***Press release and report under embargo until 00:01 Monday 11 December, 2023***

Click here to read the report


Medical Justice today publishes “If he dies, he dies”: What has changed since the Brook House Inquiry?’. This research, a comprehensive analysis of clinical evidence from 66 clients detained in Immigration Removal Centres (IRCs), visited by Medical Justice independent doctors between June 2022 and March 2023, demonstrates how unsafe and harmful immigration detention can be.

Undercover footage disclosed to the Brook House Inquiry revealed guards saying “if he dies, he dies” in 2017. The justification that this was part of the culture and a joke was found by the Inquiry to be “not only callous and unacceptable but betrays the extent of desensitisation to detained people’s health issues and vulnerabilities, and the dehumanisation of detained people by some staff”.

The experiences of the 66 people in this report shows that many of the same circumstances that were behind the mistreatment evidenced by the Brook House Inquiry, continue to exist across the UK’s IRCs.

The Brook House Inquiry provided a forensic analysis of how the abuse uncovered by Panorama in 2017 occurred. It found how the dangerous use of force, a wholesale failure of safeguards and a culture of dehumanisation led to 19 instances of inhuman or degrading treatment, breaching Article 3 of the European Convention on Human Rights (ECHR), within a 5-month period at Brook House IRC. It exposed failures, mistreatment and indifference at every level; from nurses and doctors, IRC staff, to Home Office civil servants. Light was shone on the structural deficiencies in detention safeguards and processes around use of force, segregation and responses to self-harm and suicidal thoughts.

Medical Justice has consistently evidenced the harm and dysfunctional safeguards to the Home Office. This report is the latest iteration of this work, which has stretched back over the past 18 years. All the failings documented in this report have taken place after the Inquiry’s public hearings, across the detention estate.

The Brook House Inquiry unequivocally places responsibility on the Home Office, urging action at the highest levels of government. There has been a failure to learn lessons from previous reviews; such a failure is described by the Inquiry’s Chair as a “dark thread” throughout her report. The Home Office publicly state their commitment to learning lessons to ensure that the mistreatment uncovered in Brook House never happens again. Yet, such abuse can only be avoided if there is meaningful change – which has been sorely lacking after previous investigations and reviews over the last two decades. The Inquiry made 33 recommendations which need to be urgently addressed.

The Home Office does not seem to acknowledge the severity of harm ongoing in detention and turns a blind eye to the failures over which it presides. They suggest that these are issues of the past. This ignores the important findings of the Inquiry that many of the factors which allow for mistreatment to occur, are unchanged to date. The Inquiry reached these conclusions after hearing evidence from current Home Office, custodial and healthcare staff and reviewing recent reports from His Majesty’s Inspectorate of Prisons (HMIP), the Independent Chief Inspector of Borders and Immigration (ICIBI) and the Independent Monitoring Board (IMB), as well as from Medical Justice.

This Inquiry cannot be another one for the bookshelves. Our report demonstrates how many of the issues in the Inquiry are still ongoing today, across the detention estate. Action could not be more urgent as the government plans to significantly expand detention and implement the provisions of the Illegal Migration Act, knowing the harm that is still being caused. This ongoing harm is apparent from our evidence, , the death of Frank Ospina in March this year reportedly by suicide, and another recent death in November this year of an Albanian man following a reported attempted suicide, a ‘multiple mass suicide attempt’ and the continuing failures of the Home Office safeguards, including the identification of people at risk of self-harm or suicide.


“The experience in detention is a living hell. I had a constant feeling of panic. The place is a place of despair. I would not wish it on my worst enemy. The healthcare was careless, the officers were racist and would laugh at your face. The staff were abusive and used abusive language. There was a lot of violence inside from the staff, I saw one man be thrown to the floor by his neck in front of everyone. I felt I was never listened to, a mental health nurse laughed in my face when I tried to explain my pain. The worst for me was witnessing a suicide and a couple of suicide attempts. One man did not succeed and tried it again. I am still living with that.

The message I would send is that in the world and in this detention system, I see human beings but no humanity. Don’t treat humans like animals in detention”.


Idel Hanley, Policy, Research and Parliamentary Manager, said:

This research yet again demonstrates what Medical Justice has evidenced for years; immigration detention causes unconscionable harm and distress to vulnerable people. Medical Justice agrees with the British Medical Association that immigration detention should be phased out.

Our report shows that the immigration detention of a population with high rates of vulnerabilities in a prison environment, risks causing harm through damage to their mental health, inadequate safeguarding procedures, use of force, clinically inappropriate use of segregation, and experiences of dismissive and derogatory attitudes. Ultimately, immigration detention remains a wholly unsafe environment.

It is a travesty that this has been ongoing across all UK detention centres since the Brook House Inquiry held its public hearings. The fundamental frameworks are still the same as they were in 2017.

The lack of any significant or material improvements, especially in light of a public Inquiry finding evidence of inhuman and degrading treatment, suggests indifference and an unwillingness to change. This level of desperation, despair and abuse is at risk of rising even higher with detention for removal to Rwanda.”


 Key findings

This research has found that of the case set of 66 clients:

  • 84% had evidence of a history of torture and/or trafficking.
  • 95% had a diagnosis of at least one mental health condition, with a high proportion diagnosed with Post-Traumatic Stress Disorder (PTSD) or some trauma-related symptoms such as flashbacks and nightmares, and/or depression.
  • There are alarmingly high suicide risk levels amongst the clients analysed for this report: 74% of the clients in the case set were recorded as having self-harmed, suicidal thoughts and/or attempted suicide in detention. 13 out of the 66 people in the case set attempted suicide and 17 self-harmed in detention.
  • There were instances of healthcare failing to identify or to provide adequate treatment in detention for particular mental health conditions, such as PTSD.
  • The clinical safeguards in detention – Rules 34 and 35 of the Detention Centre Rules 2001 – are not functioning effectively to identify, protect and route out those at risk of harm, suicide and/or self-harm and those who have a history of torture. The Home Office is failing to release vulnerable people from detention, when brought to their attention through Rule 35.
  • Assessment Care in Detention and Teamwork (ACDT), including constant watch, remain custodial tools for staff to “manage” the risk of suicide and self-harm in detention. Neither processes are therapeutic or clinical, nor are they sufficient to deal with those who are actively suicidal or at risk of suicide or self-harm. These processes are not connected to the safeguards in the Rule 35 process.
  • Seven people out of 66 in the case set were subjected to use of force and/or restraints in detention; three of whom had injuries attributed to the force used on them requiring medical treatment, documented by the Medical Justice clinician.
  • Fourteen out of 66 in the case set were put in segregation during their detention, one of whom was assessed as lacking mental capacity by the Medical Justice clinician. Segregation severely impacted those detained there, including increased suicidal thoughts, self-harming episodes in response and a deterioration in their mental state.


Contact : Emma Ginn on emma.ginn@medicaljustice.org.uk / 07786 517379


Medical Justice is the only charity that sends independent volunteer clinicians to visit clients detained in IRCs to document their scars of torture, deterioration of health and injuries sustained during violent incidents. It has handled 3,589 referrals for people in detention since the 2017 BBC broadcast. We publish research, undertake policy work and strategic litigation, and act as the secretariat for the APPG. Medical Justice was appointed as a CP due to its extensive first-hand experience of the clinical safeguarding and healthcare failures in IRCs.  Our comprehensive evidence submitted to BHI was pivotal in demonstrating a causal link between the complete failure of clinical safeguards and the violent abuse.