Brussels After Médecins Sans Frontières (MSF) was instructed on 5 October 2018 by the Nauruan authorities to terminate its mental health activities in the country within less than 24 hours, MSF was also ordered by the Supreme Court of Nauru to comply with national law and to hand over all medical records to the Director of Medical Services of the Hospital of Nauru. The Department of Justice and Border Control also demanded MSF delete all remaining copies of these files. The MSF team on the island was threatened with legal repercussions and informed they would not be allowed to leave the island until this was done.

“There was no time to prepare patients prior to our departure or to do a proper handover of their care”, said Dr Marc Biot, MSF’s Director of Operations. “We didn’t receive adequate guarantees about an alternative provision of medical care, and we doubted continuity of care would be ensured. It was also a problem for us that there was no time to ask for patients’ consent before transferring their medical records to the Ministry of Health.”  

MSF’s medical ethics require informed consent from patients before sharing of their records with another party.

“This raised an important question about the compatibility of the request with international medical ethics as well as patients’ rights and best interests,” said Dr Biot. “It was clear to us that our patients’ health and continuity of care was of little concern to the health authority during this process.”

Due to the particular vulnerability of refugee and asylum-seeker patients on Nauru and the expedited way MSF was forced to interrupt its mental health services, the organisation took the decision to protect patients’ rights to obtain their medical records, while still complying with the order to destroy the remaining copies of the patient files in its possession. MSF therefore ensured that patients would still be able to access their medical files, before proceeding to delete them from MSF archives. Moreover, MSF handed over only those medical files that were available in the database at the time. All files have been deleted from MSF archives and remain accessible only to the patients.

“We strongly deplore the process and pressure exercised on our team by Nauruan authorities. This showed us how far the authorities of Nauru are ready to go to protect an unfair and inhumane system of offshore detention on the island,” said Dr Biot. “Patients are owner of their medical information and jeopardising their access to it, without receiving any guarantee as to their continuity of care, was an unacceptable request.  We have reminded the Ministry of Health that they can only use this information to ensure the best care for patients and that this information is protected by medical confidentiality.”