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 August 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.

• Onshore – there are now 6 mainland detention centres (Brisbane, Villawood, Melbourne, Adelaide, Perth, Yongah Hill) see immigration detention statistics.
• Offshore – map of Nauru, Manus Island.

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). 

• As of end September 2020 - people in community detention who were not engaged in the United States resettlement process were transitioned onto a FDBVE (including children/families). This  occurred in Queensland, NSW and South Australia, but was delayed Victoria due to covid. In this circumstance, housing is withdrawn after 3 weeks, and income support within 0-3 weeks (immediately for adults who arrived alone, and 3 weeks for families). A 3-week extension was possible. 
  

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. 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, with work rights and Medicare access. 
  

Asylum seeker identification

There are several means of identifying asylum seeker status; also see information on the DHA Immicards. From 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 Aug 2021 in Victoria, there were: 

• 229 people in immigration detention at the Melbourne Immigration Transit Accomodation- MITA (of a national total of 982, approximately 21% who arrived seeking asylum). The average duration of detention is now 696 days, and 35.0% of the detention population have been detained 2 years or longer (21.9% 3 years or longer).
• 46 asylum seekers in APODs in Melbourne
• 282 asylum seekers in community detention (of a national total of 560, including 175 children)
• 1799 asylum seekers from the 'legacy caseload' with applications on hand/at review, with a further 6724 of this cohort with finalised grants
• 5483 asylum seekers on BVEs in March 2021 - last available published (Aug 2021 = national 11,630 IMA arrival BVE holders in the community, including 1653 children
• An unknown number of non-maritime arrival asylum seekers living in the community - noting that nationally there were 24,566 protection visa applications lodged in 2018-19 and 23,266 in 2019-20 (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 were accepted by the DHA-  via a spreadsheet with consent - 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 and 2020. This was related to the Health Insurance Act (1973) C^th 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). For delays in Medicare renewal - contact Medicare.Public.Eligibility@servicesaustralia.gov.au.

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 are waiting for their Medicare to be renewed (currently 8-10 weeks as of 2020).
• They remain on their entry visa/conditions of their entry visa which did not carry Medicare
• In 2018-19 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 (in 2020) 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) in 2017). These individuals have not had work rights since arrival in Australia (now 7 years), and our clinical experience has been that the vast majority are substantially unwell.

• As of end September 2020 - people in community detention who had not engaged in the US resettlement process were transitioned onto a FDBVE (including children/families) within a 3-week timeframe - this process was delayed for Victoria. In the event of proposed transition, 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, and via Victorian Covid Emergency relief -  for temporary/ provisional/ undocumented migrants (via Red Cross). 
  

Individuals may re-apply for SRSS if their circumstances change - see application form, although it is not clear this applies for the group transitioning onto a FDBVE. 

Table 1: Access to supports for people seeking asylum

Fast track assessment process

Resources

• Asylum seeker identification (Jan 2020) also see DHA Immicards, and PTV cards
• Asylum Seeker Resource Centre
• Cabrini Asylum Seeker and Refugee Health Hub
• Caseworker resources - service access for asylum seekers
• Community hubs project
• Department of Health, Victoria: Guide to asylum seeker access to health and community services in Victoria 
• Department of Health, Victoria: Hospital access for people seeking asylum
• Department of Health, Victoria: Refugee and asylum seeker health and wellbeing
  
• Department of Home Affairs:  BVE
  
• Department of Home Affairs: Immigration detention statistics, onshore processing statistics (BVE), IMA legacy caseload statistics and onshore Humanitarian program (non-IMA arrivals)
  
• Department of Social Services - TPV entitlements
  
• Foundation House:  Asylum seeker fact sheet (March 2015)
• PTV concession cards
• Refugee Advice and Casework Service (RACS)
• Refugee Legal
  
• SRSS - Status Resolution Support Services - also see Department of Home Affairs information, and  application form
  
• West Welcome Wagon - provides donated material goods to asylum seekers in Melbourne's West

^{Immigrant health resources. Author Georgie Paxton and Rachel Heenan, 2017. Updated Dec 2021. Contact: georgia.paxton@rch.org.au}