In the weeks before he contracted an infection inside the Manus Island detention centre that would ultimately lead to his death, asylum seeker Hamid Kehazaei spent his days caring for and cleaning excrement from the body, clothes and bed of a fellow asylum seeker who was in the grip of a severe “mental crisis” but whom no one else was looking after.  As the Australian government prepares to empty the controversial Manus Island detention centre and resettle those held there in other countries, a cache of government emails, incident reports and welfare assessments obtained by the Guardian has revealed the depths of Kehazaei’s suffering before he died from a treatable bacterial infection on 5 September 2014, aged 24.  I am wondering why this can’t be managed at Lorengau hospital?  The coronial inquiry into Kehazaei’s death, before Queensland coroner Terry Ryan, begins in Brisbane on Monday.  The inquiry is expected to examine the conditions of detention on Manus Island and the healthcare provided to those held there, including apparent systemic inadequacies, such as the repeated warnings from doctors about Kehazaei’s worsening condition that were not acted upon.  In particular, the coronial inquiry is expected to focus on the bureaucratic delays in transporting the perilously ill asylum seeker to a hospital that could properly treat him.  The Manus Island documents, including more than 100 emails sent between doctors, case workers and security staff on Manus Island, Department of Immigration and Border Protection officials in Australia, and members of the minister for immigration’s staff, reveal a chaotic and confused situation on the island. The documents show uncertainty and contradiction about Kehazaei’s treatment. Medical advice from the doctors treating Kehazaei – urging he be moved to a tertiary hospital in Australia – was resisted by department bureaucrats in Canberra, anxious to preserve the policy of keeping asylum seekers detained on the island in Papua New Guinea.  Kehazaei grew up in Tehran. He served in the Iranian military but, after being discharged, had grown progressively more disenchanted with the restrictions of his country’s theocratic and oppressive regime. He fled in April 2013.  Kehazaei’s mother, Goldone, told the Guardian her son “wanted to be independent, stand on his own two feet and make a life for himself”.  He arrived by boat on Christmas Island in August, a month after the Rudd government introduced its policy of offshore processing and regional resettlement for all asylum seekers who arrived by sea. Kehazaei was transferred to Manus Island in September 2013.  He was, for the circumstances, a model detainee. “Transferee reports having no difficulty with social functioning and gets along well with other transferees from different ethnicities and nationalities,” one welfare report on him reads.  “V positive person, v resilient,” a handwritten note in another says.  At the time he fell ill, nearly a year later, Kehazaei had completed the third and final stage of his refugee status determination – his application for protection – and was waiting a decision on his claim.  He was reported to be happy with his claim’s progress, and he could have reasonably expected to be granted protection: 98% of the men assessed on Manus have had their claims for refugee status upheld – that is, they have been found to have a “well-founded fear of persecution” in their homeland and are legally owed protection.  But, like most of the men held on Manus Island, Kehazaei’s life and health had deteriorated in detention. Welfare reports consistently mention his “broken teeth”. For months, there was no dentist on Manus Island, and Kehazaei told staff “the panadol he had been given was not helping much”.  He had had further difficulties. In the wake of the 2014 riots, in which fellow Iranian Reza Barati was murdered by guards, and more than 70 asylum seekers were seriously injured, including being shot by police and having their throats cut with machetes, Kehazaei reported he had been threatened by local men “making antagonising throat slitting gestures” through the detention centre fences.  Detention on Manus Island was the first time Kehazaei had lived away from his family. He told staff on the island he worried for the safety of his brother and his mother back in Iran.  But Kehazaei was resolute in detention. He told staff his mental health was “80%” even after months in detention, and said he tried to keep physically active and to attend English classes as often as he could.  “He presents as a very positive person who has a stoic attitude to his current circumstances,” his case manager wrote.  Around him, others were not faring well. One of his friends had been severely assaulted during the February riots and was undergoing a “mental crisis” his case-manager said, under continued threats. The man became essentially unable to look after himself, and it fell to Kehazaei and another friend to keep him alive.  Kehazaei’s case manager wrote in June 2014:  Hamid [Kehazaei] and [name redacted] are caring full time for their friend [name redacted] as his drastic decline in mental health makes him dependent [on] them for his basic needs such as showering, going to the toilet, eating, shopping and maintaining ‘appropriate behaviour’.  In effect this means literally washing the transferee and cleaning up him after he has soiled himself and his bedding as he often does not go to the toilets due to paranoia. They report being on constant guard as [name redacted] often takes off his clothes and wants to walk around the compound which obliges them to continually monitor him to prevent him from doing so.  Understandably this is causing great strain on Hamid and [name redacted]. Both clients report feeling very anxious about their friend’s mental state and overwhelmed with the responsibility of taking care of him (having had no mental health training or experience), and have stated that they are desperate for him to receive proper medical care.  Of particular concern is the potential trauma experienced by Hamid and [name redacted] and subsequent deleterious effect on their own mental health. Both men state that their main source of support in this situation is each other, but appreciate the on-going support provided by case management via welfare checks.  The man whose mental health was declining was ultimately moved from Manus Island to an Australian psychiatric facility. Kehazaei’s friend remains on Manus Island.  In the weeks after the man’s removal, Kehazaei again attempted to “engage” in the detention centre’s activities. He regularly played soccer on the low swampy field in the corner of the military base at Lombrum that houses the detention centre.  On the evening of Saturday 23 August, he presented to the International Health and Medical Services (IHMS) medical clinic on the island complaining of fever, chills and an aching body. He was diagnosed with a throat infection and kept overnight on intravenous antibiotics.  According to reports, by the morning he was worse.  Kehazaei was unable to walk; taken by wheelchair to the toilet, he vomited twice. An abscess was found on the lower part of his left leg and another in his groin.  On Monday 25 August, despite a change in his antibiotic regime which led to a brief improvement, Kehazaei deteriorated further and faster again. At dawn, one of the abscesses spontaneously burst, and at 9.30am, the senior doctor for IHMS, which provides healthcare to the centre on Manus Island, requested he be immediately transferred to Port Moresby.  Within an hour and a half, IHMS’s Sydney office had approved his transfer. “This client has exhausted all antibiotic treatment that is available on Manus Island,” the authorisation stated, concluding Kehazaei faced a “risk of infection spreading, leading to sepsis – life-threatening widespread systemic infection”.  At 1.15pm, the transfer request was forwarded to a Department of Immigration and Border Protection bureaucrat in Canberra for final, departmental authorisation. The request was urgent: there was a commercial flight leaving Manus for Port Moresby at 5.30pm that day.  But that flight left without Kehazaei on it.  The reply came from a DIBP officer at 6pm, but with no authorisation for Kehazaei to be moved:  I am wondering why this can’t be managed at Lorengau hospital? Even using something ‘unusual’ should be able to be managed locally. Is there a [drug] supply issue that we are unaware of? Again, these should be brought in, rather than the person being transferred if this is the case. DIBP staff on island are being pushed for this urgent transfer in the next 18 hours, however I don’t have adequate information to be able to escalate at this point if this is still warranted.  The request was forwarded that evening to a more senior officer within the department in Canberra.  But that senior officer had gone home for the day. The email wasn’t read until the next day.  It was Tuesday morning at 8.41am – 23 hours after the initial request for an urgent transfer was made - by the time Kehazaei’s transfer was finally authorised by the DIBP.  By this time, his condition had deteriorated precipitously. His transfer had to be upgraded to “medivac” – an air ambulance – because he was too unwell to travel on a commercial flight.  Also at this point, doctors on Manus Island requested that their patient be transferred, not to Port Moresby, but to Brisbane, where he could access advanced tertiary care for what was now a critical illness.  By now, Kehazaei’s blood had been poisoned by his infection. Medical reports indicate he was becoming increasingly oxygen-deprived and, as a result, agitated. In distress and confused by what was happening to him, he pulled the intravenous lines out of his body and had to be restrained by three guards.  “He was in pain and moaning,” a staff member reported when she visited him.  Despite the doctors’ request that he fly directly to Australia, Kehazaei’s air ambulance landed in the Papua New Guinean capital. He was admitted to Pacific International hospital just before 5pm.  That night, he suffered three heart attacks.  It was Wednesday morning before Australian immigration officials in Canberra approved Kehazaei’s transfer to Australia. Taken back to the airport, and boarded upon another air ambulance, he arrived at the emergency department of Brisbane’s Mater hospital at 10pm, barely alive.  He would never regain consciousness.  Over the next five days, department officials were in regular contact with Kehazaei’s family. His mother and brother asked initially that everything possible be done to save his life. When they were then told by doctors his life could not be saved, they asked that his organs be donated.  On 5 September, the then-immigration minister Scott Morrison told a media conference Kehazaei was “still with us, but his condition, as you know, is extremely, extremely parlous”.  “IHMS who work as part of that team there [on Manus] do an outstanding job,” he said. “Our focus and care, has been on this young man, from the moment he presented to medical officers at Manus Island and on focusing on the interests and engaging with the family. That’s where our attention has been.”  That night, with his family’s permission, Kehazaei’s life support machine was switched off. He died at 7.25pm.  Medical reports indicate the initial infection that ultimately led to Kehazaei’s death was caused by chromobacterium violaceum, a rare, water-borne bacteria that is potentially life-threatening, but is easily treated with specific antibiotics – cheap and widely available in PNG – if identified early.  Kehazaei’s body was repatriated to Iran for his funeral and burial.  Behrouz Boochani, a journalist and fellow Iranian asylum seeker, was one of four “community leaders” on Manus called into a meeting with detention centre staff on the evening Kehazaei died. In an article for the Guardian he writes that “it was beyond all human nature. It was easily prevented, was the result of incalculable cruelty and so our emotions were beyond those that a person usually experiences as the result of losing a friend”.  For days prior, as pictures of Hamid had begun to be posted around the detention centre, and asylum seekers held vigils in his honour, all requests for information about his condition had been rebuffed with a few cold lines of “talking points” circulated by email around detention centre staff.  “Hamid’s condition deteriorated and he was transferred to Australia to receive specialist medical treatment ... I am unable to provide any further information at this time,” detention centre staff were told to tell Kehazaei’s friends.  Most of the men on Manus had already reached the conclusion that “GDD059 was dead in all but name”, according to “atmospheric updates” compiled in emails marked “Manus Intelligence”. Those updates referred to Kehazaei only by his boat identification – GDD059 – and to his impending death as “the GDD059 issue”.  That morning, reports of Kehazaei’s death had swept the camp after one asylum seeker had reportedly spoken with his family in Iran.  But now, those community leaders of those in detention were officially told their fellow asylum seeker had died.  The meeting was fraught, bordering on hostile. Those invited, including Boochani, repeatedly asked for more information about Kehazaei’s death, fearful they were at risk of dying from the same at-that-point-unknown ailment. Detention centre staff were repeatedly asked: “Who will die next?”
Exclusive: Ahead of inquest, documents show how Australian immigration department held up transfer of asylum seeker from Manus Island for treatment