Fariborz Karami had been crying out for help for years.
Almost since being taken into immigration detention in 2013, Karami, the asylum seeker who killed himself inside the Australian-run regional processing centre on Nauru on Friday, had, over years, consistently asked for medical intervention to arrest his deteriorating mental health.
“The thought of suicide doesn’t ever leave me. I am suffering intensely every day,” the former dentistry student wrote in one plea to see a doctor.
The 26-year-old Karami died by suicide inside his tent in the RPC3 camp on Nauru on Friday morning. Recently married, he had been held on Nauru, along with his mother and 12-year-old brother, for five years.
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Karami had a background of torture and trauma. A member of Iran’s Kurdish ethnic minority, which faces systematic persecution in that country, he had been kidnapped as a 10-year-old boy and held for three months, threatened every day he would be killed. Psychiatrists identified him as “being severely traumatised”.
From his time inside Australia’s immigration detention system – first on Christmas Island, and then on Nauru – Karami’s extensive medical file is littered with requests for appointments with psychiatrists and psychologists, and charts his downward spiral to death.
In one example in 2014, he filled out a client medical request form to medical services provider IHMS, begging to see a psychiatrist. He said he could not escape thoughts of suicide.
“I want to see a psychologist, not a nurse,” he wrote in halting English, “I have severe mental problems to the point of thinking of suicide.”
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In Persian, he continued: “I am suffering from severe mental illness. I feel absolutely terrible. I am going to go mad from over thinking. Please arrange a psychiatrist meeting for me as soon as possible.”
Across dozens of pages of request forms and assessments, referrals and clinical notes, Karami’s worsening condition is laid bare. Acknowledging his traumatic past, psychiatrists reported a “decline in coping strategies” exacerbated by his long-running detention, uncertainty over his future, and concern for his brother and mother.
“I know myself. I have used reading and studying in the past as a distraction – doesn’t work anymore.”
Doctors recognised his deteriorating condition, reporting: “increased suicidal ideation and agitation. Requesting medication to ‘help with suicidal thoughts’”.
But Karami’s latest reports appear to show him disengaging. He began missing appointments. Last November, he declined to complete a mental health assessment.
“He spoke of being angry at times in the context of his long-term detention,” the report said.
“IHMS has not been helpful at all,” Karami told the doctors at that meeting, “no-one steps forward for us, and we live in a hot tent and can’t breathe.”
An IHMS health summary completed on April 24 this year said he had missed mental health screenings but that “no concerns ... had otherwise been identified”.
“He reported long-term engagement with psychiatrists in Iran and was on medication at that time. Mr Karami states though his post-traumatic stress disorder symptoms continue, that he did not wish to engage with specialist health services.”
However, those around Karami recognised his decline. Also in April, Karami’s 12-year-old brother Ali made a public plea for help for his mother, Fazileh, who was suffering acute physical and mental illnesses. She had been promised a medical transfer to Taiwan but this was cancelled at the last minute. Ali also warned his brother was suffering a mental crisis.
“I feel helpless because there is no one to help us. There is no one to see how we are suffering. My mother is very sick and my brother is totally depressed,” the boy said in a video, published in the Guardian.
International Health and Medical Services (IHMS) is contracted by the Australian government to provide health services to refugees and asylum seekers on Nauru.
Guardian Australia put written questions to IHMS about the medical treatment Karami received.
A spokeswoman for the company said: “IHMS follows a clear client confidentiality and privacy policy and will not disclose information about individual cases.”
About 9am on Friday morning, Karami was found close to death, in his tent inside the “RPC3” – or family camp – of the Australian-run regional processing centre.
He was found by his wife. Efforts by family and friends to revive him failed and he was pronounced dead at the scene.
His wife and mother were hospitalised after his death, and his younger brother taken into the care of camp authorities.
A friend of Karami said he had been frustrated by his family’s stalemate after five years of being detained on Nauru. The family’s claim for protection had not been recognised.
“I saw him only yesterday. He was a young athletic guy, but he had been suffering a long time because of his family’s situation. He was sick and tired.”
Karami is the third asylum seeker or refugee to die by suicide on Nauru, and comes only three weeks after a Rohingya refugee on Manus Island killed himself.
Twelve people have died from injuries or illness sustained in offshore processing centres since the facilities were reopened in late 2012: asylum seekers and refugees have been murdered by guards or have died from sepsis, medical neglect, accident and suicide.
A spokesman for the department of immigration said: “The department is aware of the death in Nauru today, 15 June 2018. Further enquiries should be referred to Nauruan authorities.”
Staff at the regional processing centre told the Guardian: “It is Australia’s responsibility, it happened in their camp.”
Iranian journalist and refugee Behrouz Boochani, detained on Manus Island, wrote in a tweet: “Department of Home Affairs has referred the case to Nauruan authorities as always. It’s Australia that is responsible for his death, not Nauru! You are the one who exiled people there and denied them medical treatment and support. Dutton must give an answer to people.”
Department of Home Affairs has referred the case to Nauruan authorities as always. It’s Australia that is responsible for his death not Nauru! You are the one who exiled people there and denied them medical treatment and support. Dutton must give an answer to people!#Nauru
— Behrouz Boochani (@BehrouzBoochani) June 15, 2018
The Nauruan government issued a statement on the man’s death. “We can confirm that a man has died in the Nauru regional processing centre today. Our thoughts and heartfelt prayers are with his family. Police are investigating.”
The spokesman for the Refugee Action Coalition Ian Rintoul said the Australian government was responsible for the man’s death.
“There have so many warnings but the toll mounts day by day, the neglect continues. So many cases of medical neglect.
“Peter Dutton must bring all the asylum seekers and refugees to Australia. The US deal is a farce that is now excluding Iranians and Somalis. Dutton has nowhere to settle the people who have been dumped on Nauru and are now dying of despair.”
Rintoul said news of the man’s death had devastated asylum seekers and refugees on Nauru.
“He was a well-known, well-liked, athletic young man who did everything he could for his brother and mother.”
Kate Schuetze, a refugee researcher at Amnesty International, said Australia’s policies were “reckless and cruel” and endangered lives.
“The fact that this man and his family have spent the last five years living in a tent in an Australian-run detention centre on Nauru is in itself disgraceful. He came to Australia seeking protection, a request that was denied, and was instead detained in appalling and inhumane conditions.”
Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14 or Suicide Call Back Service 1300 659 467.