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.

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.

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

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.

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.

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

An important cross-party debate in the House of Lords on the findings and recommendations of the Brook House Inquiry report took place last week. The Brook House Inquiry is the first public inquiry into the mistreatment of detained people in the UK. Medical Justice was appointed as a core participant to the Inquiry due to our extensive first-hand experience of the clinical safeguarding and healthcare failures in IRCs.

The Lords debate was organised by Liberal Democrat peer Lord German, a member of the All-Party Parliamentary Group on Immigration Detention for which Medical Justice provides the secretariat.

Medical Justice worked with peers to highlight crucial issues. A full transcript is available here.  Some extracts from the debate can be found below.

Date for government response to the Inquiry report

“The inquiry exposed the dehumanising abuse of vulnerable people held in immigration detention. Unfortunately, the report’s author states that these issues remain in place today. We understand that a senior civil servant has been tasked to prepare the Government’s response, to be published “in due course”. I wonder whether “in due course” will have ended nine months from now. Perhaps the Minister could tell us.”

Lord German (Liberal Democrat)

Ongoing failure of safeguards for vulnerable people in detention

“Another of the inquiry’s findings was that vulnerable people in detention are not being afforded the appropriate protections that the safeguards recommended by Stephen Shaw are designed to provide, because of their dysfunctional operation.

The latest report of the independent monitoring boards and new clinical evidence from Medical Justice—a core participant in the inquiry—show that the safeguards are still failing, including not identifying people at risk of self-harm or suicide, with serious and sometimes tragic consequences for mental and physical health.  

What steps are the Government therefore taking, as a matter of urgency, to ensure a more consistent and robust application of the safeguards, as called for in the inquiry report?”

Baroness Lister of Burtersett (Labour)

Need for urgent action on use of force and segregation

“My Lords, the inquiry found that the inappropriate use of restraint and force on detained persons suffering from mental illness was common at Brook House, with healthcare staff unaware of their responsibilities to monitor the welfare of detained persons during use of restraint.

“Regardless of this information, the Illegal Migration Act allows for the use of force against even children across the detention estate. What steps will be taken to ensure that the use of force is continually monitored and recorded for all detainees, but particularly vulnerable adults and children, to ensure that what occurred at Brook House is never allowed to happen again?”

The Lord Bishop of Chelmsford

“My Lords, recommendation 19 of the Brook House report is on the attitude and behaviour of healthcare staff. The use of force on one person who had a serious heart condition lasted for about 18 minutes, was positively harmful and put him at further risk.

The recommendation is for immediate guidance for healthcare staff and mandatory training. Can the Minister tell us if that has already been brought into practice?”

Baroness Brinton (Liberal Democrat)

“My Lords, Kate Eves’s report included a number of recommendations requiring immediate and urgent implementation, because they related to serious issues such as the use of force and use of segregation.

Can the Minister tell the House what the Government have now done in response to those particular recommendations? If nothing has been done, can the Minister explain why not?”

Baroness Meacher (Crossbencher)

Recommendation for a 28 day time-limit

“The Minister said that the Government are carefully considering the Brook House inquiry report and will respond in due course. Why has the Minister therefore told us that they have already come to the conclusion that they will ignore what the Brook House inquiry said, namely that there should be a 28-day limit on immigration detention?” 

Lord Coaker (Labour)

On behalf of the government, Lord Sharpe of Epsom said a 28 day time-limit would “encourage and reward abuse”.

“The abuse found in the Brook House inquiry report was by G4S staff, with terrible abuse perpetrated against some of the most vulnerable people. We believe in custody time limits in this society. Even suspected terrorists can be held for no more than 14 days.”

Baroness Chakrabarti (Labour)

So, despite being asked several times in this debate, the government is not giving any commitment as to when it will respond to the Brook House Inquiry’s recommendations or what steps it is taking as a matter of urgency.  Lord Sharpe claimed that “a lot of the work had already been done, because there was a report commissioned in 2016 by Stephen Shaw” even though this was before the 2017 BBC Panorama undercover filming that led to the Inquiry, and despite the fact that the Inquiry found that many of the same failures from 2017 were still persisting.  He claimed that “we have strengthened our capacity to provide assurance and oversight of service provision” and said “I am confident that there is no way that such a situation would be allowed to happen again” but was unable to provide any information to explain the basis of his confidence.

Further Medical Justice work in Parliament to come

This is the first time Members have debated the report in Parliament since its publication. Medical Justice is very grateful to Lord German for ensuring the debate took place, and to the many peers that took part.

In the weeks and months ahead, we will continue to raise the Brook House Inquiry in Parliament and to work closely with MPs and Peers to ensure the government is held to account on its response to the Inquiry’s findings.

Government doubles down on experimental surveillance tech to track migrants

‘Constantly on Edge’, the latest report on GPS tagging in immigration bail, has found that the Home Office has increased its use by 56% in the last year and is now using newer, experimental mobile fingerprint scanners to monitor migrants on bail, without effective safeguards in place.

Read the report here

Users of the new ‘non-fitted’ scanner devices – supplied to the Ministry of Justice by Buddi under a £6 million contract – described the experience as a “type of torture” and spoke of feeling “constantly on edge”.

The research comes a year after Public Law Project, Bail for Immigration Detainees, and Medical Justice published ‘Every move you make’ which revealed the ‘psychological torture’ caused by fitted GPS tracking devices.

Interviewees told researchers that the newer, non-fitted devices vibrate up to 10 times a day at random intervals, sometimes into the evening. If users are unable to scan their finger within a window of ‘around a minute’, they are considered to be in breach of their electronic monitoring bail condition. That breach is then reviewed by the Home Office.

Researchers found that an automated system – the Electronic Monitoring Review Tool (EMRT) – is used to decide which device type will be issued and for how long the person will be required to use it. Authors Dr Jo Hynes and Mia Leslie of the Public Law Project say there is not enough transparency around how the EMRT works to be sure that the process is free of bias.

The report found that reviews of decisions to impose GPS devices – a key safeguard in the process – are not being conducted in sufficient volumes.  As of July 2023, 622 quarterly reviews were overdue.

Author of the report Dr Jo Hynes said:

“These devices are utterly dehumanising. It is hard to imagine the vigilance required to be ready to scan your finger immediately at random times throughout the day, or risk  breaching your bail conditions. Our interviews with migrants show how oppressive this system is and the impact that constant watchfulness has on their daily lives and wellbeing.

“This level of surveillance is not only harmful, it is unnecessary. The rate of absconding from immigration bail is tiny. In 2021 it was 2.7% and in the first six months of 2022 it was 1.3%. Millions are being spent on a system to address a problem that is not evidenced, and which causes psychological harm to people already made very vulnerable by Home Office policies.

“With a pilot study having recently concluded, it seems likely that Government may look at rolling these devices out to people who arrive by ‘irregular’ means i.e. by small boat. Given what we know about the potential harm these devices can cause, such a move would be highly inappropriate.

“The systems around this surveillance regime are opaque and dysfunctional. There is limited transparency around the automated decision support tool used to decide which device type will be issued and for how long the person will be on it. In addition, in breach of its own guidelines, the Home Office has a significant backlog of reviews to complete, leaving many at risk.”

Testimony from people interviewed for ‘Constantly on edge’

Interviewees taking part in the research who have been required to use the non-fitted devices report feeling “constantly on edge” and “like a lower type of human”. Another described it as “a type of torture”.

“If you have to go to the bathroom or to use the toilet, everywhere that thing’s with you.” – Interviewee

“I felt like someone is always following me, behind me. It’s like, imagine you’re walking outside and someone is like walking behind you. Following you, like wherever you go that person is following you. You will start to panic. You shouldn’t be harming the person you are watching. That is really very bad, like I said, being watched is horrible.” – Interviewee

‘Constantly on edge’ was written with the support of Bail for Immigration Detainees (BID) and Medical Justice.

Pierre Makhlouf, Legal Director of BID, said:

“GPS tagging is a punitive measure that is unnecessary and generates fear of authority. Its use is disproportionate, entailing 24-hour surveillance and control of individuals, while being supported by policies that interfere with an individual’s right to privacy. Its use needs to be ended now.”

Emma Ginn, Director of Medical Justice said:

“Having already established that electronic monitoring carries a high risk of causing deterioration in existing poor mental health, Medical Justice is saddened that the Government has significantly increased its use. Reports of severe detrimental effects on mental health, including to the point of suicidal ideation, therefore come as no surprise.

“Many of our clients have experienced immense suffering before they reached the UK and are retraumatised by immigration detention here. Being tagged on release can impede their recovery.  Though they may have left detention, intense surveillance and control continues, with the associated risk of harm.”

Key findings:

• In 2023, there has been a 56% increase in the number of people GPS tagged as a condition of immigration bail.
• Non-fitted tagging devices were introduced from November 2022. These fingerprint scanner devices request periodic biometric verification from the user (vibrating at random times) and collect the person’s location data at all times.
• Between 1 January 2023 and 2 November 2023, 3,335 people have been subjected to fitted devices and 543 people subjected to non-fitted devices as a part of an electronic monitoring bail condition.
• Reviews of decisions to impose a GPS tag (a key safeguard) are not being conducted in sufficient volumes. As of July 2023, 622 quarterly reviews were overdue.
• An automated system – Electronic Monitoring Review Tool (EMRT) – is used as part of the process for deciding which device type people will be subject to, if they should be moved from a fitted to a non-fitted device, or if their monitoring is to be discontinued.
• The extent of the EMRT’s role in decision-making is opaque, making it difficult to assess the extent of automation bias in the decision-making process.
• The length of advised time people spend on devices is vast, ranging from 3-24 months on a fitted device to 18 months to indefinitely on a non-fitted device
• Buddi Limited was given £6 million to make these devices. The contract comes to an end on 30 December 2023.

Equal Rights Beyond Borders and Diakonie Deutschland hosted a conference on immigration detention on the Greek island of Kos from 8-10 June 2023. The conference brought together nearly 100 legal practitioners, academics, NGO representatives, activists and a number of funders supporting work across Europe to discuss detention practices, policies and legal frameworks. There were a series of country focused and thematic presentations, as well as information sharing sessions.

Read the full report here

Idel Hanley, Policy, Research and Parliamentary Manager at Medical Justice, presented at the conference about the harmful impact of immigration detention. The presentation focused on the deterioration in detention, the limited healthcare provisions, and how deterioration occurs for both those with and without pre-existing vulnerabilities.

The conference was held in Kos as it sits at Europe’s external border and has detention facilities on the island: the Closed Controlled Access Center (CCAC) and the only remaining Pre-Removal Detention Center (PRDC) on the Greek islands. Both sites have prison-like conditions with strict curfews, restricted movement, surveillance and extremely limited access to healthcare and legal aid.

Throughout the conference, it was clear that many of the most hostile and harmful detention policies and practices are replicated across Europe. The parallels between detention practices included the lack of access to legal advice, de facto detention in sites that are not necessarily designated as detention, and a lack of adequate healthcare.

It was a timely conference with the increasing criminalisation and incarceration of asylum seekers, as detention is becoming the norm, rather than the exception, across the UK and Europe.

Of the 66 clients, 52 had evidence of a history of torture, 29 had evidence of a history of trafficking and 25 had evidence of a history of both torture and trafficking. Detention had already caused the mental state of 64 clients to deteriorate and had caused harm to all 66 clients.

63 had a diagnosis of at least one mental health condition and 49 people 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 appointments.

Medical Justice was appointed a Core Participant (CP) due to its extensive experience of the clinical safeguarding failures and understanding of the inadequate healthcare provision in IRCs.  One of our greatest concerns is the government’s plans to increase detention, despite the ongoing abuse, raises fears it is ignoring BHI findings.

Medical Justice have been represented by Wilson Solicitors in a challenge to Home Office guidance providing for the Home Office to seek second opinion medical reports for people in immigration detention. 

At an oral hearing at the Royal Courts of Justice on 25th July 2023, Mrs Justice Heather Williams DBE granted Medical Justice permission to argue its case at a full hearing, to take place later this year. The judge also granted our application for a Costs Capping Order. This means that we will be protected against the risk of adverse costs we cannot afford.  

The case concerns the Home Office’s Adults at Risk policy, which is a key safeguard intended to ensure that the detention of people who are vulnerable to harm in immigration detention is kept to a minimum. The policy was introduced following Stephen Shaw’s review, which found that vulnerable people were being detained too often and for too long.  

Our challenge argues that the second opinion policy is unlawful because it purports to allow the Home Office to disregard a medico-legal report provided by a person in immigration detention while it seeks a second opinion from a Home Office contracted doctor. The process of obtaining a second opinion report can take up to 28 days, with no timescale for the Home Office to consider the report and undertake a detention review. The policy recognises that Home Office caseworkers are not clinically trained; this limits their ability to evaluate rival medical reports. Instead, the policy directs caseworkers to decide vulnerability based upon clinical issues the two doctors agree on. In practice, this will likely mean that vulnerability will be assessed at a lower level than would be the case if the medical report provided by the detainee was assessed on its terms. 

We further argue that the second opinion policy is inconsistent with the Adults at Risk statutory guidance, which states that medical reports which meet certain base line standards should be accepted as the evidence at the highest level of vulnerability (level 3). It also argues the policy frustrates the legislation the statutory guidance is made under (section 59 of the Immigration Act 2016), whose purpose is to minimise the detention of people who are particularly vulnerable to harm in immigration detention. Finally, it is alleged that it was unlawful to introduce the policy without following an established practice of consultation with Medical Justice and other stakeholders. The judge held that all of these grounds are arguable.  

The Illegal Migration Act 2023, which recently received Royal Assent, dramatically expands the government’s immigration detention powers and makes it harder for people to challenge their detention. The Adults at Risk policy will be an even more important safeguard once this legislation is operationalised.  

We are grateful to Jed Pennington and Gabriel Tan at Wilson Solicitors and to our counsel team, Shu Shin Luh and Laura Profumo, of Doughty Street Chambers.