Throughout the more than 70 sittings, there were criticisms of the inquest process, applications to dismiss evidence, and bombshell moments of new evidence being tendered – with media from all over Australia there reporting on every moment.

So, after all this time, what did Coroner Elisabeth Armitage find when she completed her inquest into the death of Kumanjayi Walker?

The ‘cascade of events’ and the officer in the centre of them

In the lead up to the “avoidable” death of Mr Walker on November 9, 2019, there were a number of failures committed by NT Police, and the officer who fired three rounds into the young man, Ms Armitage wrote in her findings.

Zachary Brian Rolfe, the officer who shot Mr Walker, had a problematic use of force history which police failed to investigate – let alone discipline – Mr Rolfe over, Ms Armitage wrote.

Most notable of these was a finding by Judge Greg Borcher that Mr Rolfe had lied to conceal his unlawful use of force during an arrest attempt only months before Mr Walker was shot.

The Territory Police’s professional standards command had flagged Mr Rolfe as “having a pattern of rushing in to arrest suspects and causing injury” but Ms Armitage found “nothing was done [by the police] to mitigate further risk to the public”.

Had police properly investigated Mr Rolfe, there is a chance he might not have been deployed to Yuendumu on November 9, 2019, Ms Armitage wrote.

Ms Armitage, in her findings, said she “is not permitted” to make findings suggesting Rolfe is guilty of a criminal offence.

Further, she could not make any findings which undermines a 2022 Supreme Court jury’s verdict which acquitted Mr Rolfe over charges of murder on the last two shots, nor did she make any findings recommending anyone be referred to the Department of Public Prosecutions over the first shot.

She did, however, find Mr Walker’s death was “avoidable,” and she could neither rule out racism played a part in Mr Rolfe’s actions on the day.

In a statement distributed by his lawyer Luke Officer, Mr Rolfe said he does not accept a number of the findings, such as he “subverted” the local Yuendumu police sergeant and instituted his own plan, nor that he “failed to adhere to operational safety training, or that he ignored his training at all”.

“Insofar as some may hold a view to the contrary, this was never about race,” his statement said.

“This might be the appropriate vehicle for the Supreme Court to give clear guidance as to the proper scope of a coronial inquest and what evidence is relevant to it, for otherwise there is a real risk that a coronial inquest will become a roving royal commission which is not the true purpose of a coronial inquest.”

When Mr Rolfe gave evidence at the inquest in May last year – after making a number of applications to stop himself from having to do so – he tendered explosive evidence of racist awards given within the Territory Response Group.

In the aftermath of the evidence, a number of officers have been accused of lying about their knowledge of racist awards within the force.

But acting NT Police Commissioner Martin Dole defended the officers – even though they’ve moved up the ranks – as ICAC, DPP, and internal investigations had “led to no employment actions against those officers”.

In her findings, Ms Armitage made 18 individual recommendations to police.

A number of the recommendations, such as an anti-racism strategy and the “early intervention policy” for officers whose performance raises “red flags”, have already been implemented by police, with the Coroner recommending police “thoroughly” evaluate their effectiveness after 12 months.

NT Police community resilience and engagement command executive director Leanne Liddle has said the police’s anti-racism strategy is awaiting final approval.

So far, acting NT Police commissioner Martin Dole has not made a firm commitment on the police implementing all 18 recommendations.

When asked about some of the recommendations – such as mandatory drug and alcohol testing for officers after they’ve been involved in a “critical incident” – Mr Dole said he would not comment on them.

In her findings, there was “no objective evidence” to either rule or rule out Mr Rolfe was under the influence of drugs when he shot Mr Walker.

Further recommendations for police including restraining on using “long arms” unless approved by a senior sergeant or in an emergency, that there are clear policies in place for the use of “long arms”; that Kumanjayi Walker’s death be used for scenario training as an example of “officer induced jeopardy” among a number of new training sessions; the NT police amend the complaint process and that complaints are dealt with in a “prompt and efficient manner”; and that police implement a policy which ensure members do at least four months policing within a remote community.

‘A troubled young man through no fault of his own’

Days before Mr Rolfe’s arrest attempt, two local police officers attempted to arrest Mr Walker – who grabbed an tomahawk and threatened both officers in response.

Ms Armitage wrote Mr Walker’s actions were “threatening, frightening, and highly dangerous,” but the two officers tried to talk him down instead of drawing their weapons.

Mr Walker escaped, and three days later, Mr Rolfe – despite deriding the two officers ahead of his deployment to Yuendumu – would put himself in the exact same situation as the two officers: in a room with Mr Walker, but only this time he was closer to the young man.

In her findings, Ms Armitage detailed Mr Walker’s difficult upbringing.

When Kumanjayi Walker was five-years-old, his father died. His mother died when he was 12-years-old.

Growing up, he’d had little contact with either, and was brought up in a home surrounded by violence stemming from alcohol abuse.

He’d likely been exposed to alcohol in utero, Ms Armitage wrote, and when he was young he struggled through ear infections, chest infections, meningitis, and more.

He’d started taking drugs at 13-years-old – the same age he began having run-ins with the criminal justice system.

“Some of his childhood offences were in the form of breaches of bail or court orders, or absconding from youth detention or a residential rehabilitation program. Efforts made by the Court to keep him away from Yuendumu were not successful and he regularly returned to Yuendumu,” Ms Armitage wrote.

He was “a troubled young man through no fault of his own,” according to former Yuendumu Police Station sergeant Anne Jolley when asked about Kumanjayi.

But despite Mr Walker’s tough upbringing, “it does not excuse what he [Mr Walker] did when he stabbed Mr Rolfe with the scissors, nor does it make it less dangerous”.

He’d come back to the community for his grandfather’s funeral, and a local police had negotiated a plan to arrest him once the funeral concluded, if Mr Walker did not hand himself in first.

When Mr Rolfe, disregarding the local police’s plan, finally confronted Mr Walker in house 511, he would claim at his trial Mr Walker tried to grab his gun before he shot him.

But in her findings, Ms Armitage found the young man did not reach for the officer’s firearm – something which “validated” the family, Samara Fernandez-Brown said.

Ms Fernandez-Brown, Mr Walker’s cousin, welcomed many of Ms Armitage’s recommendations, and said “it’s now our opportunity to take back control”.

“We don’t want to be focused on Band-Aid solutions anymore,” she told media in Yuendumu a day after the findings were delivered.

“We want to have programs that help our young people come up and be able to dare to dream and do some really strong things and we want that to be centred around the Warlpiri and mob.

“By doing that it’s going to sort of prevent deaths in custody because there will be programs that sort of offer alternative pathways.”

Of the 33 recommendations made, 10 are directed at the government, many of which are directed towards giving more power to Yuendumu to help them deal with troubled youth.

Ms Armitage has recommended a review into youth services in Yuendumu, convene a meeting with local council in the community, the government train and resource skilled cultural mediators, co-design a 10-year plan with the community to deal with troubled youth, and develop a strategy to help deliver culturally competent mental health services for Aboriginal people in Central Australia.

A CLP government spokesperson, responding to questions sent to Chief Minister Lia Finocchiaro asking if her government was committed to implementing all the recommendations, said the government was “working through” the recommendations.

They did not offer a firm commitment to implementing all of them, as “much has changed over the last six years”.

The traumatic aftermath and the ‘sad reality’

Kumanjayi Walker was first shot at 7.22.01pm on November 9, 2019. Five hours earlier, the nurses at the Yuendumu Clinic left the town.

The nurses were given the all clear to evacuate by NT Health after there had been a series of break-ins at the nurses accommodation in the lead up to the fatal shooting of Mr Walker.

Nurses from nearby Yuelamu were called to assist in the wake of the shooting, but when they arrived, Mr Walker was already dead.

The lack of communication between NT Health and police was the subject of its own chapter – one of 12 – in Ms Armitage’s findings.

While all the white staff had left, unbeknown to police, an Aboriginal health practitioner was still in the community.

While Mr Walker was in his cell being provided with first aid – who was provided with “first rate” CPR by Mr Rolfe in “an example of one of his strengths” – family was not allowed to see him.

Further, they were told he’d been taken to Alice Springs hospital, when in reality, he had died inside the cells of the Yuendumu police station.

Had the local Aboriginal health practitioner been called to the station, they could have provided “considerable comfort” to the young man in his final moments, Ms Armitage wrote.

But, despite the withdrawal of the nurses, the “optimal chain of events” in which Mr Walker could have survived his wounds could have never occurred.

The three shots had “caused a pneumothorax or hemopneumothorax” on Mr Walker, but, had he been transferred to the staffed Yuendumu clinic, “it is not likely to have led to him surviving the injuries,” Ms Armitage found.

If the clinic was open, they most likely wouldn’t have had the necessary equipment to perform the complex medical procedures required to keep him alive until a medical evacuation flight arrived, Ms Armitage found.

“The sad reality of that night and for Kumanjayi was that, given the inevitable delays in retrieval, it was almost certain that he could not have survived the shooting,” she wrote.

In the wake of the department’s handling of the withdrawal, Ms Armitage has made five recommendations to NT Health.

One of them is NT Health revising its temporary withdrawal guidelines to “ensure withdrawal is a last resort” and that withdrawal is to only take place after consultation with Aboriginal staff and community stakeholders

Others include the department screening all children under five; the department strengthen local health advisory groups; the department “actively participate in” and promote “additional forums for collaboration with remote community groups”; and the department strengthen recruitment and professional development of Aboriginal staff.

NT Health was asked if the department is committed to implementing all five recommendations.

A spokesperson replied, and said the department “acknowledges” the findings, but did not give a commitment the department will implement all the findings.

“NT Health will fully consider the findings and recommendations and provide a consolidated response in due course,” the spokesperson said.

In her findings, Ms Armitage wrote the department was working to implement a number of recommendations, with the department “presently updating” its temporary withdrawal policy.

She also wrote “attempted home invasions and other violence and crime against Yuendumu clinic staff has continued”.

Five years, two deaths in custody for one NT community

While the findings of the Kumanjayi Walker coronial inquest mark the closure of a gruelling process for the Yuendumu community, it’s also not the only death in custody investigation the community is grappling with.

Weeks before the findings were due to be released, Kumanjayi White, a 24-year-old man from Yuendumu, died inside Coles in Alice Springs after he was restrained by two serving police officers.

While the coronial findings were deferred a month for the community to go into sorry business, what effect the Walker inquest findings will have on the investigation remains to be seen.

Acting NT police commissioner Mr Dole has refused to “confabulate” the two investigations, and has also previously “respectfully” rejected calls for an independent investigation into the death – a call made by the family, and backed up politicians, human rights groups, and more than 700 signatories on a petition.

The investigation into Kumanjayi White’s death remains ongoing, with a cause of death yet to be determined, and none of the officers involved have been charged with any wrongdoing.

Following the release of her findings into Mr Walker’s death, Ms Armitage hopes there will be “a period of reflection and healing”.

“With the commitment of those who have power to act on the recommendations, the circumstances of Kumanjayi’s death could be a catalyst for change that avoids a similar tragedy,” she wrote in her findings.