Immigrant Health Service

Asylum seekers

  • Background

    An asylum seeker is someone who has applied for refugee status and who is awaiting a decision on this application. Asylum seekers in Australia can broadly be divided by:

    • Their means of arrival - this determines whether they are (or have been) subject to mandatory detention
      • Boat arrivals without a visa (subject to mandatory detention)
      • Plane arrivals who clear immigration (i.e. on a valid student or travel visa - not subject to mandatory detention)
    • Their date of arrival - this determines how they are processed and whether they are subject to offshore processing/resettlement
      • People who arrived by boat without a visa after 13 August 2012 (and before 19 July 2013) could be subject to offshore processing and offshore settlement
      • People who arrived by boat without a visa after 19 July 2013 were subject to offshore processing and offshore settlement. Some of this group remained in detention on Christmas Island or the mainland, and then were included in the 'Legacy caseload' and remained in Australia
      • People who arrived by boat without a visa between 13 August 2012 and 1 January 2014 will have their protection claims processed under the new Fast Track Assessment process. Also see RACS flowchart of asylum claim process (Dec 2015)
    • Their stage in the asylum claim process
      • There were substantial delays in processing protection claims for people who arrived after August 2012 - processing halted between September 2013 and May 2015
      • People who have had their claims assessed and declined at all stages of review may be described as 'finally determined'.

    See: Refugee policy and timeline.

    Groups of asylum seekers include:

    • Asylum seekers in held (locked) immigration detention (As of 2017, the detention population is approximately one third people who arrived by boat without a valid visa, one third criminal cancellations and one third 'other', the last children were released from detention in April 2016)
    • Asylum seekers in community detention (now predominantly people transferred back from Nauru and Manus Island for medical reasons)
    • Asylum seekers in the community
      • People on a Bridging visa E (BVE) - usually people who arrived by boat without a valid visa and have spent time in held detention. 
      • People who arrived with a valid visa (i.e. by plane) and have claimed asylum (people in this group may also be on bridging visas, which generally revert to the conditions of their substantive visa)
      • People who have had an initial (or later) claim rejectedand are in a review process, or awaiting judicial review/outcomes - this group will increase in size going forwards

    Asylum seeker identification

    There are several means of identifying asylum seeker status; also see information on the DIBP Immicards

    Asylum seekers found to be owed Australia's protection

    Prior to 13 August 2012, people who were successful in their asylum claim were granted a Protection visa (subclass 866). This visa grants permanent residency, work rights, Centrelink eligibility, Medicare and settlement support; therefore 866 visa holders are no longer asylum seekers. People who arrived before 13 August 2012 whose claims were not finalised, are subject to retrospective application of Temporary Protection Visas (TPV).

    People on Temporary Protection Visas (TPV) - TPVs were proposed for reintroduction in October 2013 - see NSW Refugee Advice and Casework Service (RACS) Factsheet and the Victorian Refugee Health Network Asylum seeker fact sheet from that time. Legislation changes in December 2014 allowed TPVs to proceed, reintroducing the TPV 785 (XD) and introducing a new form of 'Safe Haven Enterprise' (SHEV) Visa - see DIBP TPV and Protection Application Information and Guides (PAIG). SHEV became available in July 2015. See DIBP fact sheetRILC fact sheet - SHEV, and Department of Social Services - TPV entitlements.

    Numbers

    In April 2017, in Victoria there were: 

    • 204 asylum seekers in Immigration detention or Immigration transit accommodation (31 Jan 2017)
    • 204 asylum seekers in Community Detention (of a national total of 568) (31 Jan 2017)
    • 10,031 asylum seekers on BVEs in December 2016 (of a national total of 25,810 BVE holders in the community at that time; 28,621 BVE holders nationally in March 2016)
    • Approximately 1800 non-IMA asylum seekers living in the community.

      Asylum seeker health screening

      All asylum seeker groups have a health assessment – either in held detention where it is provided by IHMS, or in the community where it may be provided after release from detention as part of refugee health care, or by BUPA (contracted by DIBP)

      • For adults and adolescents 15 years and older this comprises: CXR, limited blood testing including HIV, FBE, Hepatitis B screening and syphilis screening
      • For children less than 15 years this comprises: CXR for children 11 years and older. Additional health screening was introduced in mid 2014 for children < 15 years in held detention - details are not available, although clinical experience suggests this is similar to adult screening
      • Additional tuberculosis (TB) screening is provided for people in held detention with known TB exposure (e.g. on boats) - interferon-gamma-release assay (IGRA) screening in adolescents/adults, and Mantoux testing in children. Protocols were not clear, and it is important to check what has (or has not) been completed, more recently, in 2015, extended tuberculosis screening was introduced for children aged 2-11 years.
      • Immunisation catch-up is provided for people in held detention (with all Australian schedule vaccines including varicella vaccine and HPV; and additional vaccines including hepatitis A and influenza). Immunisation catch-up delivery was patchy through early 2013, coverage improved from mid-2013, although the majority of individuals released from detention still required catch-up vaccinations
      • Detention health checks are recorded in the IHMS Health Discharge Assessment (HDA) - all people released from held detention have a copy of their HDA. 

      Health assessments - letters requesting BUPA health assessments 2017

      As of late 2016 and early 2017, asylum seeker clients have been sent proforma letters from DIBP requesting health examinations as part of the processing for TPV or SHEV - to be completed at BUPA Medical Visa Services. Key details include:

      • The letters come from 'Mark' (no surname given) position number 60008795, Temporary Protection Visa Assessment Branch, PO Box 25 Belconnen, ACT 2616
      • These letters have been sent to individuals where there was no record of IHMS screening being completed
      • They provide a list of codes, although no detail on what the codes are - The codes listed are: 501=medical examination, 502=CXR, 707=HIV blood test, 708=hepatitis B serology, 716=hepatitis C serology, 712=syphilis and 719=IGRA testing
      • The letter asks people to bring copies of any previous letters/reports to the visit
      • Bupa fee schedules are available, these are substantial costs to asylumn seeker families, these fees are reimbursed by the SRSS provider (note people seeking asylum will not have SRSS if they are working)
      • There is no defined process to update the results of other testing (i.e. tests completed after release from detention) - the Health Undertaking process allows registered clinicians to update the DIBP emedical system, this appears to be a separate process, at present we would advise writing to BUPSA and Mark, and are seeking further clarification
      • There is complexity for tuberculosis screening, especially as TB screening tests are likely to stay positive, and individuals may have been managed and completed treatment for LTBI and then be re-referred for a positive screening test- it is not clear what processes are in place to manage this situation.

      Access to supports (health, housing, education, work rights)

      Access to services, workrights, and Medicare for the different asylum seeker groups is shown in Table 1. 

      • Medicare cards for all BVE holders expired at the end of 2014.  This was related to the Commonwealth Health Insurance Act 1973 and administrative procedures that only allow time limited access for asylum seekers to Medicare.  Medicare access has been extended for another 3 years; however, all BVE clients need to renew their Medicare card when their BVE expires. People with expired BVEs are not eligible for Medicare until their BVE is reissued.
      • Work rights were permitted for BVE holders after the legislation changes in December 2014. The restriction on work rights is lifted as BVE are renewed (i.e. work rights were granted when BVE were renewed after December 2014). In practice, BVE durations became very short over 2016 (often only 2-3 months), which precluded employment. 
      Group of asylum
      seekers
      Visa
      status
      Health Housing Workrights Income
      support   
      Education Case support, legal access
      Held detention No status IHMS,
      no Medicare
      Detained No

      No No longer relevant, previously primary and secondary (routine school access 6/2014 on CI)

      DIBP. Able to engage legal assistance under the Migration Act

      Community detention No status IHMS pays for
      services, assigned GP & pharmacy, no Medicare
      Provided by
      DIBP/
      agencies
      No = 60% 
      Special 
      Benefit, utilities paid through DIBP
      Kindergarten, primary, secondary and language school

      Red Cross, Life without Barriers, contracted by DIBP. SRSS band 2-3. Able to engage legal assistance under the Migration Act. Generally no funded legal assistance - see PAIG, some applicants have been eligible for assistance through the Primary Application Information Service (PAIS)

      BVE
      in community
      BVE Medicare tied
      to having
      valid BVE
      6 weeks support
      then private
      rental
      Yes (from
      12/2014, with
      renewal of BVE)
      = 89%
      Newstart
      or Special
      Benefit



      Kindergarten, primary, secondary and language school

      Life without Barriers, AMES, Red Cross. SRSS band 4-6. Band 4 = transition, Band 5 = vulnerable, Band 6 = majority. Generally no funded legal assistance - see PAIG, some applicants are eligible for assistance through the Primary Application Information Service (PAIS)

      TPV
      in community
      SHEV, TPV, THC
      Medicare Private rental



      Yes Centrelink eligible, conditions on SHEV visa Not eligible for settlement support
      Non-IMA BVA, 
      BVC
      or BVE
      Medicare eligible
      if visa holds
      workrights
      Varies No Kindergarten, 
      primary, secondary 
      and language school,
      fees may be
      charged, depending
      on entry visa 

      Often no case support, may be eligible for SRSS and Red Cross support, may get case support through ASRC. May be eligible for IAAAS if meet disadvantage criteria

      After claim
      rejected
      Varies Often no Medicare Varies, generally not No - SRSS payments stop after 1 week unless Band 5 approved Usually no case support, some legacy caseload asylum seekers may be eligible for band 5 support and ongoing SRSS income support. Not eligible for funded legal assistance


      SRSS - Status Resolution Support Services is the program that provides supports to non-citizens as their immigration status is resolved. SRSS replaces the previous CAS – Community Assistance Support (changed to band 5) and ASAS – Asylum Seeker Assistance Scheme (changed to band 6). 

      Resources

      Immigrant health resources. Updated April 2017. Contact: georgia.paxton@rch.org.au