When Abdirahman Ahmed Mohammed first sought asylum in Australia, he still carried a bullet in his leg.
But the Somali refugee’s health problems would only become more severe in his years in offshore detention on Manus Island in Papua New Guinea, and later on Nauru.
Mr Mohammed died of a heart condition in Perth this month, on February 15, a day after his 39th birthday.
He is survived by his wife, from whom he is separated, and other relatives in Australia who did not wish to speak to the media at this time.
Mr Mohammed reported frequent chest pains and first received tests on his heart in late 2014, when he was in PNG, according to the Asylum Seeker Resource Centre (ASRC).
He was given further heart tests in 2017 and battled other health issues, including eye problems and a compound fracture to his thigh where the bullet struck.
But he was not transferred to Australia for treatment until almost five years later, when he suffered a heart attack on Nauru in April 2019.
Refugee advocates said his case painted a “sad picture of the ongoing medical neglect” in offshore detention, which they said created new health problems for refugees and exacerbated existing issues.
And a close friend told the ABC they believed if Mr Mohammed had access to better healthcare during his years on Manus Island and Nauru, he would still be alive today.
The ASRC has seen Mr Mohammed’s medical records as they helped him apply for a transfer to Australia under now-repealed medevac laws, which allowed asylum seekers and refugees to come to Australia for treatment on the recommendation of doctors.
Although the ASRC cannot share medical records with the ABC due to privacy laws, the group has permission from a family member to speak to the ABC about Mr Mohammed’s care.
The Department of Home Affairs told the ABC it did not comment on individual cases, but “can confirm the death of an individual who was living in the community”.
“We extend our sympathies to the individual’s family. To ensure we respect their privacy, no further information will be released,” it said in a statement.
In 2013, the then-Labor government installed a system of offshore processing, saying anyone who came to Australia seeking asylum by boat would never be resettled here, a policy that continued under the current government.
On Thursday, there were fresh calls to overturn that policy, with medevac refugees and advocacy groups presenting a petition to Parliament, with almost 37,000 signatures, calling for those transferred from offshore processing to be released and resettled.
‘A genuine man of peace’
Julia Hall hardly ever called her close friend by his name. To her, he was always Biixi — a family name, from his grandfather — or “aboowe” which is Somali for “brother”.
“He was a deep thinker and had a lot of wisdom,” Ms Hall told the ABC.
“Many of his friends from detention have told me, since he died, how he was always the one to calm them down and help them see things from a bigger perspective, when they weren’t coping.
“He didn’t believe in fighting fire with fire. He was a genuine man of peace.”
Ms Hall said his pacifism came from his Muslim faith and an aversion to the kind of violence that led him to flee Somalia, where his family faced civil unrest and violent extremism.
He witnessed his father and brother being shot dead, and was shot himself as he fled, Ms Hall said.
She added he was beaten in the head during the unrest, which left him half blind in one eye.
“Biixi had always been an overcomer. He’d always managed to stay upbeat and crack a smile and even laugh at his situation, but when I finally got hold of him on Nauru — after weeks of losing contact — he was a shell of the man I’d known,” she said.
She said the government’s policies ultimately deprived her friend of the future he dreamed of and the kind of life he could have built in Australia.
“Like every refugee, all Biixi wanted was a chance to live and contribute to society. Biixi longed to work and provide for his wife and family,” Ms Hall said.
“Biixi never got the chance to pursue any of those dreams. Instead, he went over eight years without knowing if or when he would be free and safe. It’s a slow, crushing kind of torture.
“There’s no doubt in my mind that had Biixi been allowed to settle in Australia when he first sought to in 2013, he’d still be alive today.”
‘The ultimate neglect’
Nina Field, the ASRC’s detention rights and advocacy casework coordinator, said Mr Mohammed’s case amounted to medical neglect.
“This is a really sad picture of the ongoing medical neglect that occurred on Nauru, Manus, and PNG,” she said.
“Conditions were ignored, minimised, not properly treated.
“A culmination of physical and mental health problems contributed to significant deterioration of people, and it unfortunately, in this case, it led to someone’s death. And that is the ultimate neglect.”
She said the health of detainees on both Manus and Nauru was overseen by government-contracted International Health and Medical Services (IHMS), and that Mr Mohammed’s tests in 2017 were undertaken at PNG’s Pacific International Hospital in Port Moresby.
He opted to move to Nauru in 2019, as the government made that an option for people on PNG, and was approved for transfer to Australia under medevac in early 2019.
But he suffered a heart attack on Nauru in April 2019, Ms Field said.
She said he collapsed and required CPR and defibrillation, and was transferred to a Brisbane hospital two days later.
The ABC approached spokespeople at Queensland Health and WA Health, who referred questions to the Department of Home Affairs. The ABC also approached the Pacific International Hospital for comment.
After treatment, Mr Mohammed was held in immigration detention in Brisbane and then Perth, before being released into community detention in late 2019.
He was then released into the community on a bridging visa in 2020, his friend Ms Hall said.
In a statement, the Department of Home Affairs said the government supported Nauru and PNG “to deliver health care to transitory persons by contracting specialist health services, including mental health”.
“When essential health care is not available in Nauru or PNG, temporary transfer to a third country may be undertaken,” the Department of Home Affairs said, adding that “people detained in immigration detention facilities are treated in accordance with human rights standards”.
“Healthcare services available to detainees is comparable to those available to [the] Australian community under the public health system.”
Calls for more oversight and better care
The Department said the conditions of immigration detention were subjected to “regular internal and external review” by bodies including parliamentary committees, the Commonwealth Ombudsman, the Australian Human Rights Commission and the Australian Red Cross.
“Scrutiny from external bodies helps to ensure detainees are treated humanely and fairly,” the Department said.
But ASRC’s Ms Field said there wasn’t enough independent oversight, and there was “patchy” medical treatment for those brought onshore under medevac.
“There are still over 100 people who are transferred for medical treatment, under the medevac laws in onshore detention in Australia,” she said.
“And many of these people have not had their medical issues addressed adequately.”
Refugee Council of Australia’s senior policy officer, Sahar Okhovat, said 12 people had died on Nauru or Manus Island, “mainly as a result of inadequate healthcare or by suicide”, and another man took his own life in community detention in October 2019.
“The death of Mr Mohammed brings the total death toll of refugees and people seeking asylum subject to offshore processing to 14,” she said.
“We are also aware of a number of people in this cohort who died after being returned to countries of origin.”
She said the ongoing limbo can damage people’s mental and physical health, adding that “years of substandard medical care” had exacerbated pre-existing health issues and created new ones.
“Those who have been transferred to Australia for medical care continue to face uncertainty and many remain in closed detention,” she said.
“We know this makes people more unwell. We fear that unless people are provided with a durable solution, we will see more deaths.”
ASRC’s Ms Field said Mr Mohammed’s death had a deep impact on those who knew him, and that the grief reverberated far beyond his immediate family.
“There’s basically a whole group of guys who spent a lot of years with him on Manus, who are just devastated by this loss — absolutely devastated,” she said.
Ms Hall, shared details of her friendship with Mr Mohammed because she hopes it will provoke change.
“He had a heart of gold — as anyone who knew him would tell you,” she said.
“Nothing can bring Biixi back to us, but I implore all members of Parliament to examine their own hearts in the light of Biixi’s death,” she said.
“My prayer today is that we will see a radical change in the government’s treatment of all who’ve come seeking our protection.”
