The Home Office locked Frank up in an environment known to cause severe harm co, then its notoriously dysfunctional and failing safeguarding ran their fatal course.

On 11th October 2024 an inquest jury found that Frank, a 39 year old Colombian man, killed himself in a locked cell at Colnbrook Immigration Removal Centre (IRC) on 26th March 2023 after three incidents of self-harm or attempted suicide. The jury found that multiple failings contributed to Frank’s death. 

The Home Office cannot keep saying that it takes every detained person’s safety seriously – it is patently not true  

Medical Justice clinicians and caseworkers assist over 600 people in detention each year and encounter alarmingly high suicide risk levels and deterioration in health on a daily basis – we provide evidence of these ongoing systemic and lethal failures to the Home Office, yet IRCs remain as dangerous as ever. HM Inspector of Prisons reported in July 2024 on the worst conditions it has seen in detention, including a ligature point not removed despite being used in three suicide attempts. 

Immigration detention is known to cause severe harm – the evidence is undisputed. Yet, chillingly, the Home Office has purposefully weakened its already failing clinical safeguards at the same time as planning to expand detention. Clearly, increasing detention whilst weakening safeguards means severely harming more people. This harm is not accidental.  

“That would have been the last opportunity I had to embrace my son but I couldn’t” – Frank’s Mother 

Frank had disclosed no health issues when he was detained on 4th March 2023 for working without permission while spending time near his mother in the UK before taking up a place on a master’s course in Spain. 

He became suicidal in detention and jumped from the second floor internal balcony, landing on safety netting. He was found banging his head against a wall after self-harming with a television cable which he insisted to staff he had been using to whip rather than strangle himself.   

Frank’s mother, who left the coroner’s court in tears, described in a statement her struggle to book a visit with her son at Colnbrook and was eventually allowed a “closed visit” behind a glass screen which the inquest found “contributed to the deterioration of his mental health and incurred further stress”. She said “I was horrified, as I did not recognise my son. He was staring at me as if I was not there. … I felt helpless … That would have been the last opportunity I had to embrace my son but I couldn’t.”  Frank’s brother-in-law, Julian Llano, told the BBC: “He kept insisting that he felt very bad, mentally, that he needed to get out of there. He didn’t ask for help – he begged for help, not only to us, but also to the people there.” 

Unacceptably inadequate suicide watch observations failed to recognise Frank was not in his bed and was in fact dead 

On 19th March a triage nurse assessed Frank and advised him to eat healthily, do some exercise and keep busy. 

On the day he died, Frank was on a suicide prevention plan that required him to be checked on by a Detention Custody Officer (DCO) twice each hour after being deemed a “ticking time bomb”. CCTV shows that on 26th March, a DCO checked on Frank at 7.22am, 7.42am and 7.52am and said that he saw Frank in bed on each occasion. At around 8.00am, another DCO took over and falsely recorded that he had checked on Frank at 8.30am – CCTV shows that he did not. 

Shortly after 9.00am, the DCO went to Frank’s cell. He opened the door and looked in. Frank was not in his bed. The DCO closed the door and called for other staff. After 13 minutes, staff attended and went into the room, finding Frank lying on the floor of the toilet area. Staff started CPR even though there were signs that Frank had been dead for some time as he appeared stiff and cold. No one called a medical emergency code. When healthcare staff arrived, they also continued with CPR until paramedics arrived and confirmed that Frank was dead. 

Rigor mortis and staining on Frank’s body suggests he had been dead for at least 2 hours. The Prison & Probation Ombudsman noted that this casts doubt on the DCO’s account that he saw Frank in bed at 7.22am, 7.42am and 7.52am.  

The inquest jury found Frank died by suicide, having been left in possession of an item which could be used for suicide, despite three instances of self-harm or suicide attempts in the previous days. 

Two days later, an “attempted mass suicide” took place at Harmondsworth IRC, adjacent to Colnbrook IRC. 

“if we had done the Rule 35  … then we wouldn’t have had that outcome.” – Colnbrook IRC healthcare 

An IRC doctor who treated Frank in an emergency appointment after his first suicide attempt failed to undertake a ‘Rule 35’ report alerting the Home Office of Frank’s suicidality and triggering a review of his continued detention. Frank later again told staff that he was having thoughts of suicide but again, no Rule 35 report was submitted. Asked at the inquest why not, the Practice Plus Group (PPG) head of healthcare at Colnbrook said: “It was not done. Healthcare missed that … We keep a waiting list for Rule 35 … At some point we had a waiting list of over 100 people… I can confidently say that if we had done the Rule 35 on the 22nd or 23rd [of March], then we wouldn’t have had that outcome.” He also added that the number of people waiting for a Rule 35 “has only increased.” 

In a statement  to Liberty Investigates PPG stated that there is no legal time limit for completing a Rule 35 and that urgent mental health issues are best dealt with via good clinical care instead. It confirmed that Frank was not even on the waiting list for a Rule 35 assessment. 

Four ’Part C’ forms about Frank’s situation were submitted in the four days leading up to his death, but each time Home Office staff failed to forward them to his case worker and no assessment was made. 

Medical Justice is not surprised by the failures and neither should the Home Office be as it has the data 

Based on our evidence from assisting over 600 clients in detention each year, we have been warning the Home Office for the last 20 years that Rule 35 is not working, about dangerously long waiting lists for assessments, the specific lack of Rule 35(2) reports on suicide risk, and the inadequacies of suicide watch processes.   

The Medical Justice “If he dies, he dies” research report found an alarming 74% of the 66 clients cases examined for the report had self-harmed, had suicidal thoughts and/or attempted suicide in detention yet very few Rule 35(2) reports documenting their suicidality were completed. Even after people attempted suicide, Rule 35(2) reports are rarely completed, and if they are, the assessment is often inadequate and incomplete, for example missing information such as a suicide attempt. Of the 46 detained people in this case-set who had suicidal thoughts, this was documented in their medical records for only 23. There should be a Rule 35(2) report for everyone on suicide watch. The Independent Monitoring Board’s report for Yarl’s Wood IRC published 17th October 2024 noted that just 1 of 181 detained people on suicide-watch had a Rule 35(2) report. 

It’s not a matter of ‘if’, but ‘when’ the next person dies in detention – Medical Justice challenging the inexcusable inertia   

A Home Office spokesperson said: “We offer our sincere condolences to Mr Ospina’s loved ones, and since his death in 2023 a number of actions have been taken to improve the safeguards for individuals in detention”. Yet disturbingly the Home Office has weakened its key Adults at Risk policy which sets out how Rule 35 reports are considered, removing the aim of reducing the number of vulnerable people in detention. Furthermore, it plans to re-open and expand two IRCs, adding capacity to detain an additional 1,000 people at any given time. 

Following the Brook House [public] Inquiry (BHI) finding that the wholesale dysfunction of safeguards led to alarming levels of inhuman and degrading treatment in detention in 2017, the Home Office has mentioned a review of its Rule 35 policy but not provided any details about what this review will entail. Meanwhile, NHS England has produced Rule 35 Guidance – which Medical Justice has raised concerns about – as an interim measure before commissioning training from a Royal College on Rule 35, which has been paused while the Home Office review is awaited.   

On 14th October 2024, supported by Medical Justice, the House of Lords debated Adults at Risk policy changes, which are contrary to BHI recommendations. We learned that the review is to be completed by “spring 2025”.  Meanwhile, at least 312 people were on suicide watch in IRCs between April and June 2024. 

Regarding ongoing Rule 35 failures and the increasing numbers of deaths in detention, Medical Justice will ; 

• Continue with urgency our policy advocacy aimed at the Home Office and NHS England  

• Continue to document the severe harm caused by dysfunctional clinical safeguarding failures 

• Support the securing of an adjournment debate about conditions at Harmondsworth and Colnbrook IRCs 

• Support and hopefully join parliamentarians in meeting with Ministers about the deaths and safeguarding failures 

• Send our independent clinicians to visit suicidal clients in detention and produce medico-legal reports 

• Continue our specialised casework, providing emotional support for suicidal clients and advocating for them 

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When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at jo@samaritans.org, or visit samaritans.org to find your nearest branch. 

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Do you have personal lived experience of the UK asylum and immigration system and/or immigration detention in the UK and would like to work as a casework trainee?

Come and work with Medical Justice, a small and dynamic team that builds on casework to produce research that is used to challenge systemic failures in healthcare provision in immigration detention. We expose medical mistreatment in detention and strive for lasting change for all detained people through policy work, strategic litigation, media coverage and parliamentary action.

As a trainee at Medical Justice, you’ll have the chance to learn extensively about Medical Justice and our operational framework as a charity. You will be working as part of our casework team which works directly with people in detention to support them in accessing adequate healthcare and obtaining high-quality independent medical evidence to progress their legal case. You’ll also gain exposure to all areas of our organisation, with the opportunity to interact with research, policy, and advocacy colleagues. This practical experience will give you first-hand experience in the different areas that Medical Justice works in and how we collaborate across those areas to advocate for systemic improvements as well as deliver impactful support for clients.

Our traineeship program is designed to enhance your understanding of the immigration system and broader detention issues, enabling you to gain deeper insights into the interconnected issues and challenges experienced by individuals within these systems.

Through this holistic approach to learning, we hope you’ll emerge from the traineeship equipped with a nuanced understanding of the immigration and detention sectors, as well as valuable insights into the inner workings of Medical Justice as a charity dedicated to promoting justice and human rights. We hope this experience will help to enhance your prospect of further employment with Medical Justice or in the sector, whilst also increasing lived experience amongst Medical Justice staff.

 

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For full Job Description and Application Form download the Application Pack

 

Job Title: Casework Traineeship (Lived Experience)

Salary: London Living Wage – £25,642.50 per annum (pro rata)

Reports to: Casework Manager/Senior Caseworker

Working hours: 3 days per week

Based: Medical Justice office (near Finsbury Park, London)

Length of contract: 6 months

Terms: 8 days holiday, plus statutory bank holidays. Other conditions as statutory requirements and/or Medical Justice polices.

Timeline: The closing date for applications is Sunday 17th November 2024. The interview dates are Monday 25th, Tuesday 26th or Wednesday 27th November 2024 at the Medical Justice office and will include a written and verbal exercise. The ideal timeframe for starting the job is as soon as possible.

To apply: Please read the Application Pack which includes the Job Description and the application form. Email your competed application form and your CV to Anthony at a.omar@medicaljustice.org.uk

We look forward to receiving your application !

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Support from Experts by Experience Employment Network

We are proud to be a member of the Experts by Experience Employment Network (www.ebeemployment.org.uk), which aims to increase representation of people with lived experience in the charitable sector.

If you are an expert by experience (a refugee or a migrant with direct, first-hand experience of issues and challenges of the UK asylum or immigration system), you can ask for an independent and confidential support for your job application from the Experts by Experience Employment Network (www.ebeemployment.org.uk). Please complete this form to request support and they will confirm if they can match you with a mentor to support your application.

Please feel free to use information and resources at https://www.ebeemployment.org.uk/ebe which may help in preparing your job application. The Network can also mentor the lived experience trainee during and after their traineeship with Medical Justice, for up to 8 sessions.

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Information Sessions

We are offering informal information sessions about Medical Justice and its work as well as an opportunity to ask questions about the Casework Traineeship (Lived Experience) role and the organisation before the application deadline.

Our final session will be Monday 11 November at 1.15pm

If you are interested in participating, please email our Office Manager, Anthony Omar on a.omar@medicaljustice.org.uk for more information.

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Are you as determined as we are to reduce the harm caused by immigration detention and to ultimately end it?

Join the Medical Justice team, described by a fellow organisation:

“It is regarded as principled, expert and evidence-based, tenacious in its casework and policy work, fierce and ferocious when needed and brave in the way it speaks truth to power.”

You will be joining an organisation that is making a life-changing difference to hundreds of vulnerable clients in detention each year, as well working to reduce the harm caused by the toxic detention regime with its near-routine levels of inhuman and degrading treatment.

As Head of Advocacy, you will lead the development and delivery of Medical Justice’s advocacy programme, drawing on our evidence of the harm caused by immigration detention, to secure lasting change through combinations of research, policy, parliamentary, and media work, as well as contribute to strategic litigation.

Reporting directly to the Director, you will lead our experienced advocacy team, help develop our strategic objectives and shape our emerging Senior Management Team.

Medical Justice has an organisational commitment to improving the representation of people with lived experience at all levels of organisation, especially leadership roles.  We are keen to look beyond the traditional review of your qualifications and work experience to what relevant knowledge and skills you may have acquired through your life experience. Medical Justice is a member of the Experts by Experience Employment Network so candidates with lived experience can receive its support for our jobs.

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For full Job Description and Application Form download the Application Pack

 

Salary : £38,162 per annum

Working hours : Full time.

Responsible for : Line-management of the Parliamentary & Research Analyst and the Researcher

Location :  Based at the Medical Justice office in London, with flexibility to work at home up to 3 days a week

The closing date for applications is Friday 20th September 2024. Interviews are planned to take place on Thursday 26th September 2024 at the Medical Justice office and will include a written and verbal exercise

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Information Session

On Friday 13 September at 11.30am, we are offering an informal information session about Medical Justice and its work as well as an opportunity to ask questions about the Head of Advocacy role and the organisation before the application deadline – if you are interested in participating, please email our Office Manager, Anthony Omar on a.omar@medicaljustice.org.uk.

Printed before the change in government.

Read the Annual Report here

 

563 clients assisted – we provided practical and emotional support, with many visited in detention by our clinicians.  Our medico-legal reports (MLRs) documented evidence of torture and deterioration of health in detention. 

Targeting Albanians and tragic deaths – through the very high numbers of referrals in 2023, we saw the impact of the Home Office’s targeting of Albanian people and the celebration of deportation flights to Albania featured prominently in the Home Office’s relentless social media. One Albanian man is believed to have taken his own life in quasi detention on a barge, another Albanian man died in detention, and there were many more suicide attempts in detention. Detention is life threatening and we must act with urgency. 

‘Second opinion’ Judicial Review win : around 500 people a year spared languishing in detention for longer – the ‘second opinion’ MLR policy was found unlawful. It allowed the Home Office to disregard an MLR by an independent clinician while it obtained a report from a Home Office contracted doctor, who may lack the needed expertise and who may never actually meet the detained person. Home Office caseworkers, who are not clinically trained to evaluate rival reports, then reached decisions which have led to vulnerability being assessed at a lower level and people deteriorating in detention for longer.  The Home Office intended to do 10 ‘second opinion’ reports a week, so this win means about 500 people each year are spared languishing in detention for longer. The judge also found an unlawful failure to consult with Medical Justice on changes to the Adults at Risk policy, importantly confirming that we must always be consulted on this ‘flagship’ policy. 

Challenging the Illegal Migration Act (IMA) – rushed through parliament, this Act enables a ban on anyone entering the UK irregularly from claiming asylum, gives greater powers to detain them indefinitely and to deport them to a ‘safe third country’. It enables detention to become the default rather than the last resort, and the mass incarceration of men, women and children held in perpetual limbo.  Together with Garden Court Chambers, we organised a planning meeting with peers and over 40 representatives from 27 NGOs to discuss a strategy for amendments to the disastrous Bill.  It was uplifting to be part of a passionate coalition that acted swiftly and with such determination. 

 

APPG briefing meeting with the Chair of the Brook House Inquiry

Our evidence as a Core Participant to the Brook House Inquiry (BHI) was placed beyond question – We dared to hope for a report from BHI that properly linked the extent of the vile mistreatment of people in detention to the root causes, and to make recommendations that could make a difference. It did just that.  Our evidence was not questioned by the Home Office.  It was uncontested and extensively cited, greatly bolstering our position and that of others relying on our evidence in individual cases, strategic litigation, parliamentary debate, and media work. The BBC featured our headline research statistics about the ongoing abuse in IRCs a week ahead of BHI’s report, and it was followed by extensive media coverage, including the BBC Radio 4 The Today Programme, several interviews with Medical Justice staff and clients with BBC TV News, ITV News, and Channel 4, and coverage in the Guardian, the Independent and the Daily Mirror. As the secretariat of the All-Party Parliamentary Group on Immigration Detention, we organised a briefing meeting with the BHI Chair, attended by staff from the then Shadow Immigration Minister’s office and the Joint Committee on Human Rights.  

‘“If he dies, he dies”: What has changed since the Brook House Inquiry?’ research report – our comprehensive analysis of clinical evidence from 66 clients detained since BHI ; 84% had evidence of a history of torture and/or trafficking, and 74% had self-harmed, suicidal thoughts and/or attempted suicide in detention. In March 2023 Frank Ospina is believed to have taken his own life in Colnbrook IRC, a death which then triggered a wave of suicide attempts.   

Embedding lived experience : “I can feel the development of Medical Justice since the days I was a client, we have come a long way am particularly proud this year of our achievement to further embed and promote lived experience within the organisation by developing a lived experience Traineeship role.” – Bridget Banda, Medical Justice Vice-Chair 

We can influence government to change – The ongoing harm caused by detention has been well known by the Home Office ; it is not accidental. Knowing this can feel overwhelming. Though we must not let that paralyse us as it underlines why the small but mighty Medical Justice is needed more than ever. We remain convinced that in time, we can persuade perhaps a new government to end immigration detention. But it won’t be possible without the evidence and case law we help build today. 

We are motivated by the courage of our clients. Each and every member of our community deserves thanks and recognition – every staff member, volunteer, donor, supporter and friend makes their vital contribution. Thank you for being resilient and continuing to witness and challenge the shameful impact of detention. Please don’t stop. 

 

Medical Justice Staff and Volunteers on the London Legal Walk, 2024

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Would you like to work as a Caseworker for Medical Justice assisting people in immigration detention?

We particularly welcome applications from people with lived experience – see the Application Pack for details.

Come and work with Medical Justice, a small and dynamic team that builds on casework to produce research that is used to challenge systemic failures in healthcare provision in immigration detention. We expose medical mistreatment in detention and strive for lasting change for all detained people through policy work, strategic litigation, media coverage and parliamentary action.

 

“Joining Medical Justice as a Caseworker has been a great experience right from the beginning. The team at Medical Justice are very supportive, knowledgeable, and passionate about the work that they do, it has been a great environment to work in. I found the role to be very rewarding; you get to make a real difference in the lives of those that are vulnerable during some of the most difficult times they are experiencing.

The support I received from the Experts by Experience Employment Initiative was really helpful in applying to and joining this role. They offer support from the beginning stages of applying to support once you join the role e.g., CV/cover letter advice, interview preparation, and onboarding support. I found the advice to be thorough and detailed, the mentor I had was very communicative and supported me throughout the different stages of the application.”

Lujain, Medical Justice caseworker

 

For full Job Description and Application Form download the Application Pack

 

Job Purpose: Ensure Medical Justice assists as many people in detention as it can and as well as it can, to access adequate healthcare and obtain high-quality independent medical evidence to progress their legal case.

Salary: £32,283.97 with cost of living increases (if relevant) three times a year plus an annual increase of £500 for 5 years.

Reports to: Casework Manager

Working hours: Full time (37.5h/week)

Based: Medical Justice office (near Finsbury Park, London). After an initial period there will be some flexibility for working from home. The post holder will be expected to attend some external meetings as agreed with the Casework Manager.

Length of contract: 2 years, with renewal if funding available

Terms: 28 days annual leave per annum plus statutory bank holidays

Timeline: The closing date for applications is Sunday 8th September 2024. The interview dates are Thursday 12th and Friday 13th September 2024 at the Medical Justice office and will include a written and verbal exercise. The ideal timeframe for starting the job is as soon as possible.

To apply: Please read the Application Pack which includes the Job Description and the application form. Email your competed application form and your CV to Anthony at a.omar@medicaljustice.org.uk

We look forward to receiving your application !

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Medical Justice exposes Home Office dangerous Use of Force policy ignores Brook House Inquiry recommendations

The BBC has filmed inside aircraft fuselages in a massive hangar where the Home Office is training 800 staff on forcing people into deportation flights to Rwanda. The BBC filmed guards pretending to escort a passive person onto a plane. This is far from the reality of what took place on the (later aborted) 2022 flight to Rwanda; evidence shows how guards forced a suicidal detained person into a waist restraint belt and physically attached them to a seat. Medical Justice’s clients targeted and detained for that 2022 flight included a child, someone who attempted suicide twice, and someone who was likely to have a psychotic disorder and lacked mental capacity.

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Watch the BBC TV News footage below

Credit: BBC Breakfast

Read BBC online: “Inside the secret government Rwanda training base”

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On May 1st, just before the local elections, the Home Office paraded on social media footage of rounding up and detaining asylum seekers for deportation to Rwanda. Medical Justice has been assisting 36 of them; men and women from Iran, Iraq, Afghanistan, Syria, Sudan, and Eritrea.  Even though it’s been announced that there will be no flight to Rwanda before the general election – and likely ever – many remain detained. We demand their immediate release – to not do so, given the medical evidence of abuse in detention, means the harm the government is inflicting is basically premeditated.

This month the Home Office ‘consulted’ Medical Justice on its new Use of Force policy. The policy is as dangerous as ever. It ignores recommendations of the recent Brook House Inquiry into mistreatment of detained people in an immigration removal centre (IRC), finding wonton inhuman and degrading treatment; 19 instances in just one IRC in just 5 months.

The public inquiry found extensive, unnecessary, excessive Use of Force – findings included;

• A toxic culture and normalisation of the infliction of pain, suffering and humiliation of detained people
• Staff using force to provoke and punish detained people
• Unauthorised techniques, including one used by guards who unlawfully killed a detained man on a deportation flight
• Riot gear used routinely, including when detained people offered little threat of violence
• Force used against people who were physically and/or mentally unwell and against naked people being dragged out of their cell to be taken to a flight
• Many detained people who have deteriorated in detention wrongly treated as non-compliant and disruptive, taken to segregation – often by force – as a means to manage distress, self-harm and mental illness symptoms
• IRC healthcare staff often facilitated use of force by pre-authorising it and not intervening when it became dangerous
• Evidence of pervasive, derogatory and violent verbal abuse and racism revealed an underlying lack of any empathy, even when people were at their most distressed and vulnerable – even in life-threatening situations
• Mistreatment in IRCs is ongoing, evidenced in our report “If he dies, he dies”, a callous mantra amongst guards

The Home Office’s new Use of Force policy does not consider the impact of force on those with mental illness at all, ignoring a key recommendation of the Inquiry – established by the Home Secretary – to undertake a review on the use of force on the mentally ill. The policy allows for the use of pain-inducing techniques when these are contraindicated for those with mental illness and, in particular, those who lack mental capacity. Most clients targeted for Rwanda deportation in 2022 that Medical Justice assessed were torture survivors for whom use of force can be experienced as a terrifying re-enactment of past abuse.

The Inquiry found that wholly dysfunctional clinical safeguards were likely to have led to vulnerable detained people deteriorating in their mental and physical health, putting them at risk of mistreatment. Its recommendations included strengthening safeguards, yet the Home Office has just weakened its ‘Adults at Risk’ policy which will allow more vulnerable people to be held in detention, just as the dangerous Use of Force training is rolled out to 800 staff, and at a time when the Illegal Migration Action calls for a massive expansion of immigration detention.

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Notes

1. The reality of the brutality of the 2022 Rwanda flight – Liberty Investigates reported extracts from official Use of Force forms; one man was bleeding and would not stop cutting himself until officers seized his arms, that he was treated by a nurse before being handed over to guards to take him by force to the plane. After boarding, another man whose wrists, arms, and head were restrained was screaming, hitting his head against the seat in front – after he started biting his tongue, officers applied a “mandibular angle” pain technique to make him release it. The Independent Monitoring Board reported that one man offering no physical resistance was put in a waist restraint belt (WRB). Two men in WRBs started to scream out their fear and distress, each trying to hurl his torso and head backwards and forwards. Each was seated with an escort on either side, his arms tightly held, his head controlled by an escort facing him. The legs of one had been ‘secured’.

2. “Who’s Paying The Price” report evidences vulnerability of 51 clients targeted for Rwanda in 2022 – Out of 17 people Medical Justice doctors conducted clinical assessments for, 14 had evidence of torture histories and 6 of trafficking. 15 had a diagnosis or symptoms of Post Traumatic Stress Disorder. One required urgent investigations regarding a brain tumour. 11 people had suicidal thoughts, including one who attempted suicide twice.

Recording now available of the recent Medical Justice joint event with the British Medical Association (BMA) about findings of the Brook House Inquiry in relation to healthcare, safeguards and vulnerable people in immigration detention.

You can read the British Medical Journal’s coverage here

Speakers included;

• Mr M – formerly detained person
• Kate Eves – Chair of the Brook House Inquiry
• Dr Brodie Paterson – Honorary Senior Lecturer, Queen Mary’s University
• Dr Andrew Green – Deputy chair of the BMA Medical Ethics Committee
• Professor Cornelius Katona – Hon Medical and Research Director, Helen Bamber Foundation
• Dr Rachel Bingham – Clinical Advisor at Medical Justice
• Dr John Chisholm CBE – BMA International Committee Deputy Chair
• Stephanie Harrison KC – Joint Head of Garden Court Chambers

The event exposed how the dysfunctional safeguards, inadequate healthcare provisions and human rights abuses that were exposed by the Brook House Inquiry and highlighted how little has changed.

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M, a client of Medical Justice who was detained for 52 days in 2023: 

M, explained the mistreatment, suicidality and use of force he experienced and witnessed whilst in UK immigration detention.

Speaking about his experience, M said:

“It’s hard to speak about this. I went to my room. I was having panic attacks, and at one moment I was almost feeling quite suicidal. 

I witnessed a lot of mistreatment during my time there. The guy who died by suicide … I remember his birthday, because I was the one who helped him write a letter to the Home Office about his situation. They were his words, but in English, because he didn’t know how to write in English. That’s never going to leave my mind. There was another guy who set himself on fire. He had been kicked out of the medical centre when he went to request help. 

I also witnessed the officers using an excessive amount of force with one of the guys, damaging his jaw and leaving a scar on his throat. He couldn’t eat or swallow for a week. I think he’s still in detention. 

It seemed like the doctors were against you. There were humans in there, but there was no humanity.” 

 

Kate Eves, the Chair of the Brook House Inquiry

Kate Eves outlined the 19 instances of credible evidence of mistreatment capable of amounting to a breach of Article 3 of the ECHR. She raised concerns around the approach to the use of force, the systemic failures of detention safeguards, a lack of understanding from healthcare staff of their responsibilities and duties, and the concerning involvement of healthcare in the use of force.

She urged that her findings and recommendations must be taken seriously, saying:

“it would be in my view, completely unacceptable not to respond in a meaningful way. One of the annexes in my report is essentially setting out all of the previous recommendations that have been made and its really palpable just how often we’re repeating the same things. We’re spending public money to look at the evidence, and saying the same things”.

 

Dr Brodie Paterson, Honorary Senior Lecturer, Queen Mary’s University

Speaking about mental health and the use of force, Dr Brodie Paterson emphasised that the starting point should be that restraint should not happen and should be prevented. He explored the importance of cultivating a positive culture, of trauma-informed care, of sufficiently robust governance for the use of force, and of adequate staffing and training.

He explained how the phenomena of staff perceiving the behaviour distressed detained people as wilful rather than a function of their mental distress.

Dr Paterson explained:

“Brook House had an inappropriate culture, an inappropriate physical environment, inappropriate training, inappropriate leadership and inappropriate oversight. If you were trying to create a service that would go wrong, then Brook House is a recipe for how to do that”.

If we fail to put the ethical infrastructure, the resources, the culture, the training in place, such services will fail. The lesson from Brook House is that unless we get it right: services will fail, and vulnerable people will get hurt”.

 

Dr Andrew Green (Deputy chair of the BMA Medical Ethics Committee) chaired a panel discussion of the healthcare and safeguarding in immigration detention

 

Professor Cornelius Katona MD FRCPsych (Hon Medical and Research Director, Helen Bamber Foundation and Hon Professor, Division of Psychiatry, UCL) discussed the mental health conditions and high levels of trauma amongst detained people.

Professor Katona spoke of why it is that detained people have high rates of mental health conditions:

“there is a diminished sense of safety, a diminished sense of freedom from harm and […] often painful reminders of traumatic past experiences of detention and sadly often of ill-treatment. There is an aggravated fear of the imminence of return” as well as a separation from support networks and disruption to their continuity of care.

He outlined that in immigration detention, the:

“primary purpose is administrative, and the length of detention is uncertain […] that is one of the key elements, the terrible uncertainty. In prison you count the days down, in detention, you count them up”.

 

Dr Rachel Bingham, Clinical Advisor at Medical Justice, showed how detention safeguards fail at every stage from a lack of pre-detention screening and systemic flaws in healthcare screening, and the Rule 34 and Rule 35 processes. Outlining Medical Justice’s recent audit of their clients. Dr Bingham drew comparisons with Kate Eves’ findings from 2017 to show that the catastrophic failures were because there was too often a disregard and lack of understanding of how to implement safeguards.

Dr Bingham emphasised that:

“the bottom line is not only that health is harmed in this situation or that suicide risk increases […] but [there are ongoing failures in the safeguarding processes designed] to prevent mistreatment and to prevent the kinds of abuses that happen when health is not managed.”

 

Dr John Chisholm CBE, BMA International Committee Deputy Chair, echoed that:

“detainees are vulnerable. They’ve often been the victims of torture, yet they’re detained in an environment that is detrimental to their health and wellbeing.”

He called the current indefinite detention system a “national disgrace” and said that it must be “phased out and abolished”.

Dr Chisholm urged that:

“we must continue to lobby, advocate, and campaign for change and to rid us, our country, of this performative cruelty.”

 

Stephanie Harrison described how healthcare staff “put the Home Office’s priorities of enforcement over the welfare of their patients” and “remained silent in the face of human rights abuses committed against individuals in the care of them as healthcare professionals”.

She called on IRC doctors to “stop being complicit in these forms of mistreatment [including safeguarding failures, inappropriate use of force and the misuse of segregation] by failing to report, to identify, and to call it out.” Instead, IRC healthcare must call out the culture of dehumanisation and racism “which is still entrenched within those institutions.”

Trustee vacancy: Medical Justice Treasurer

(We also need other trustees, so do apply if you would like to be a trustee even if it’s not as the Treasurer)

Though not a requirement, we particularly welcome and encourage applications from people with lived experience of the asylum process and/or immigration detention.

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Medical Justice is seeking a Treasurer to join our Board of Trustees.

Medical Justice was set up in 2005 by a man on hungerstrike in an Immigration Removal Centre (IRC) and the volunteer doctor who visited him and wrote a medical report that helped secure his release. People with lived experience have been trustees of Medical Justice ever since. Today we have a team of 38 volunteer clinicians, 20 volunteer interpreters and 18 members of staff.  Medical Justice remains the only charity sending volunteer clinicians into all the UK’s IRCs to document clients’ scars of torture and deterioration of health in detention, and to expose instances of medical mistreatment.  We use medical evidence to secure lasting change through research, strategic litigation and policy, parliamentary and media work.

“It has strong characteristics and a highly respected reputation. It is regarded as principled, expert and evidence based, tenacious in its casework and policy work, fierce and ferocious when needed and brave in the way it speaks truth to power.” – Ceri Hutton, author of the independent Evaluation of Medical Justice

“They stand out as an uncompromising advocate. A loud voice in a clearly identified niche.” – Funder, interview for the independent Evaluation of Medical Justice.

The trustee role

Being a trustee is a rewarding role. You will be joining a strong team of experienced Trustees who include people with lived experience of detention.  Our trustees bring their expertise to shape the strategic direction of Medical Justice, ensuring our decisions are guided by our mission, our values and the best interests of our beneficiaries. Trustees have overall legal responsibility for our charity, making sure our finances and resources are well used and are required to participate fully in the governance of the charity. For more information see the Government Guidance  or watch this video

The Treasurer will take the lead in financial governance and in shaping our financial strategy, supporting our Director in financial forecasting and budgets, and in liaising with our auditors.  We have external accountants and our end of year accounts are audited so that our Treasurer does not need an accountancy background, but does need to be able to comment on our financial records and financial strategy and communicate effectively on these matters with other trustees.  The pivotal responsibilities of this role means that the Treasurer is also a member of the Executive Committee of Trustees which meets online between full trustee meetings and when needed at times of crisis.

Where is it based?

The Medical Justice office is in Finsbury Park, London, N7 7DT.  We would ideally like you to attend Board meetings in person in the office though some trustees attend some meetings online.

Expenses

The role of trustee is a voluntary position. Expenses incurred in relation to fulfilling trustee duties can be paid by the Medical Justice, e.g. travel, phone top-ups.

What is involved?

We expect that that trustees prepare for (read papers, which involves a time commitment of between one to three hours) which are provided several days in advance and attend 4 Board meetings per year.  The Treasurer is additionally expected to attend Executive Committee meetings 4 times a year – in person or online.  Board meetings are on a weekday evening and Executive Committee meetings are during the day. You may need to attend occasional other ad-hoc meetings.

We are looking for someone who can commit to being the treasurer for at least three years. All trustees have to be re-elected every three years. The successful applicant will be required to disclose any unspent criminal records and be willing to undergo a basic DBS check.

The support you will receive

Medical Justice provides resources and can provide training for trustees on good governance and the duties of a trustee, as well as on charity finance. Trustees will also receive training on safeguarding and other key policies.  Training costs are covered by Medical Justice. You will also have induction meetings with Medical Justice staff.

‘Buddying up’ with an existing trustee can also be arranged, and this is encouraged for those for whom this is their first time serving as a trustee. This involves meeting up with a longer-serving trustee outside of board meetings, occasionally or regularly, to discuss:

• The format, style and content of board meetings generally
• Papers submitted to upcoming trustee board meetings
• Experiences serving on the board

Who we are looking for

An understanding of the UK asylum system and immigration detention is particularly important and we welcome applications from those with lived experience.  We have a strong commitment to equity, diversity and inclusion.

Your relevant skills and experience could be from working, training, volunteering, interests or life experience – in the UK or outside the UK.

• A finance professional, ideally with knowledge of charity finance.  Otherwise someone with an enthusiasm to learn, drawing on sound commercial experience and an understanding of small/medium-sized enterprise
• A strategic thinker with the ability to balance risk and opportunity
• A clear communicator able to bring financial information alive to non-specialists
• A willingness to play an active role in areas such as financial forecasting, reviewing budgets and liaison with external auditors
• An ability to take on responsibilities and liabilities as a Trustee and to act in the best interests of Medical Justice
• A capacity to think creatively and strategically and to exercise good independent judgement
• Effective communication skills
• A personal commitment to equity, diversity and inclusion
• Enthusiasm for our mission and vision

• A commitment to lead according to the values of Medical Justice
• A commitment to the Nolan principles of public life: selflessness, integrity, objectivity, accountability, openness, honesty and leadership

Our current trustees have skills and experience covering lived experience of immigration detention, the asylum system, law, medicine, and marketing.

What difference will you make?

The current context of asylum and immigration is challenging, particularly with the increasing use of both detention and quasi-detention and uncertainty about how government policy will develop.  The need for Medical Justice has never been more urgent, both in terms of case work with individuals and our endeavours to secure lasting change.  Our responsibility is to work in the most effective way possible, using our resources wisely.  The role of the Treasurer is therefore of vital importance to us.

“When someone tells you the doctor is coming it is like a saviour coming to save me from this hell that I am in” – former client

“[If Medical Justice had not made contact] I would have died. I was on suicide watch. I wanted to die. If Medical Justice wasn’t there, I would have been in the ground today” – former client

Valuing Lived Experience

Medical Justice has an organisational commitment to improving the representation of people with lived experience at all levels of organisation, especially the trustee role. We recognise that some potential candidates who bring the voice and lived experience that we need, may have had less opportunity to develop a track record in this role. We are keen to look beyond the traditional review of your qualifications and work experience to what relevant knowledge and skills you may have acquired through your life experience. Medical Justice considers lived experience as real expertise and as vital to the organisation.

To reflect the composition of our client group, and in any case, we welcome and encourage applications from refugees and other migrants, and in particular from people with lived experience of detention – this could include detention in another country, or in the UK (immigration detention in an immigration removal centre, prison or institutional asylum accommodation such as military barracks). Whilst the fact that your lived experience will be of relevance, there will be no expectation that you talk about your personal experiences.

Completed applications must be received by 28th February 2024

Please email your CV to our chair of trustees, Ruth Talbot on ruthtalbot10@gmail.com. If you do not have a CV, you may provide a written, audio or video summary of your education, experience and skills.

Ruth will email you back an application form which should be completed and returned by 28th February 2024. This will include an explanation as to why you are interested in being a Medical Justice trustee.

If you are an expert by experience (with direct, first-hand experience of immigration detention or the UK asylum or immigration system), we may be able to arrange for independent and confidential support for your application from the Experts by Experience Employment Network (of which Medical Justice is a member) who may be able to provide a mentor to support your application.

You can ask for an informal conversation about the role and about Medical Justice before you make an application. Shortlisted candidates will be invited to an informal interview with the one of the Chair of Trustees, current Treasurer or Director. The costs of participating or attending can be paid by Medical Justice, e.g. travel or phone data. The preferred candidate will then be invited to observe a board meeting so that both they and the organisation can feel confident that the role and organisation is right for them.

Please email our chair of trustees, Ruth Talbot, on ruthtalbot10@gmail.com if you would like further information about the role or to have an informal discussion with her, or an existing trustee, or the Director.

Email your application by 28/02/2024

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Support from Experts by Experience Employment Network

We are proud to be a member of the Experts by Experience Employment Network, which aims to increase representation of people with lived experience in the charitable sector. Please feel free to use information and resources at https://www.ebeemployment.org.uk/ebe which may help in preparing your application.

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About the need for Medical Justice

Immigration Removal Centres (IRCs) in the UK are so harmful that Medical Justice believes the only solution is to close them down.  Meanwhile, we aim to assist as many people held in immigration detention as we can and to campaign for lasting change.

Immigration detention in the UK is arbitrary and indefinite. It is not part of any criminal sentence nor is it ordered by a judge, yet 20,354 people were detained in year ending June 2023 in IRCs, mostly run by private companies, and in mainstream prisons. Many have mental and physical scars of torture and other forms of persecution. Their medical conditions are often exacerbated by, and sometimes caused by, prolonged detention and inadequate healthcare.

Medical Justice clients include men, women and children who are survivors of war, torture, trafficking, and rape. Many have fled persecution due to their political activity, religion, and sexual orientation. Many end up being trafficked and during long, perilous journeys to the UK, get detained, raped, extorted, and sold, some a number of times over. Some arrive with untreated injuries, are extremely sick, mentally ill and left with complex medical needs. Immigration detention can exacerbate medical conditions and be the cause of mental illness, yet healthcare in IRCs is inadequate.

Medical mistreatment in detention is rife and inquests have found that neglect has contributed to deaths, including an 84 year old who died in handcuffs. One man died after 6 days in detention, in a segregation cell, naked and emaciated, having suffered psychosis, dehydration, malnourishment and hypothermia – he had received no medical treatment whatsoever. Last year there was a ‘mass suicide attempt’ after a Colombian man – Frank Ospina  – died in detention, reportedly by suicide.

Our latest audit of medico-legal reports for 66 detained clients show that ;

• 79% had of a history of torture, 38% of both torture and trafficking. The mental state of all had been harmed by detention
• 95% of the clients had a diagnosis of at least one mental health condition
• 74% clients were recorded as having self-harmed, suicidal thoughts and/or attempted suicide
• Uses of force included during transfer to segregation, removal from suicide netting and transfer to hospital

Abuse in detention – BBC Panorama undercover filming exposed widespread mistreatment inside Brook House IRC, including 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.  A subsequent public inquiry found a dangerous use of force, a wholesale failure of safeguards and a culture of dehumanisation led to 19 instances of inhuman or degrading treatment at Brook House during a 5 month period. Dysfunctional safeguards were found likely to have caused actual harm to vulnerable detained people who were allowed to deteriorate in their mental and physical health, putting them at risk of mistreatment.

Healthcare staff in IRCs do not understand their safeguarding obligations and have a tendency to view detained persons as wilfully disobedient and obstructive instead of understanding their behaviour may be manifestation of mental anguish or ill health. This is interlinked with the inappropriate use of segregation and a quick resort to the use of force on people who are physically unwell and to ‘manage’ symptoms of mental illness, self-harm and mental health crises.  Force is used unnecessarily and excessively in widespread cases. Unauthorised and potentially lethal “control & restraint” techniques were being used. Approved techniques were being used incompetently, becoming dangerous and risking injury. It has gone without proper scrutiny until the Inquiry.

There was found to be normalisation of the infliction of pain, suffering and humiliation, even whilst detained people were naked, and in one case where a man was emaciated and 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. The Inquiry found a “toxic culture” at Brook House, a “culture of dehumanisation of detained people”, and a “breeding ground for racist views”. Evidence of pervasive derogatory and violent verbal abuse and racism revealed an underlying lack of any empathy even when people were at their most distressed and vulnerable – even in life-threatening situations.

Despite Medical Justice and others reporting these issues to the Home Office for many years, the abuses continue. Home Office and IRC staff, including some who are still in post, were described by the Inquiry as ‘unapologetic’ and ‘intransigent’.

Immigration detention is indefinite.  It is not part of any criminal sentence. Many trafficking survivors are wrongfully convicted of crimes they were forced to commit, jailed, and then held in indefinite immigration detention in mainstream prisons. 78% of the 20,354 people held in immigration detention in 2023 were eventually released back into the community.

The Home Office uses charter deportation flights.  There were 3 such flights on one day alone.  Charter flights to Albania have ramped up, especially since the Home Office signed an agreement with Albania to expedite removals, we are dealing with distressing levels of suicide attempts. Most of our Albanian clients are trafficking survivors. In November there was a protest after two detained Albanian attempted to kill themselves in Brook House  – one died and the other was swiftly deported but immediately returned to the UK and detained again.

On the horizon : The Illegal Migration Act (IMA) is set to ban asylum seekers entering the UK via an ‘illegal’ route from claiming asylum, to detain them indefinitely, and to deport them to a ‘safe third country’ – with few returns agreements other than with Rwanda (which has been found unlawful), this would mean mass incarceration of people held in perpetual limbo. The Refugee Council estimates 190,000 (including 45,000 children) could be detained over 3 years. The government is developing new IRCs and asylum seekers are being held in emerging quasi-detention sites, including military barracks and the Bibby Stockholm barge where an Albanian man died last month.

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Some points relevant to trustees from a 2021 independent Evaluation of Medical Justice

• “They have been bold enough to take litigation against the government in ways which others haven’t and basically not set a limit to the challenge they make through their policy work. That’s something which is not just a credit to the staff at but also to the trustees – I know the debates which go on in small organisations and the risks such decisions entail.” (Lawyer)

• A commitment to making hard-nosed judgement calls in favour of using resources well. Staff and trustees are constantly considering whether or not engaging in various forums, policy issues or cases uses their expertise to best effect or whether others are best left to do the job.
• “As a doctor, the quality of the medical reports we did was really integral to my happiness at being a trustee. I was proud of what we produced, and still am even after having left the board. I felt as a doctor my reputation was never in jeopardy, and that the reports were of outstandingly high quality.” (Volunteer doctor, former trustee)
• The staff team at Medical Justice are viewed as a team of highly committed individuals with a strong commitment to the issue, guided by individuals (both at senior staffing level and on the trustee board) with institutional memory and long experience in judging tactics and approaches within policy and legal fields.

“Places of detention are the hidden spaces in our society… They are places where communication is restricted, rights and freedoms are curtailed, where isolation from loved ones is a fact of life, and where the toll of detention can have an impact on people’s mental and physical wellbeing. For anyone who has been detained by the State, it is a profoundly life-altering experience.”

(Brook House Inquiry Report, Vol. 1, p.1)

 

On Tuesday 29 November 2023, the APPG on Immigration Detention – for which Medical Justice provides the secretariat – and APPG on Migration jointly held a briefing for Members on the Brook House Inquiry Report, with the Chair of the Inquiry, Ms Kate Eves.

The Brook House Inquiry is the first ever statutory inquiry on immigration detention in the UK. Set up to investigate abuse revealed by the BBC at Brook House Immigration Removal Centre (IRC) in 2017, the Inquiry has also gathered evidence on the systemic failings – in terms of policies, practice, and culture – which allowed that abuse to occur.

The Chair of the Inquiry, Ms Kate Eves, published her final report in September 2023. Its carefully evidenced analysis shines a vital light into the “hidden space” of immigration detention.

Many of the problems identified within the report are continuing today across the UK’s detention system. It is crucial reading for anyone seeking to understand the ongoing failures in detention, their devasting effect on detained individuals, and what needs to change.

The joint APPG event was an opportunity for Members to learn more about the important issues raised in the Inquiry’s final report, and to assess its implications for the use and operation of immigration detention in the UK going forward. Members also discussed ways to raise awareness of the Report in Parliament, and to monitor government implementation of its recommendations.

 

Access a full copy of the meeting minutes here.

 

The Inquiry Report and APPG event have come at a particularly salient time, with the Illegal Migration Act 2023 granting the Home Secretary even greater powers to detain individuals, including children, whilst at the same time dramatically reducing the avenues available to people to challenge their detention. Alongside these legislative changes, the Home Office has also announced plans to significantly expand the detention estate – including increasing capacity at current sites and opening new ones. Based on these developments, it appears that the government going forward intends to detain greater numbers of people under immigration powers in the UK, for longer periods of time.

Additional links of interest:

• Letter from Ms Eves to the Home Secretary (19 October 2023), requesting details of the government’s response to the Inquiry’s recommendations and the response from the Home Secretary (4 January 2024).

• Further correspondence published by the Inquiry can be accessed here.

• Evidence from Home Office officials to the Home Affairs Committee regarding the Brook House Inquiry (29 November 2023), see Q173-Q182 + Q186 from APPG Chair, Alison Thewliss MP

• Lords debate on the Brook House Inquiry report (11 January 2024), tabled by APPG Member Lord German