Between 2013 and 2019, an estimated 200 children seeking asylum in Australia were detained on the island of Nauru. In 2018, 15 of these children developed the rare and life-threatening pervasive refusal syndrome (PRS). This paper describes the PRS case cluster, the complexities faced by clinicians managing these cases, and the lessons that can be learned from this outbreak.
Conclusions:
The emergence of PRS on Nauru highlighted the risks of long-term detention of children in settings that are unable to meet their physical and psycho-social needs. The case cluster also underscored (a) the difficulties faced by doctors working in conditions where their medical and legal obligations may be in direct conflict, and (b) the role of clinicians in patient advocacy.
NgoTHodesM.Pervasive refusal syndrome in asylum-seeking children: review of the current evidence. Clin Child Psychol Psychiatry2020; 25: 227–241. DOI: 10.1177/1359104519846580.
NewmanLKSteelZ.The child asylum seeker: psychological and developmental implications of immigration detention. Child Adolesc Psychiatr Clin N Am2008; 17: 665–683.
6.
NewmanLK.Children seeking asylum – mental health and human rights. In: HovenCW (ed.), An international perspective on disasters and children’s mental health. Switzerland: Springer Publishing, Chapter 17, 2019, pp. 343–361.
7.
JaspersTHanssenGMvan der ValkJA, et al. Pervasive refusal syndrome as part of the refusal-withdrawal-regression spectrum: critical review of the literature illustrated by a case report. Eur Child Adoles Psychiatry2009; 18: 645–651.
EssexR.Do codes of ethics and position statements help guide ethical decision making in Australian immigration detention centres?BMC Med Ethics2019; 20: 52. DOI: 10.1186/s12910-019-0392-8.
BodegardG.Comment on the paper “Pervasive Refusal Syndrome (PRS) 21 years on-a reconceptualization and renaming” by Ken Nunn, Bryan Lask and Isabel Owen. Eur Child Adoles Psychiatry2014; 23: 179–181.
13.
BodegardG.Pervasive loss of function in asylum-seeking children in Sweden. Acta Paediatr2005; 94: 1706–1707.
14.
CousinsS.Australia repeals medical evacuation law. Lancet2019; 394: 2138. DOI: 10.1016/S0140-6736(19)33067-3.
NunnKPLaskBOwenI.Pervasive refusal syndrome (PRS) 21 years on: a re-conceptualisation and a renaming. Eur Child Adoles Psychiatry2014; 23: 163–172.
20.
SondergaardHPKushnirMMAronssonB, et al. Patterns of endogenous steroids in apathetic refugee children are compatible with long-term stress. BMC Res Notes2012; 5: 186.
