A Papua New Guinea hospital has recommended a rare set of conjoined twins remain in the country, saying at least one of the twins would be unlikely to survive if they were to travel overseas for surgery to separate them.
The boys, Tom and Sawong, were born in remote Morobe Province on October 9 and airlifted to the capital Port Moresby for further care.
Conjoined twins are extraordinarily rare, accounting for fewer than every two in 100,000 births, with surgery required to separate the infants.
The public hospital where the newborns are currently being treated does not have a neonatal intensive care unit and there are concerns the country's medical system is not well placed to deal with the complex case.
The parents initially hoped to travel to Australia for specialised treatment but said doctors in Port Moresby later advised them it would be too expensive.
They then began investigating treatment options at a major hospital in the German city of Freiburg with the help of Jurgen Ruh, the pilot who flew the twins to Port Moresby.
But now the Port Moresby General Hospital has recommended Tom and Sawong remain in Papua New Guinea for treatment.
Both twins were found to have "complex congenital anomalies" including sharing a liver, a bladder and portions of their gastrointestinal tract, the hospital said in a statement.
Hospital chief executive Paki Molumi said, if the twins were separated, one or both would likely die, and the surviving twin would require long-term medical care, interventions and rehabilitation.
Tom, the smallest twin, has a single kidney, a severe congenital heart defect and "hypo plastic lungs" — a condition where the lungs are underdeveloped and can affect breathing, as well as overall development.
"Taking all these factors into account, our team collectively agreed that it is in the best interest of the twins and their family to continue care here at the Port Moresby General Hospital," Dr Molumi said.
"We remain committed to providing the specialised clinical and supportive care to both infants as well as psychological and social support to the parents and family during this difficult time."
A spokesperson for Foreign Minister Penny Wong said the Australian government was "working closely with our partners in Papua New Guinea to help ensure the twins receive the best medical care".
"Our thoughts are with the family during this incredibly distressing time," the spokesperson said.
"This is a complex and challenging situation for the family and we have been working with medical partners to support them."
Pilot Jurgen Ruh said he would continue to advocate for the boys to receive treatment abroad.
"If the twins pass on in a hospital with best neonatal care equipment and manpower, we can say that we tried our best. If the twins pass on in Port Moresby General Hospital, where there is only basic equipment, we did not try our best," he said.
"Little Tom needed neonatal open-heart surgery two weeks ago, which cannot be performed in Port Moresby, but he is still fighting on."
The ABC understands German doctors are still reviewing the case.
The Australian government said it was working "in the best interests of the twins, guided by their medical teams".
"Australian government funding has not been an issue," a spokesperson said in a statement.
"Our thoughts are with the twins, their parents and their family at this time."
