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Asylum seekers

  • Please note all people seeking asylum are entitled to free medical care in Victorian hospitals - see Guide to asylum seeker access to health and community services in Victoria (this document is still current (2020) and has been in place since 2011, with earlier iterations from 2005).

    Background

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

    Whether they have a valid visa on arrival - This determines whether they are (or have been) subject to mandatory immigration detention and whether they are eligible for permanent protection.

    • Boat arrivals without a valid visa - subject to mandatory detention, eligible for temporary protection (not permanent protection)
    • Plane arrivals without a valid visa or plane arrivals who do not clear immigration - subject to mandatory detention, eligible for temporary protection (not permanent protection)
    • Plane arrivals who clear immigration (on a valid visa i.e. student, tourist, work, other) - not subject to mandatory detention, eligible for permanent protection.

    Their date of arrival This determines how their protection claims are processed and whether they are/were 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. Many of this group remained in detention on Christmas Island or mainland Australia, and were then included in the 'legacy caseload' at the end of 2014 (and have remained in Australia)
    • People who arrived by boat without a visa between 13 August 2012 and 1 January 2014 have their protection claims processed under the 'Fast Track Assessment' process. See RACS summary fast track process (updated November 2019) and flowchart of asylum claim process (December 2015).

    Their stage in the protection claim process - There were substantial delays in processing protection claims for people who arrived after Aug 2012 - processing halted between September 2013 and May 2015. The stages in the protection claim process can be divided into: 

    1. Assessment by the Department of Home Affairs (DHA) 
    2. Review of negative DHA decision 
    3. Judicial review of refusal by appeal body; and
    4. Review within the judicial system.

    People who have had their claims assessed and declined at all stages of review may be described as 'finally determined'.

      Groups of asylum seekers include:

      Asylum seekers in held immigration detention

      As of October 2019 (latest available at December 2019), the detention population is approximately 33% people who arrived by boat without a valid visa, 42% criminal cancellations and 25% 'other'. The last asylum seeker children who spent time in Nauru and were held in prolonged detention were released in April 2016.  A small number of children remain in prolonged held detention. Detention centres also have ongoing turnover - with flows in and out of the detention network.

      Asylum seekers in community detention (residence determination)

      Now predominantly people transferred back from Nauru or Manus Island for medical reasons. Some of this group were placed on Final Departure Bridging Visa E (FDBVE), announced in Aug 2017 (and moved out of community detention). The FDBVE was initially applied to adults who arrived alone (late 2017), and then extended to a small number of families with children (from mid-2018). 

      Asylum seekers in the community

      • People on a Bridging visa E (BVE) who are awaiting a decision on their protection claim - 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. usually by plane) and have claimed asylum (people in this group may: i) remain on their entry (substantive) visa, ii) be on bridging visas that revert to the conditions of their substantive visa, iii) be on a BVE - for numbers see Onshore Humanitarian Program (non-IMA) 2018-19. Individuals in this group should have a letter acknowledging they have submitted a protection claim.
      • People who have had an initial (or later) claim rejected and are in a review process, or awaiting judicial review/outcomes - this group will increase in size going forwards. Individuals who have lodged for judicial review may also have a BVE or a letter noting they have reapplied for a BVE.
      • A small number of asylum seekers who arrived by boat (around 70 people) did not apply for protection prior to the 1 October 2017 deadline, and are subject to removal from Australia. This group were also placed on a 6-month FDBVE, which held work rights and Medicare access. 

      Asylum seeker identification

      There are several means of identifying asylum seeker status; also see information on the DHA Immicards. As of 2019, Public Transport Victoria (PTV) cards have also recognised asylum status.

      Asylum seekers found to be owed Australia's protection (refugees)

      Prior to 13 Aug 2012 (all asylum seekers; ongoing for those asylum seekers who arrived by plane)

      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 by boat before 13 Aug 2012 and whose claims were not finalised, were then subject to retrospective application of Temporary Protection Visas (TPV) - either TPV or Safe Haven Enterprise Visas (SHEV). Asylum seekers who arrive by plane and who are found to be refugees are granted a Protection visa (subclass 866).

      People on Temporary Protection Visas

      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) (available from May 2015) and introducing a new form of SHEV Visa (790) (available from July 2015). SHEV arrangements included Victoria from October 2016. Also see Department of Social Services - TPV entitlements

      Numbers

      Both immigration detention statistics and onshore processing statistics are available. In late 2019 in Victoria, there were: 

      • 284 people (approximately 33% asylum seekers) in immigration detention in Melbourne (at the Melbourne Immigration Transit Accomodation- MITA) - October 2019
      • 255 asylum seekers in Community Detention (of a national total of 834) - October 2019
      • 3754 asylum seekers from the 'legacy caseload' with applications on hand/at review, with a further 5644 of this cohort with finalised grants - November 2019
      • 6354 asylum seekers on BVEs (of a national total of 13,827 BVE holders in the community at the time) - September 2019
      • An unknown number of non-maritime arrival asylum seekers living in the community (previously around 1800 in 2016-17) - noting that nationally there were 24,566 protection visa applications lodged in 2018-19 (i.e. plane arrivals with a valid visa who lodged a protection claim)

      Asylum seeker health screening

      All asylum seekers should have had a health assessment – either in held detention (through IHMS), or in the community after release from detention as part of refugee healthcare, or by BUPA (contracted by DHA). This assessment is similar to the offshore Immigration Medical Examination.

      • For adults and adolescents 15 years and older this comprises: chest x-ray (CXR), limited blood testing including FBE; HIV, hepatitis B, hepatitis C and syphilis screening. Additional tuberculosis (TB) screening is provided for people in held detention with known TB exposure en-route to Australia or in detention - using interferon-gamma-release assays (IGRA).
      • For children <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 were never publicly available, although clinical experience suggested this was similar to adult screening. Additional TB screening for all children aged 2-10 years (Mantoux test or IGRA, generally IGRA) was introduced in Nov 2016, including for asylum seeker children, who were by that time in the community (as they submitted their protection claims). 
      • Immunisation catch-up: should be 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 available evidence suggests the majority of individuals released from detention still required catch-up vaccinations at the time of release. 

      Detention health checks are recorded in the IHMS Health Discharge Assessment (HDA) - all people released from held detention should have a copy of their HDA. Initially these HDA were available through the Community Detention Assistance Desk (CDAD) - 1800 725 518. In 2017, this information stopped being available, and IHMS advised completing a freedom of information (FOI) request to the (then) DIBP. From early 2018, IHMS has provided a copy of an individual's health record (to the individual) with consent.

      Health assessments - letters requesting BUPA health assessments 2017

      In late 2016/early 2017, asylum seeker clients were sent proforma letters from the (then) DIBP requesting health examinations as part of the legacy caseload processing - to be completed at BUPA Medical Visa Services. Letters were sent to individuals where there was no record of IHMS screening being completed. Key details included:

      • The letter provided a list of codes, without detail on what the codes were - The codes listed were: 501=medical examination, 502=CXR, 707=HIV blood test, 708=hepatitis B serology, 716=hepatitis C serology, 712=syphilis and 719=IGRA testing
      • Bupa fee schedules are available, these were substantial costs to asylum seeker families. Health assessment fees could be reimbursed by the SRSS provider
      • Previous test results are accepted by the DHA- complete this spreadsheet with consent and email to health@border.gov.au (i.e. tests completed after release from detention can be used for the health assessment).

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

      Access to services, work rights, and Medicare for the different asylum seeker groups (and those on a TPV) is shown in Table 1. 

      Medicare

      Medicare cards for all asylum seeker BVE holders expired at the end of 2014 and again at the end of 2017. This was related to the Health Insurance Act (1973) Cth and administrative procedures that allow (time-limited) access for non-citizen access to Medicare.  Medicare access has been extended for another 3 years; however, Medicare is dependent on having a valid BVE, and expires when an individuals BVE expires (although in 2018, we saw cases where Medicare duration was not connected to BVE duration). BVE duration was short (often 3-6 months) across 2016-17. Once people submitted protection claims (prior to the 1 October 2017 deadline) they were issued with longer duration BVEs (through to the end of their fast track assessment). If individuals have a negative initial and review decision, they revert back to short duration BVE (with the same issues with Medicare arising). Further, if Medicare has expired, Australian Immunisation Register (AIR) records cannot be viewed, although this situation is now being addressed in 2020. 

      Individuals who arrived on a valid visa and sought asylum usually remain on their entry visa (and associated conditions) for the duration of that visa. This means they usually do not have Medicare access (for example - arrival on student, tourist and short term visas which do not carry Medicare access), although there is an expectation that individuals arriving on such visas have their own (private) health insurance.

      Asylum seekers may not have access to Medicare if:

      • Their BVE has expired
      • They have not renewed their Medicare (also related to frequent short duration BVE)
      • They remain on their entry visa/conditions of their entry visa which did not carry Medicare
      • In 2018 we saw cases where the length of Medicare was different to their BVE duration (both shorter and longer).

      Work rights

      Work rights were permitted for BVE holders after the legislation changes in December 2014. The restriction on work rights was lifted as BVE were renewed (i.e. work rights were granted when BVE were renewed after December 2014). In practice, BVE durations became very short over 2016-17, which precluded employment. 

      SRSS

      Status Resolution Support Services (SRSS) is a program providing supports to non-citizens as their immigration status is resolved, that includes casework, income support payments and access to torture-trauma counselling. In 2014, SRSS replaced the previous CAS – Community Assistance Support (changed to band 5) and ASAS – Asylum Seeker Assistance Scheme (changed to band 6) - see Department of Human Services information, application form, and 2018 policy manual. Most (but not all) people on SRSS were individuals who arrived by boat and sought asylum. 

      SRSS - asylum seekers in the community on BVE

      From 2017, access to SRSS decreased for asylum seekers in the community on BVE. SRSS access stops if an asylum seeker:

      • Is working
      • Has sent money overseas or received money from overseas while they were on SRSS payments (limit $1000)
      • Is granted a protection visa (in which case they become eligible for other welfare support)
      • Has a negative decision at the IAA (SRSS stops one week later)
      • Is assessed as being 'employment ready' by their SRSS provider based on criteria provided by DHA - see VFST Fact Sheet (May 2018). Clinicians should ensure SRSS providers and the DHA are aware of health status (with consent) to ensure accurate assessment of vulnerability where relevant.

      SRSS - asylum seekers or refugees in community detention

      SRSS also applies for the cohort in community detention (previously band 3) which is now (Dec 2019) predominantly the medical transfers from Nauru and Manus. For this group, SRSS stops if they transition to a FDBVE within a period of weeks (one week for the first cohort to be granted a FDBVE (adults who arrived alone) and 4-6 weeks for later cohorts (details difficult to clarify). These individuals have not had work rights since arrival in Australia (now 6 years), and our clinical experience has been that the vast majority are substantially unwell. For this group - clinicians should ensure IHMS, SRSS providers and the DHA are aware of health status (with consent) to ensure accurate assessment of vulnerability. Timelines may be urgent where loss of SRSS support/payments poses immediate health and safety risk. The Victorian government has provided support for this group - in 2017, and again in 2019-2020.

      Individuals may also re-apply for SRSS if their circumstances change - see application form.

      Table 1: Access to supports for people seeking asylum

      Group of asylum seekers Visa status Healthcare, disability services Housing Work rights Income support    Education Case support, legal access
      Held detention No status IHMS, no Medicare, referred to specialists (private or public) Detained No No Previously primary and secondary, small numbers at present DHA status resolution officer. Able to engage legal assistance under the Migration Act

      Community detention (CD) also called Residence Determination, now mostly medical transfers from offshore

      No status IHMS pays for services, assigned GP & pharmacy, no Medicare, can be referred to specialists (with IHMS approval). Children <7 years eligible for early childhood intervention services (ECIS) through State funding in Victoria (not NDIS), older - not eligible NDIS Provided by DHA, utilities paid No = 60% 
      Special 
      Benefit
      Kindergarten, primary, secondary and language school DHA status resolution officer; Life Without Barriers, AMES contracted by DHA. Able to engage legal assistance under the Migration Act 

      Final Departure BVE people previously in CD

      BVE - 6m duration (expectation of return to country of origin/offshore processing)Medicare (no health care card, medication costs challenging). Children <7 years eligible ECIS as above (not NDIS), older not eligible for NDISPrivate rentalYes, but will not have had work rights for yearsNoKindergarten, primary and secondary accessDHA status resolution officer. No SRSS. Able to engage legal assistance under the Migration Act 
      BVE BVE Medicare tied to having valid BVE. Children <7 years eligible for ECIS (not NDIS), older not eligible for NDIS  6 weeks support
      then private
      rental
      Yes - from
      12/2014, with
      renewal of BVE
      = 89%
      Newstart
      or Special
      Benefit. Not eligible Carer allowance




      Kindergarten, primary, secondary and language school
      Tertiary education at international student rates

      Life without Barriers, AMES. SRSS Band 5 = vulnerable, Band 6 = majority.  Able to engage legal assistance as above

      TPV
       i.e. refugee, no longer an asylum seeker
      SHEV, TPV Medicare, healthcare card. Children <7 yrs eligible for ECIS as above (not NDIS), older not eligible NDIS




      Private rental

      Yes Centrelink eligible, including Carer allowance, conditions on SHEV visa Not eligible for settlement support
      Air arrivals 'non-IMA' - asylum seekers who arrived by plane

      Most remain on entry visa for the duration of that visa. May be on BVA, BVC or BVE, conditions may revert to entry visa

      May be Medicare eligible if visa holds
      work rights. Children <7 yrs eligible for ECIS as above (not NDIS), older not eligible NDIS
      Varies Not usually Kindergarten, 
      primary, secondary 
      and language school,
      fees may be
      charged, depending
      on entry visa 
      Tertiary education at international student rates

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

      After claim
      rejected
      Varies, depends on stage of decision, should have some form of bridging visa, may be short duration Often no Medicare,  may be tied to having valid BVE.  Varies, generally no work rights, FDBVE have work rights No - SRSS payments stop after 1 week unless Band 5 approved Usually no case support; some legacy caseload asylum seekers may be eligible for ongoing SRSS on a case-by-case basis. Not eligible for funded legal assistance


      Fast track assessment process

      Fast track assessment process final

      Resources

      Immigrant health resources. Author Georgie Paxton and Rachel Heenan, 2017. Updated January 2020. Contact: georgia.paxton@rch.org.au