Refugee advocates have broken down telling senators about the experiences of people held on Manus Island and Nauru, citing suicide attempts, children banging their heads against walls and detainees being called by number.
A parliamentary inquiry has also been told of mouldy food, limited access to water and squalid living conditions at the Australian-run immigration detention centres.
Psychologist Paul Stevenson on Tuesday handed senators a 700-page dossier recording all incidents reported to him while working on Nauru and Manus Island between July 2014 and July 2015.
The documents form the basis of what are known as the Nauru files, some 2000 leaked reports outlining allegations of abuse, neglect and self-harm.
Mr Stevenson said he witnessed through email, transcripts of incident reports and personal experience a 30 per cent systematic downgrading of incidents categorised as “critical” to “major” and “minor”.
“I suggest to the Senate that these downgradings were deliberate,” he told senators in Brisbane.
“Their purpose was in relation to the avoidance of abatement fees to the value of $80,000 per incident imposed by Transfield (the manager of the centre) to Wilson (the security contractor) in the event that critical incidents were not reported to Transfield within three hours of their occurrence.”
The inquiry also heard refugees and asylum seekers in need of medical scans have been left waiting months for tests requested by doctors on Nauru and Manus Island.
Dr Paddy McLisky from Doctors for Refugees says reviews of medical records from offshore detention centres revealed patients had waited months for authorities to give approval for them to be transferred to Port Moresby or elsewhere for treatment.
Patients had also been removed from medical facilities prematurely and returned to detention facilities.
“There have been cases where it seems the Department of Immigration may have taken people from hospital a little earlier than the doctor had recommended, perhaps post surgically or after an event of harm,” he said.
There were also cases where refugees and asylum seekers transferred to Australia for medical treatment had been taken back to Nauru or Manus in “medically inappropriate” circumstances before they had had adequate time to recover.
“We do know of a case where a young woman was dragged across the courtyard and sent back to Nauru and she was not long out of hospital, Dr McLisky said.
“She was actually on a suicide watch program at the time.”
Of the 250 cases Doctors for Refugees was reviewing, half indicated delays in treatment, Dr McLisky said.
“We commonly find that recommendations for treatment are delayed longer than we would find acceptable in Australia. That’s just sort of run of the mill,” he said.
Liberal backbencher Ian Macdonald hit back, saying it would be the same for Australians in rural areas.
Dr McLisky said health professionals on the islands were working in a system that impeded their ability to provide care, requiring the approval of the immigration department in order to access medicines or treatments that weren’t available.
“You’re taking a clinical decision and putting it into the hands of a non-clinician and we find that this is a dangerous practice,” he said.
Doctors for Refugees, along with the Australian Churches Refugee Taskforce, recommended the urgent evacuation of all refugees and asylum seekers on Nauru and Manus Island.
Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14.
Suicide Call Back Service 1300 659 467.