title: Measuring the health impact of human rights violations related to Australian asylum policies and practices: a mixed methods study.
abstract: BACKGROUND
  Human rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes.
  
  
  METHODS
  We designed a mixed methods study to address the study aim. A cross-sectional survey was conducted with 71 Iraqi Temporary Protection Visa (TPV) refugees and 60 Iraqi Permanent Humanitarian Visa (PHV) refugees, residing in Melbourne, Australia. Prior to a recent policy amendment, TPV refugees were only given temporary residency status and had restricted access to a range of government funded benefits and services that permanent refugees are automatically entitled to. The quantitative results were triangulated with semi-structured interviews with TPV refugees and service providers. The main outcome measures were self-reported physical and psychological health. Standardised self-report instruments, validated in an Arabic population, were used to measure health and wellbeing outcomes.
  
  
  RESULTS
  Forty-six percent of TPV refugees compared with 25% of PHV refugees reported symptoms consistent with a diagnosis of clinical depression (p = 0.003). After controlling for the effects of age, gender and marital status, TPV status made a statistically significant contribution to psychological distress (B = 0.5, 95% CI 0.3 to 0.71, p <or= 0.001) amongst Iraqi refugees. Qualitative data revealed that TPV refugees generally felt socially isolated and lacking in control over their life circumstances, because of their experiences in detention and on a temporary visa. This sense of powerlessness and, for some, an implicit awareness they were being denied basic human rights, culminated in a strong sense of injustice.
  
  
  CONCLUSIONS
  Government asylum policies and practices violating human rights norms are associated with demonstrable psychological health impacts. This link between policy, rights violations and health outcomes offers a framework for addressing the impact of socio-political structures on health.
authors.affiliation: Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia. vanessa.johnston@menzies.edu.au
authors.forename: Vanessa
authors.initials: V
authors.lastname: Johnston
authors.forename: Pascale
authors.initials: P
authors.lastname: Allotey
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.forename: Milica
authors.initials: M
authors.lastname: Markovic