Immigrant Health Service

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 (2018) 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.

    • 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 Aug 2012 (and before 19 Jul 2013) could be subject to offshore processing and offshore settlement
    • People who arrived by boat without a visa after 19 Jul 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 Aug 2012 and 1 Jan 2014 have their protection claims processed under the new 'Fast Track Assessment process'. See schema fast track process, RACS  flowchart of asylum claim process (Dec 2015), and a more recent flowchart below.

    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 Sep 2013 and May 2015. The stages in the protection claim process can be divided into: 

    1. Assessment by the Department of Home Affairs (DHA) - previously Department of Immigration and Border Protection (DIBP) 
    2. Review of negative DHA/DIBP 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 end-2017, the detention population was approximately 25% people who arrived by boat without a valid visa, 35-40% criminal cancellations and 35-40% 'other'. The last asylum seeker children held in prolonged detention were released in April 2016. 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 and Manus Island for medical reasons. Some of this group are subject to the 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), but is being introduced for families with children aged 6 years and older (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 - see  IAA (plane arrival) caseload (Apr 2016). 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 Oct 2017 deadline, and are subject to removal from Australia. This group were also placed on a 6-month FDBVE, which has work rights and Medicare access.

      Asylum seeker identification

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

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

      Prior to 13 Aug 2012

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

      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 Dec 2014 allowed TPVs to proceed, reintroducing the  TPV 785 (XD) and introducing a new form of SHEV Visa (790). TPV became available in May 2015, SHEV became available in Jul 2015, and SHEV arrangements included Victoria from Oct 2016. Also see RILC fact sheet - SHEV, and  Department of Social Services - TPV entitlements

      Numbers

      Both immigration detention statistics and onshore processing statistics are available. In Feb 2018 in Victoria there were: 

      • 172 people (approximately 25% asylum seekers) in immigration detention (Maribyrnong) or immigration transit accommodation (MITA)
      • 161 asylum seekers in Community Detention (of a national total of 442) in Feb 2018
      • 8,200 asylum seekers on BVEs in Dec 2017 (of a national total of 19,590 BVE holders in the community at that time)
      • Approximately 1800 non-maritime arrival asylum seekers living in the community.

      Asylum seeker health screening

      All asylum seekers have a health assessment – either in held detention (through IHMS), or in the community after release from detention as part of refugee health care, or by BUPA (contracted by DHA).

      • 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 are not 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: 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 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, we have been advised IHMS will provide a copy of an individuals health records (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. Key details included:

      • The letters came from 'Mark' (no surname given) position number 60008795, TPV Assessment Branch, PO Box 25 Belconnen, ACT 2616.
      • Letter were sent to individuals where there was no record of IHMS screening being completed.
      • They provided a list of codes, although the letters do not provide 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 asked people to bring copies of any previous letters/reports to their BUPA visit.
      • Bupa fee schedules are available, these are substantial costs to asylum seeker families. Health assessment fees are reimbursed by the SRSS provider - although the letter does not clarify this - (note: as of late 2017, access to SRSS has reduced - see below).
      • Previous test results will be 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).
      • There is complexity for TB screening with the BUPA assessments - 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 - we suggest adding this information in an email.

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

      Access to services, workrights, 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 Commonwealth Health Insurance Act 1973 and administrative procedures that allow (time-limited) access for asylum seekers 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 have seen cases where Medicare duration is not connected to BVE duration). BVE duration was short (often 3-6 months) across 2016-17. Once people submitted their protection claims (usually mid 2017, 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). 

      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 (which has been a frequent occurrence in practice).
      • 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 have seen individuals where the length of Medicare is different to their BVE duration.

      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 has 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 (which includes links to application forms) and policy manual. Most (but not all) people on SRSS are individuals who arrived by boat and sought asylum. 

      SRSS - asylum seekers in the community on BVE

      From 2017, access to SRSS has 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.

      SRSS - asylum seekers or refugees in community detention

      SRSS also applies for the cohort in community detention (band 3). 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 families with children (details difficult to clarify at present). These individuals have not had work rights since arrival in Australia (now 4-5 years), and our clinical experience is that they 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.

      In late 2017, the Victorian government announced a support package for this group - see fact sheet.

      Assessment of SRSS eligibility for both the BVE and CD cohort was planned for May 2018, although this appears to have been delayed beyond initial suggested timelines. - see VFST Fact Sheet

      Individuals may also re-apply for SRSS if their circumstances change - see DHA form 1445 (to get onto the program) and also DSS form SU691 (to get income support payments - this can also be used to apply for Medicare).

      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 No longer relevant, previously primary and secondary DHA status resolution officer. Able to engage legal assistance under the Migration Act
      Community detention (CD) 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. Red Cross, Life without Barriers, AMES, contracted by DHA. SRSS band 2-3. 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 NDIS.Private 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, Red Cross. SRSS band 4-6. Band 4 = transition, Band 5 = vulnerable, Band 6 = majority.  
      TPV
       i.e. refugee, no longer an asylum seeker
      SHEV, TPV, THC 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.  Medicare retained if protection claim not submitted. Varies, generally no work rights. FD-BVE 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 band 5 support and ongoing SRSS. Not eligible for funded legal assistance.


      Fast track assessment process

      Fast track assessment process final

      Resources

      Immigrant health resources. Updated July 2018. Contact: georgia.paxton@rch.org.au