to dietitians and other health professionals to date has been through personal communications with visiting professionals or reports from ex staff or ex detainees. To the best of our knowledge no dietitian has been involved in the planning or provision of food services or nutritional assessment and management of detainees nor has any been allowed access to detention centres.
The UN Convention on the Rights of the Child has highlighted the following;
Article 24 : States Parties shall pursue full implementation of (the right of the child to the highest attainable standard of health) and, in particular, shall take measures … to combat disease and malnutrition… through the provision of adequate nutritious foods.
Initial and Ongoing Food and Nutrition Support for Children
Reported communications with an ex detention centre staff and visiting health professionals have indicated that initial assessment of children in detention did not include assessment by a child health or nutrition specialist. There were no specific procedures in place to assess initial nutritional status, nor records of ongoing growth monitoring including height and weights.
Asylum seekers coming to Australia come from countries in the Middle East, Africa, former Yugoslavia and may have experienced nutritional deficiencies in their countries of origin or during travelling. These countries have been identified by the WHO as low-income food deficit countries (LIFDC). In the abovementioned countries indices of food insufficiency, principally undernutrition among children under five years, are high. Therefore children arriving in Australia as refugees or asylum seekers may be malnourished before even setting foot on Australian soil. Furthermore, refugees may come to Australia after time spent either in refugee camps or living with relatives, friends or strangers in non-camp settings, where food access is problematic. The nutritional status of refugees in both camp settings and in non-camp settings has been characterised as poor. An appropriate initial health assessment would identify any problems associated with food intake and behaviour, growth and nutritional status and provide guidelines for ongoing support and management. This is especially critical for children under five who are more nutritionally vulnerable than adults.
There is general international consensus that the best way to measure a child’s health and nutritional status is by assessing the individual child’s growth against standard weight-for-height, height-for-age and weight-for-age charts such as those produced by the World Health Organisation, taking into account cultural and geographic differences in child development. In order to evaluate a child’s nutritional needs, there should be an initial assessment of the child’s height and weight upon arrival and ongoing monitoring of growth using a growth chart. Micronutrient deficiencies, for example, iron deficiency should be identified early so appropriate intervention and careful ongoing monitoring can occur.
Further indicators of high standards for nutritional assessment and management would include:
- The use of WHO endorsed growth charts (ie. National Centre for Health Statistics NCHS) for the initial assessment and ongoing monitoring of every child under 12 years in detention.
- The existence of policies and protocols to ensure ongoing follow-up and intervention for children assessed as being at risk of weight loss; poor growth or excessive weight gain. Referral protocols for child health nurses, paediatricians or dietitians as appropriate.
- Strategies to ensure interventions or recommendations are communicated and understood by parents through interpreters if necessary.
- Protocols established for biochemical, haematological and immunological testing and deworming if children are considered at risk of nutritional deficiencies.
- Established communication channels with food service staff for provision of special dietary requirements for children with identified nutrition issues.
Nutritional Requirements for Children
Various personal communications with individuals who have visited detention centres and families released from detention have indicated generally that:
- Food in detention centres is provided at three mealtimes during the day with limited access between times.
- That no food is allowed to leave the canteen.
- If children are sick or asleep in their rooms food cannot be taken back to them, they have to come to the canteen if they want to eat at that meal.
- The only food provided outside mealtimes is available in a kiosk that sells foods like chocolate, crisps, soft drinks and lollies. Prices are higher than in similar outlets outside detention centres.
- No nourishing snacks or drinks are available free of charge between meals for children.
- Most of the children intensely disliked the food in the detention centre.
- The environment (eating in public) in which food is taken is completely alien to refugees and it does not support good behaviour and the development of family relationships.
Children have particular nutritional requirements that are not easily catered for in a food service operation designed for adults. This is especially important for those children who are assessed to be underweight or deficient in micronutrients as mentioned above.
A child’s energy and nutrient needs are high but their capacity is small or as is the case in detention, their appetite can be erratic or compromised. For example, the energy requirements for a one year old child are 435kJ/kg and for an adult 130kJ/kg. Therefore they require a more frequent food and fluid intake than adults. There is no evidence from the report of observers that children in detention were eating the quantity and quality of food required to meet their nutritional needs.
If only three meals a day are served in detention centres this is likely to be insufficient for children; especially infants and toddlers. It is recommended that children under five years eat a smaller quantity of food distributed throughout five meals or nutritious snacks a day.
Some of the practical issues of feeding children should be taken into consideration. The practical issues include children’s small capacity, fussy eating, erratic interest in food, the need for supervision by an adult to ensure intake and the knowledge that eating best is a family experience.
There are also indications that some children became overweight in detention centres from eating excessive quantities of high calorie purchased snacks or sweets provided by visitors. The consumption of food other than that provided may indicate that the food provided was not timely, insufficient in quantity or culturally inappropriate for the needs of children.
It is reported that nutrient dense snacking foods like milk and fruit, have not been available in detention centres throughout the day and when requested only given in limited quantity. Children have instead been reported to be eating nutrient poor or ‘empty-kilojoules’ snacks such as chips and sweets.
Children in detention are likely to be nutritionally compromised on arrival. If the food they receive in detention is inadequate or inappropriate their nutritional status will be further worsened. They will lose weight, fail to meet growth targets for their age and develop micronutrient deficiencies such as anaemia or scurvy.
Further indicators of high standards in the provision of nutritionally adequate food for children would include:
- The involvement of dietitians in providing resources for menu planning for detention centres.
- Attention to the provision of a variety of foods from the core food groups on a daily basis; in sufficient quantity and quality to ensure nutritional adequacy for all detainees.
- The provision of culturally acceptable, nutritious choices for children; including weaning foods.
- The provision of crockery and cutlery suitable for small children.
- Attention to the provision of additional nutritional requirements of pregnant and breastfeeding women.
The Nutritional Needs of Pregnant Women and Breastfeeding Mothers
A range of sources including staff, visitors and ex detainees have provided information that supports the following statements:
- Breastfeeding is not actively encouraged in detention. For example a breastfeeding mother only had access to one set of clothing, which was not maternity clothing i.e. not suitable for breastfeeding. Food safety issues for the infant occurred because of dirty clothing of mother. Large barriers existed for this mother to overcome in terms of trying to breastfeed her infant.
- There are no weaning foods.
- There is little access to advice regarding feeding, e.g. a mother who could not continue breastfeeding was then given formula for her infant. She could not read the instructions on the formula package and received little assistance in helping to feed her infant.
Australia is obliged under Article 24(2)(d) of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to ‘ensure appropriate pre-natal and post-natal care for mothers’.
This includes ensuring that the special nutritional needs of pregnant women and new mothers are met. Poor maternal nutrition is associated with various disorders in babies and with low birth weight. Mothers also have increased nutritional needs whilst breastfeeding and may need education and encouragement to breastfeed their babies. The WHO recommends exclusive breastfeeding for six months, with introduction of complementary foods and continued breastfeeding thereafter as an important aspect of a baby’s diet.
Further indicators of high standards in nutritional care and management for pregnant and breastfeeding mothers would include:
- Nutritional assessment and weight monitoring of pregnant women.
- Ensure access for pregnant and breastfeeding new mothers to child health nurses or breastfeeding consultants for support with breastfeeding and other feeding issues for young infants. The existence of policies and protocols to ensure ongoing follow-up and intervention for women assessed as being at risk of nutritional deficiency e.g. Vitamin D deficiency or iron deficiency. Referral protocols for medical staff or dietitians as appropriate.
- Protocols for the release of medical information and referral to relevant health professionals in the community for families that leave detention centres.
Social, Cultural and Psychological Needs
Article 30, of the Convention on the Rights of the Child states the following:
In those States in which ethnic, religious or linguistic minorities or persons of indigenous origin exist, a child belonging to such a minority … shall not be denied the right, in community with other members of his or her group, to enjoy his or her own culture [or] to profess and practice his or her own religion.
Reports of personal communications with ex detention centre staff, ex detainees or visiting professionals have revealed the following issues:
- Cultural foods are not routinely provided in detention.
- The Halal food available is often frozen and lacks variety.
- People do not enjoy the food provided.
- Some of the women helped in cleaning and chopping but not cooking the meal itself.
- Many of the children were aggressive, irrational and crying most of the time.
Food is far more than nutrients. Food is a universal expression of cultural identity, sociability and nurturing. Parents’ inability to control food provision for children that is culturally and religiously significant can further heighten anxiety and family relationships in detention. In order for children to develop positive attitudes to eating and mealtimes their behaviour should be modelled on positive behaviours of parents. The anxiety associated with detention is unlikely to be conducive to the establishment of normal healthy eating habits in children. Stress associated with detention would be likely to lead to poor appetite along with other symptoms amongst families.
Recommendations
1. That appropriately qualified and experienced Accredited Practising Dietitians be involved in planning and standard setting at government level to ensure adequate nutritional care across the system.
2. That Accredited Practising Dietitians be involved in assessment and care provision at detention centre level.
3. That DAA be invited to contribute to an official visitor program to ensure maintenance of standards and transparency.
4. The government policy of detention of asylum seekers should be reviewed if adequate nutrition welfare standards cannot be established and maintained.
Conclusion
Children and their families should ideally be accommodated in the community where they have access to services and are able to make decisions about food selection and preparation. While children remain in detention this submission has attempted to outline nutritional standards that would be expected to ensure Australia is achieving its international obligations under UN conventions. Sources available to DAA raise some questions in respect to the standards of nutritional care and management of children in detention. If current conditions do not meet international standards it is imperative that government policy be reviewed to enable asylum seekers to better access government and non-government support in the community. DAA would be pleased to recommend members who could provide expert advice and assistance to investigate these issues more fully and make recommendations to improve services.
Contact Information
Noel Roberts
Professional
Services Director
Dietitians
Association of Australia
1/8 Phipps
Close
Deakin ACT
2600
E-mail: <nationaloffice@daa.asn.au>
Telephone:
02 6282 9555
Fax: 02 6282
9888
