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Dozens of babies have been born among the Nauru refugee population and many children are traumatised, a child psychiatrist says.
Child and adolescent psychiatrist Vernon Reynolds was working for International Health and Medical Services, a firm contracted by the Australian authorities to provide health services at the detention centre.
He told Checkpoint the island was hot, cramped and the refugee detention complex was on the site of a disused mine in the island's interior, where the temperature often reached 40°C.
Many children were already traumatised when they arrived on Nauru, Mr Reynolds said.
About 30 babies have been born to the refugee population and while he was there working, he treated about 50 children, he said.
"For those kids that's all they've known. A lot of the other children that we saw came as infants, three to seven years old, and have now spent a huge chunk of their life on the island," he said.
"Many of the refugees have been there for about five years."
Most of the mental health conditions related to trauma, Mr Reynolds said.
"Most of these kids have had various traumas, whether it'd be the initial trip in their attempt to get to Australia and the boats that they took, the experiences that they've had through the detention process, which is a paramilitary prison-like process," he said.
"You're looking at near on 50 percent of the children in that situation have had serious mental health concerns."
The 21sqkm island is home to 119 child refugees at present.
Prime Minister Jacinda Ardern is due to visit Nauru next month for the Pacific Island Forum.
Mr Reynolds said the prime minister's visit was a great opportunity for New Zealand to speak out more strongly on these issues.
"I think we have to speak strongly that this is an intolerable situation which has a political situation and that is really the only solution that these children have," he said.
"We can offer them a home and I know New Zealand's offered to take 150 people from Nauru and Australia has decline, we can put pressure on Australia to make that happen.
"We can speak out loudly, we can speak out in the UN we can use means to give these innocent and vulnerable children a voice, which they have not had up to date."
Mouldy tents in an area of the regional detention centre have been pulled down, in a move refugee advocates say is a cynical attempt to "pretty up" the island before dignitaries arrive.