Since the High Court’s judgement on the 19th of December, which found the government’s plans to remove asylum seekers to Rwanda to be lawful, Medical Justice welcomes the fact that applications to appeal this decision are being made.

The Rwanda Scheme between the UK government and Rwanda enables the UK to forcibly remove those asylum seekers deemed to have arrived by irregular routes, to Rwanda.

People seeking asylum continue to receive notices about potential removal to Rwanda. This continues to cause distress and worry. The harms to mental health, as documented in our report Who’s Paying the Price, remain to be of concern.

See coverage from BBC World Service’s Focus on Africa programme, featuring Medical Justice and Prof. Martin McKee, the president of the British Medical Association.

BBC World News / BBC Africa – January 2023

In December we held a joint webinar with the British Medical Association and Medicines Sans Frontières. This event discussed the severe health impacts of the UK’s policy to remove people seeking asylum in the UK to Rwanda. It shone light the parallels with Australia’s failed offshore detention policy where people seeking asylum were detained on Nauru and Manus Islands with horrific consequences for their health.

Speakers included

• Prof. Martin McKee – chair
• Dr Rachel Bingham, clinical advisor at Medical Justice (pictured)
• Prof Cornelius Katona MD FRCPsych, Hon Medical and Research Director, Helen Bamber Foundation and Hon Professor, Division of Psychiatry UCL
• Reem Mussa, humanitarian advisor and coordinator of the Forced Migration Team in MSF’s analysis department
• Elahe Zivardar, person with lived experience of being held on Nauru Island

The recording of our joint event is now available. you can access this here:

Indefinite despair – Health consequences of the UK’s plan to expel asylum seekers to Rwanda – YouTube

Since the High Court’s judgement on the 19th of December which found the government’s plans to remove asylum seekers to Rwanda to be lawful, we welcome the fact that applications to appeal this decision are being made.

The Rwanda Scheme between the government and Rwanda enables the UK to forcibly remove those attempting to claim asylum in the UK deemed to have arrived by irregular routes, to Rwanda. The policy is already having a devastating impact on the health and wellbeing of those targeted and has been strongly condemned by the BMA and the rest of the medical community.

People seeking asylum are continuing to receive notices about potential removal to Rwanda. This continues to cause distress and worry. The harms to mental health, as documented in our report Who’s Paying the Price, remains to be of concern.

Along with the British Medical Association (BMA) and Medicines Sans Frontières, we are organising an open letter from health professionals urging the Prime Minister to abandon the Rwanda Scheme.

The harms that the prospect of removal to Rwanda is causing to individuals is unconscionable. As health professionals, committed to alleviating suffering, we cannot turn a blind eye to the harmful effects this policy is having and will continue to have on people who are made vulnerable by restrictive border policies.

You can add your name and affiliation to the letter here:

SIGN THE OPEN LETTER (bma.org.uk)

Content warning : distressing video scenes of abuse and self-harm

This video provides an overview of everything most people need to know about the past and continuing abuse of vulnerable people in immigration detention, and how clinical ‘safeguards’ are unworkable.

This recording is of an All-Party Parliamentary Group (APPG) on Immigration Detention briefing session organised by Medical Justice to summarise the evidence heard by the Brook House Public Inquiry (BHI), set up to investigate the shocking mistreatment of detained individuals at Brook House Immigration Removal Centre (IRC) which was caught on undercover cameras and exposed by BBC Panorama in 2017.

Speakers :

• Alison Thewliss MP: chair of the APPG
• Callum Tulley: the whistle-blower G4S custody officer who filmed undercover
• Stephanie Harrison KC: represented Medical Justice and people mistreated in detention
• Dr Rachel Bingham: undertakes clinical assessments of Medical Justice clients in detention
• Mishka: Allies for Justice member who has experienced detention in the UK

Read the accompanying Medical Justice written summary

Panorama showed a vulnerable detained person being choked by an officer who threatened to kill him, and being demeaned and threatened by other officers with further violence after a suicide attempt.  This was just one example of abuse of one individual, in one IRC – built to detain 448 people at a time – where mistreatment was widespread.

The Home Secretary resisted setting up a public inquiry but was compelled to do so following legal proceedings by formerly detained persons subject to abuse.  The BHI is a unique opportunity for public scrutiny as it is the first ever public inquiry into immigration detention conditions despite decades of documented concerns, including inhuman and degrading treatment and neglect contributing to deaths of detained people.

Only undercover reporting has exposed the true nature and scope of the abuse.  It has taken a public inquiry to compel witnesses including – for the first time – senior officials of the Home Office and its contractors, plus extensive disclosure of documents and camera recordings, to enable all the dots to be joined up and the causes and contributing factors to be properly investigated.

The BHI examined institutional practices and culture at Brook House IRC, within G4S and within the Home Office, in 2017 and also at the time of the public 2021-22 hearings. It heard evidence over 46 days from all involved: detained persons, privately contracted doctors and nurses, G4S senior management and custody officers, Serco, Home Office officials, official inspectors and monitors. It also heard evidence from experts chosen by the Inquiry to address use of force, institutional culture, healthcare and safeguards. 40,000 documents, amounting to approximately 250,000 pages of material, were reviewed; as well as video recordings, including IRC CCTV, body-worn cameras and un-broadcast BBC footage.

Central to the Inquiry was the extent to which Home Office policy or practice, or clinical care issues caused or contributed to mistreatment.  Medical Justice was appointed a Core Participant (CP) due to its extensive first-hand experience of the clinical safeguarding failures and understanding of the inadequate healthcare provision in IRCs. As a CP, we were able see all the disclosed evidence as the Inquiry’s investigation developed. Medical Justice provided policy and other safeguarding information specific to immigration detention which added to the evidence from the Inquiry’s clinical expert whose main experience was around prison healthcare. We submitted suggestions to the Inquiry’s legal team for questions to put to witnesses. Medical Justice’s witness statements and oral evidence were referenced extensively throughout the hearings.  Our analysis of our recent casework demonstrated the failures in IRCs are ongoing.

The evidence that emerged confirmed the longstanding serious concerns of Medical Justice and others, but also exposed even more shocking abuses than had previously been understood.  The clinical safeguard failures and harm caused that Medical Justice saw in 2017 was just the tip of the iceberg that lay below.

Vulnerable people were detained indefinitely – manifestations of their deterioration and distress were not identified and there was no adequate treatment. They were often responded to with excessive and disproportionate use of force, which was routine and normalised in the context of removals, the use of segregation, and the “management” of mental distress and self-harm.

1. Doctors and nurses admitted they did not understand how the clinical safeguards were meant to operate and had never applied them properly. They often failed to identify or assess symptoms of trauma, nor did they have the means to provide treatment for it, alarming given that detention itself is inimical to the treatment of mental disorders, especially for the many detained torture and slavery survivors with trauma-related mental illness.
2. Clinicians wrongly sanctioned the use of force on vulnerable detained individuals, failed to stop violent ‘control and restraint’ that they were responsible for observing, and colluded in falsifying records.
3. There was a complete deprivation of clinical safeguards as well as inadequate oversight by the Home Office and its contactors created conditions for mistreatment and abuse at Brook House; a causal link was identified between the complete failures of clinical safeguards and the violent abuse.
4. Use of pain-based “control & restraint” techniques against those in mental distress and who lacked capacity, who may therefore have had impaired responses to the use of pain, risking prolonged and more extreme force.
5. A ‘prevailing’ culture of not using body-worn cameras and evidence of cover-up amongst staff.
6. Widespread mistreatment and abuse by custody officers, IRC doctors and nurses – with the complicity of G4S Managers and indifference amongst Home Office officials – was facilitated by an absence of accountability.
7. Brook House was built and operated like a prison, despite detention there not being part of any criminal sentence. The Home Office contract with G4S had higher penalties for failed removals than for self-harm acts or even death; a premium on profit over fundamental human rights. G4S employees said that there was Home Office pressure to prioritise removal of detained persons over welfare, creating a breeding ground for the desensitised, racist, inhumane environment uncovered. One officer, when asked why a removal proceeded despite the concern that the person had swallowed razor blades said “It was an escorted removal so we were obliged to present him. If he had swallowed a blade it would not have presented a huge problem.”
8. Normalisation of the infliction of pain, suffering and humiliation, even whilst the detained person was naked, or so emaciated the man could barely hold his own body weight. Use of force against naked detained persons was “unusually high” and was a direct consequence of the no notice removal window policy (later found to be unlawful in the course of Medical Justice litigation).
9. Evidence of pervasive derogatory and violent verbal abuse and racism to or about detained people revealing an underlying lack of any empathy even when people were at their most distressed and vulnerable- even in life-threatening situations.
10. An inability to learn lessons. There is no formal process for reporting back on criticisms to managers of IRCs and Home Office decision makers – not even court findings of inhuman & degrading treatment, or from coronial jury findings of failures, where the harm caused resulted in death.

The reaction of the Home Office and its contractors has been one of indifference and intransigence. Phil Riley, Director of Detention and Escorting Services, insisted in his evidence that the Home Office had taken “every step we could take proportionately to deliver a safe environment”.

There have been no criminal charges brought against any individual Home Office or G4S employees officials for misfeasance in public office. The Inquiry did not hear evidence of any public apology to any individual or any admission of liability of unlawful conduct.

Today Medical Justice sees the same tip of the iceberg we did in 2017 in terms of clinical safeguarding failures and the harm this causes, and we fear this suggests that the violent abuse identified at Brook House IRC may be continuing across the detention estate.

The government knows of this avoidable abuse, yet is set to ramp it up with plans to increase detention capacity by 1,000 spaces in 2023, the detention of asylum seekers being removed to Rwanda, the inhumane Manston detention site, the reintroduction of Labour’s discredited detained fast track process, as well as emerging forms of quasi-detention in military barracks.

The Chair of the Inquiry is yet to publish her report. Meanwhile, Medical Justice has produced a summary of the evidence heard by the Inquiry that has been made publicly available, providing references we consider of most public interest – Brook House Inquiry Briefing Key Issues

Published today by the Independent Chief Inspector of Borders and Immigration

Third annual inspection of ‘Adults at risk in immigration detention’ – “On the basis of this inspection, the Rule 35 process needs to be called out for what it is – ineffective. It is in the gift of the Home Secretary and senior officials to make the system more effective. However, Home Office senior managers demonstrated a lack of interest in improving Rule 35 specifically… The system is not effective and will remain not effective until leadership action is taken … I am concerned that the Home Secretary has judged this to be an appropriate moment to terminate her predecessor’s commission to ICIBI to carry out an annual review of ‘Adults at risk’ policies and safeguards.”

Medical Justice’s evidence for BHI

BHI’s evidence