Darwin, Australia - A toddler sits in a sandpit, staring vacantly into space. He's a handsome, dark-haired boy, about one and a half years old. There's no-one around, but he doesn't seem to notice.
It's an image that stays with Dr Emma Adams, a perinatal and infant psychiatrist, following a visit to three immigration detention facilities in Darwin, Australia. "I have seen babies behave like that, and often it's most clearly when the parents have a significant mental illness or trauma," Adams says. "We saw so many people who were depressed who clearly weren't getting appropriate treatment… When a child's attachment figure is absent or scared themselves, those children can become frozen."
More than 340 children are detained in Darwin's three detention facilities, alongside about 40 pregnant women, most with babies due within the next 10 weeks, according to refugee advocacy group ChilOut. Nationwide, there are almost 1,200 children in detention.
In December, two ChilOut directors, as well as Adams and Caroline de Costa, a professor of obstetrics and gynaecology, gained a rare look into the conditions at the Wickham Point, Blaydin Point and Darwin Airport Lodge detention facilities.
The facilities, which the Australian government calls "alternative places of detention", have become temporary accommodation for women flown from Australia's Christmas Island detention centre to receive antenatal care or give birth at Royal Darwin Hospital.
In a report detailing the visit and meetings with refugee service providers, the specialists wrote that families detained in Darwin were exposed to "unnecessary cruelty". Mothers were often separated from husbands or partners and other children, whom they said remain detained on Christmas Island when the women are transferred to Darwin for care.
Parents spoke of being woken two to four times per night by officers doing head counts, in which they were required to respond verbally. They also noted there was limited access to primary health care, and witnessed a 12-day-old baby in need of medical attention being turned away by medical staff. The parents were told to return in two days' time.
"Overall we were told time and again that service providers want decisions to be 'parent-led' and senior staff repeatedly explained away issues as being 'cultural differences'," the report said. "There appeared to be no acknowledgement whatsoever that parents' sense of agency, their dignity, was taken from them. That the system itself destroys the family unit and makes pro-active parenting nearly impossible."
Refugee advocates in Australia have long called for an end to the detention of immigrant children, arguing that the practice has long-term negative mental health effects on an already vulnerable population.
However, the Liberal-National coalition government, which was voted into power in September, has shown no sign of adopting a gentler approach to vulnerable groups in detention. It has instead focused on its election promise to "stop the boats" of immigrants heading for Australia, and launched a military-led operation, named Sovereign Borders, against people smugglers.
In November, the government came under fire following reports that the immigration department separated an asylum seeker and her sick newborn baby in Brisbane. The mother, a Rohingya woman from Myanmar, was detained for several days while her baby stayed in a neonatal intensive care unit. She was allowed to visit the infant at the hospital during the day.
Prime Minister Tony Abbott said at the time that he deeply regretted what happened, but refused to apologise on the government's behalf. "I don't, as it were, apologise for what happens when people come to Australia illegally by boat, because I am determined, as the new government is determined, to stop this dangerous, this horrible business," he told journalists.
In another controversial decision, the government announced in December that it would disband the Immigration Health Advisory Group, which gave advice on the health needs of refugees, and replace the group with an independent health adviser. Health advocates, including the nation's top medical body, the Australian Medical Association, criticised the move, arguing that specialist health advice was necessary to ensure refugees had access to quality health services.
The immigration department said that the decision was made because the large membership of the group "made it increasingly challenging to provide balanced, consistent and timely advice".
Immigration Minister Scott Morrison's spokesman did not respond to numerous phone calls or emails from Al Jazeera. However, in a media statement issued on December 27, Morrison announced: "The boats have not yet stopped, but they are stopping."
In December 2013, 355 asylum seekers on seven boats were intercepted by Australian authorities - 70 percent fewer compared with December 2012, and the lowest number of arrivals in December in five years, he said. There are now 841 refugees detained in Nauru and 1,229 on Papua New Guinea's Manus Island.
Professor Michael Permezel, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, says women and their children in Australian detention facilities should have standards of care equivalent to those in similarly remote locations across the nation.
However, there remains little information available about maternity health care services in detention centres, such as the qualifications of medical staff, the level of staffing and the availability of medical equipment and drugs, the professor said. "I don't think there's enough information at the moment to say that the only possibility to provide adequate [maternity] care is within the community," he said. "We need to know the levels of care being delivered and the circumstances within the detention centres."
The college has asked to meet with the government's new immigration health adviser to find out what care is being provided to women and their children in detention.
Adams, who works in a private practice in Canberra, knew little about asylum seekers prior to her visit to Darwin. She responded to a request for specialists to accompany the ChilOut team because she thought her experience in perinatal and infant psychiatry might be useful.
However, after her visit, she felt "absolutely appalled and ashamed" over what she saw in the detention facilities.
"I saw some women who were clearly depressed - that blank, flat expression. Some were tearful, some talked of suicide. And when their babies were indicating they were distressed, there was a distinct lack of engagement, which I see with severe post-natal depression in my community practice," Adams said.
"[But] they weren't waiting outside in a queue in a psychiatric appointment. This was just their every day."
Follow Nyssa Skilton on Twitter: @NyssaSkilton