Human rights groups have warned that a mental-health crisis on the Pacific island of Nauru is exploding as hundreds of asylum seekers stranded there lose hope of making it to their intended destination: Australia.

Despite those concerns, however, Nauruan authorities demanded that staff members of Doctors Without Borders cease their operations on the island, the humanitarian group announced Wednesday.

The group, which provided psychiatric and psychological assistance to the local population and asylum seekers, said the decision will jeopardize the safety of many patients who relied on its doctors for urgent treatment. At least 78 people under the group’s care have contemplated suicide or “engaged in self-harm or attempted suicide,” Doctors Without Borders — which goes by its French initials, MSF, for Médecins Sans Frontières — said in a statement.

In 2013, Australia began holding migrants and asylum seekers who try to reach the country by boat in offshore detention. About 900 asylum seekers are held on Nauru, and some have been there as long as five years. Many, including children, suffer from severe mental-health conditions, including depression and anxiety, doctors and human rights groups say.

In a telephone call with The Washington Post on Thursday, MSF humanitarian affairs adviser Aurélie Ponthieu said the demand for mental-health resources on Nauru was so high that the group had a waiting list of about 100 people seeking consultation.

Ponthieu said the local hospital lacked resources to care for large numbers of people with mental illnesses. And while some doctors are contracted by the Australian government to treat patients there, she said, MSF is concerned that those services are inadequate. Asylum seekers “don’t trust anything provided by the Australian government because the government has put them there in the first place,” she said.

The group has provided support on Nauru since November 2017. Australian Home Affairs Minister Peter Dutton told the Guardian on Wednesday that MSF was “invited onto Nauru by their government to provide medical services to local people in Nauru,” saying the group was “never contracted, as I’m advised, to provide medical support to transferees on Nauru.”

But Ponthieu called that claim “completely incorrect” and said MSF had a memorandum of understanding with the Nauruan government that clearly stated it was to provide services to asylum seekers living there.

Asylum seekers stuck on Nauru arrived “with a certain amount of trauma,” Ponthieu said, referring to conflicts or human rights abuses they may have been exposed to in their home countries. Once on Nauru, some of them have been sexually and physically abused, she said. Uncertainty and hopelessness also have set in among this group after years of hoping to reach Australia.

“In the last month, we’ve seen people deteriorating quite seriously,” she said. “We had children as young as 9 years old saying they want to die. We have seen adolescents suffering from resignation syndrome.”

Beth O’Connor, an MSF psychiatrist who worked on Nauru, told The Washington Post that children with resignation syndrome became more depressed, “they withdrew socially.”

“They were no longer eating or drinking sufficient amounts to keep themselves alive,” she said, and stopped responding to her when she spoke to them. “They would just stare through me. And seeing that level of deterioration in the children was really quite horrific.”

In the wake of the humanitarian group’s forced departure from Nauru, MSF has “called for the immediate evacuation of all asylum seekers and refugees from Nauru and an end to Australia’s offshore detention policy."

Australia’s Department of Home Affairs referred the Post to a statement saying that MSF’s removal “is a matter for the Government of Nauru.” The statement said 33 mental health professionals are “providing services to transferees on Nauru,” and said that they are “free to move around the island; they are not in detention.” Nauru is one of the smallest nations in the world: the island is only 8.1 square miles.

O’Connor said that she doesn’t believe there is a “therapeutic solution for these patients as long as they are trapped on the island indefinitely.”

“I fear the withdrawal of MSF’s psychiatric and psychological health care from Nauru will claim lives," she said.

And MSF has warned the plight of families stranded there is only becoming worse.

“I’ve talked to families who said they have to monitor children all the time so they don’t kill themselves,” Ponthieu said. “It’s an awful situation. It’s one of the most dramatic situations I’ve seen in a migration context. It’s very heartbreaking.”

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