At least nine asylum seekers on Nauru have contracted dengue fever amid an outbreak on the island, including one man who was medically evacuated to Australia for treatment and then returned this week, according to a legal aid group and an asylum seeker there.
Cases of dengue, also known as break-bone fever, rose sharply in July amid a broader outbreak of the virus in the Pacific. The infection is transmitted through mosquito bites, and those with symptoms can experience a high fever, body aches, headache and nausea. Severe cases may require hospitalisation, and in extreme cases lead to death.
Those infected a second time are at even greater risk of severe dengue.
Nauru’s president, David Adeang, said last week he was “overwhelmed by the increased number of dengue fever cases”, including among families and children.
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Two children died of dengue in Nauru on Wednesday, the government said in a public statement on social media.
“The health of our community depends on the actions we take now,” Adeang said. “This rapid spread of dengue requires every one of us to unite.”
Heidi Abdel-Raouf, the manager of detention casework advocacy at the Asylum Seeker Resource Centre (ASRC), said the group was aware of nine men who have dengue, “but there are reports of many more”.
There are approximately 93 asylum seekers and refugees on Nauru, who mostly live in the community on a stipend of $230 a fortnight from the Australian government. They have been there between two and 22 months, and will never be settled in Australia under government policies. Those with refugee status currently have no resettlement options.
“Many of the men have pre-existing health conditions, which mean that the illness that they have with dengue is just compounding,” Abdel-Raouf said.
“We know from the history of offshore detention that … due to indefinite detention and poor living conditions and limited and inadequate healthcare services, that detention effectively makes people really unwell.”
An asylum seeker on Nauru told the Guardian he was diagnosed with dengue four or five days ago. He said through an interpreter that he still had a fever, his entire body was painful and he could not eat.
He was taken to a facility for blood tests and told to take two tablets of Panadol every six hours after his diagnosis. There is no specific treatment for dengue and doctors generally advise the use of analgesics to control pain.
“I am very concerned because I don’t think the medication, Panadol, will be helping me, especially because I cannot eat,” he said.
“It’s hard to move around, I don’t have enough strength because I cannot eat enough, so I am very concerned.”
Accessing mosquito nets, he said, was “impossible”.
“There are no mosquito nets available anywhere in Nauru.”
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The ASRC said some of the men on Nauru who were sick with dengue had reported difficulties getting enough paracetamol to deal with the pain caused by the virus, with some reporting receiving 10 tablets when they required at least 30 to help manage a few days of sickness. Abdel-Raouf also said the men had difficulty accessing Hydralyte and fruit and vegetables to aid their recovery.
The asylum seeker who spoke to the Guardian said in his case, he had been given enough Panadol to comply with his doctor’s treatment plan.
ASRC also said some of the men had requested mosquito repellant and insect netting, but authorities and case managers were not able to help them.
“Some men were particularly concerned because they live in a jungle-like area, with a higher number of mosquitoes, a higher chance of getting dengue,” Abdel-Raouf said.
Guardian Australia contacted the Australian Border Force for comment on medical supplies and insect control measures provided to those on Nauru, as well as figures on the number of people sickened with dengue. The Nauru government did not reply to a request for comment on the outbreak.
The Department of Home Affairs said it was aware cases of dengue fever were rising in Nauru, adding it is following the lead of the country’s government “to coordinate the response to the dengue outbreak”.
A spokesperson said transfer to Australia for temporary treatment “may occur on a case-by case-basis depending on individual circumstances where necessary medical treatment is not available on Nauru or to support engagement with third country migration options”.
The department added that transitory persons “do not have a settlement pathway in Australia”.
The Department of Foreign Affairs’ website notes that severe dengue fever is rare, but “a medical emergency that needs hospital treatment”.
Islands across the Pacific including Samoa, Fiji and Kiribati all reported high numbers of dengue cases in recent weeks. At least two people died in Samoa in the latest outbreak.
Abdel-Raouf said the situation on Nauru would only grow worse the longer people seeking asylum in Australia remained there.
“The health system on Nauru is already fragile and easily overwhelmed – it will struggle to cope with this outbreak,” she said. “Australia has a clear responsibility for the refugees our government has banished there.”
A UN watchdog ruled in January that Australia had violated the rights of asylum seekers detained on Nauru, finding a nation “cannot escape its human rights responsibility when outsourcing asylum processing to another state”. Australia has maintained it is not responsible for the treatment of asylum seekers of refugees there, saying it works “closely” with the country to “support the provision of health, welfare and support services”.