Under the new ‘Illegal Migration Bill’, women fleeing persecution who arrive in the UK via ‘irregular’ means will be prevented from claiming asylum and detained indefinitely, with no exemption for those who are pregnant, removing the vital protection introduced by the 2016 72-hour time limit on the detention of pregnant women.
Being locked up and deprived of your liberty is distressing and harmful for anyone. For women who are pregnant, however, the impact of detention can be particularly acute:
The Royal College of Midwives has said: ‘The detention of pregnant asylum seekers increases the likelihood of stress, which can risk the health of the unborn baby.’
In his 2016 review of the welfare of vulnerable people in immigration detention, Stephen Shaw explained: ‘That detention has an incontrovertibly deleterious effect on the health of pregnant women and their unborn children… I take to be a statement of the obvious.’
Healthcare in immigration detention if often very poor. The antenatal care and support provided to women who are detained has often fallen short of the care normally available to pregnant women.
Research by Medical Justice found that in Yarl’s Wood, women often missed antenatal appointments; some women had no ultrasound scans while detained; and women did not have direct access to a midwife and could not request visits.
We cannot go back to what was happening before 2016, when many pregnant women were being detained for weeks, and sometimes months on end, with no idea of when they would be released.
Medical Justice speaks to BBC Africa about Rwanda Scheme
Since the High Court’s judgement on the 19th of December, which found the government’s plans to remove asylum seekers to Rwanda to be lawful, Medical Justice welcomes the fact that applications to appeal this decision are being made.
The Rwanda Scheme between the UK government and Rwanda enables the UK to forcibly remove those asylum seekers deemed to have arrived by irregular routes, to Rwanda.
People seeking asylum continue to receive notices about potential removal to Rwanda. This continues to cause distress and worry. The harms to mental health, as documented in our report Who’s Paying the Price, remain to be of concern.
See coverage from BBC World Service’s Focus on Africa programme, featuring Medical Justice and Prof. Martin McKee, the president of the British Medical Association.
BBC World News / BBC Africa – January 2023
Video: Our joint webinar with BMA and MSF
In December we held a joint webinar with the British Medical Association and Medicines Sans Frontières. This event discussed the severe health impacts of the UK’s policy to remove people seeking asylum in the UK to Rwanda. It shone light the parallels with Australia’s failed offshore detention policy where people seeking asylum were detained on Nauru and Manus Islands with horrific consequences for their health.
Speakers included
Prof. Martin McKee – chair
Dr Rachel Bingham, clinical advisor at Medical Justice (pictured)
Prof Cornelius Katona MD FRCPsych, Hon Medical and Research Director, Helen Bamber Foundation and Hon Professor, Division of Psychiatry UCL
Reem Mussa, humanitarian advisor and coordinator of the Forced Migration Team in MSF’s analysis department
Elahe Zivardar, person with lived experience of being held on Nauru Island
The recording of our joint event is now available. you can access this here:
SIGN OUR joint letter for clinicians to oppose the Rwanda Scheme
Since the High Court’s judgement on the 19th of December which found the government’s plans to remove asylum seekers to Rwanda to be lawful, we welcome the fact that applications to appeal this decision are being made.
The Rwanda Scheme between the government and Rwanda enables the UK to forcibly remove those attempting to claim asylum in the UK deemed to have arrived by irregular routes, to Rwanda. The policy is already having a devastating impact on the health and wellbeing of those targeted and has been strongly condemned by the BMA and the rest of the medical community.
People seeking asylum are continuing to receive notices about potential removal to Rwanda. This continues to cause distress and worry. The harms to mental health, as documented in our report Who’s Paying the Price, remains to be of concern.
Along with the British Medical Association (BMA) and Medicines Sans Frontières, we are organising an open letter from health professionals urging the Prime Minister to abandon the Rwanda Scheme.
The harms that the prospect of removal to Rwanda is causing to individuals is unconscionable. As health professionals, committed to alleviating suffering, we cannot turn a blind eye to the harmful effects this policy is having and will continue to have on people who are made vulnerable by restrictive border policies.
You can add your name and affiliation to the letter here:
Content warning : distressing video scenes of abuse and self-harm
This video provides an overview of everything most people need to know about the past and continuing abuse of vulnerable people in immigration detention, and how clinical ‘safeguards’ are unworkable.
This recording is of an All-Party Parliamentary Group (APPG) on Immigration Detention briefing session organised by Medical Justice to summarise the evidence heard by the Brook House Public Inquiry (BHI), set up to investigate the shocking mistreatment of detained individuals at Brook House Immigration Removal Centre (IRC) which was caught on undercover cameras and exposed by BBC Panorama in 2017.
Speakers :
Alison Thewliss MP: chair of the APPG
Callum Tulley: the whistle-blower G4S custody officer who filmed undercover
Stephanie Harrison KC: represented Medical Justice and people mistreated in detention
Dr Rachel Bingham: undertakes clinical assessments of Medical Justice clients in detention
Mishka: Allies for Justice member who has experienced detention in the UK
Panorama showed a vulnerable detained person being choked by an officer who threatened to kill him, and being demeaned and threatened by other officers with further violence after a suicide attempt. This was just one example of abuse of one individual, in one IRC – built to detain 448 people at a time – where mistreatment was widespread.
The Home Secretary resisted setting up a public inquiry but was compelled to do so following legal proceedings by formerly detained persons subject to abuse. The BHI is a unique opportunity for public scrutiny as it is the first ever public inquiry into immigration detention conditions despite decades of documented concerns, including inhuman and degrading treatment and neglect contributing to deaths of detained people.
Only undercover reporting has exposed the true nature and scope of the abuse. It has taken a public inquiry to compel witnesses including – for the first time – senior officials of the Home Office and its contractors, plus extensive disclosure of documents and camera recordings, to enable all the dots to be joined up and the causes and contributing factors to be properly investigated.
The BHI examined institutional practices and culture at Brook House IRC, within G4S and within the Home Office, in 2017 and also at the time of the public 2021-22 hearings. It heard evidence over 46 days from all involved: detained persons, privately contracted doctors and nurses, G4S senior management and custody officers, Serco, Home Office officials, official inspectors and monitors. It also heard evidence from experts chosen by the Inquiry to address use of force, institutional culture, healthcare and safeguards. 40,000 documents, amounting to approximately 250,000 pages of material, were reviewed; as well as video recordings, including IRC CCTV, body-worn cameras and un-broadcast BBC footage.
Central to the Inquiry was the extent to which Home Office policy or practice, or clinical care issues caused or contributed to mistreatment. Medical Justice was appointed a Core Participant (CP) due to its extensive first-hand experience of the clinical safeguarding failures and understanding of the inadequate healthcare provision in IRCs. As a CP, we were able see all the disclosed evidence as the Inquiry’s investigation developed. Medical Justice provided policy and other safeguarding information specific to immigration detention which added to the evidence from the Inquiry’s clinical expert whose main experience was around prison healthcare. We submitted suggestions to the Inquiry’s legal team for questions to put to witnesses. Medical Justice’s witness statements and oral evidence were referenced extensively throughout the hearings. Our analysis of our recent casework demonstrated the failures in IRCs are ongoing.
The evidence that emerged confirmed the longstanding serious concerns of Medical Justice and others, but also exposed even more shocking abuses than had previously been understood. The clinical safeguard failures and harm caused that Medical Justice saw in 2017 was just the tip of the iceberg that lay below.
Vulnerable people were detained indefinitely – manifestations of their deterioration and distress were not identified and there was no adequate treatment. They were often responded to with excessive and disproportionate use of force, which was routine and normalised in the context of removals, the use of segregation, and the “management” of mental distress and self-harm.
Doctors and nurses admitted they did not understand how the clinical safeguards were meant to operate and had never applied them properly. They often failed to identify or assess symptoms of trauma, nor did they have the means to provide treatment for it, alarming given that detention itself is inimical to the treatment of mental disorders, especially for the many detained torture and slavery survivors with trauma-related mental illness.
Clinicians wrongly sanctioned the use of force on vulnerable detained individuals, failed to stop violent ‘control and restraint’ that they were responsible for observing, and colluded in falsifying records.
There was a complete deprivation of clinical safeguards as well as inadequate oversight by the Home Office and its contactors created conditions for mistreatment and abuse at Brook House; a causal link was identified between the complete failures of clinical safeguards and the violent abuse.
Use of pain-based “control & restraint” techniques against those in mental distress and who lacked capacity, who may therefore have had impaired responses to the use of pain, risking prolonged and more extreme force.
A ‘prevailing’ culture of not using body-worn cameras and evidence of cover-up amongst staff.
Widespread mistreatment and abuse by custody officers, IRC doctors and nurses – with the complicity of G4S Managers and indifference amongst Home Office officials – was facilitated by an absence of accountability.
Brook House was built and operated like a prison, despite detention there not being part of any criminal sentence. The Home Office contract with G4S had higher penalties for failed removals than for self-harm acts or even death; a premium on profit over fundamental human rights. G4S employees said that there was Home Office pressure to prioritise removal of detained persons over welfare, creating a breeding ground for the desensitised, racist, inhumane environment uncovered. One officer, when asked why a removal proceeded despite the concern that the person had swallowed razor blades said “It was an escorted removal so we were obliged to present him. If he had swallowed a blade it would not have presented a huge problem.”
Normalisation of the infliction of pain, suffering and humiliation, even whilst the detained person was naked, or so emaciated the man could barely hold his own body weight. Use of force against naked detained persons was “unusually high” and was a direct consequence of the no notice removal window policy (later found to be unlawful in the course of Medical Justice litigation).
Evidence of pervasive derogatory and violent verbal abuse and racism to or about detained people revealing an underlying lack of any empathy even when people were at their most distressed and vulnerable- even in life-threatening situations.
An inability to learn lessons. There is no formal process for reporting back on criticisms to managers of IRCs and Home Office decision makers – not even court findings of inhuman & degrading treatment, or from coronial jury findings of failures, where the harm caused resulted in death.
The reaction of the Home Office and its contractors has been one of indifference and intransigence. Phil Riley, Director of Detention and Escorting Services, insisted in his evidence that the Home Office had taken “every step we could take proportionately to deliver a safe environment”.
There have been no criminal charges brought against any individual Home Office or G4S employees officials for misfeasance in public office. The Inquiry did not hear evidence of any public apology to any individual or any admission of liability of unlawful conduct.
Today Medical Justice sees the same tip of the iceberg we did in 2017 in terms of clinical safeguarding failures and the harm this causes, and we fear this suggests that the violent abuse identified at Brook House IRC may be continuing across the detention estate.
The government knows of this avoidable abuse, yet is set to ramp it up with plans to increase detention capacity by 1,000 spaces in 2023, the detention of asylum seekers being removed to Rwanda, the inhumane Manston detention site, the reintroduction of Labour’s discredited detained fast track process, as well as emerging forms of quasi-detention in military barracks.
The Chair of the Inquiry is yet to publish her report. Meanwhile, Medical Justice has produced a summary of the evidence heard by the Inquiry that has been made publicly available, providing references we consider of most public interest – Brook House Inquiry Briefing Key Issues
Third annual inspection of ‘Adults at risk in immigration detention’ – “On the basis of this inspection, the Rule 35 process needs to be called out for what it is – ineffective. It is in the gift of the Home Secretary and senior officials to make the system more effective. However, Home Office senior managers demonstrated a lack of interest in improving Rule 35 specifically… The system is not effective and will remain not effective until leadership action is taken … I am concerned that the Home Secretary has judged this to be an appropriate moment to terminate her predecessor’s commission to ICIBI to carry out an annual review of ‘Adults at risk’ policies and safeguards.”
Clinical Assessor – Doctor
£11,560 per annum per day (for 1 to 4 days a week; £57,800 per annum pro-rata)
Reports to: Clinical Advisor
Responsible for: Volunteer clinicians who may accompany your clinical assessments in a training/observer role
Job purpose: To carry out assessments for people detained in immigration removal centres (IRCs). To write Medico-legal reports in accordance with the Istanbul Protocol.
Working hours: 1 to 4 days a week depending on the candidate’s availability.
Where based: The post-holder will carry out work at Immigration Removal Centres (IRCs) to visit people in detention, and may do some assessments remotely. They will write up their assessments remotely, or from the Medical Justice office in Finsbury Park. The post holder will be expected to attend occasional team meetings, trustees’ meetings, training events and other gatherings as required. Remote attendance at these is often possible.
Length of contract: Six months (we will consider a minimum of 3 months). Renewal may be possible based on project funding.
Terms: Pro rata 24 days per annum holiday, plus statutory bank holidays and 4 additional days’ holiday associated with bank holidays which may be decided on by your manager (usually associated with the office closure during Christmas and New Year).
Closing date: This is a rolling advert, so the recruitment will be closed when the vacancy is filled.
To apply: Please read the Job Description and complete the Application Form. Email your completed application form and your CV to Anthony at a.omar@medicaljustice.org.uk
Outbreaks of diphtheria and scabies and a case of meticillin resistant Staphylococcus aureus have been reported at the overcrowded immigration processing centre in Manston, Kent.
MRSA was identified in an asylum seeker who initially tested positive for diphtheria, the Guardian newspaper reported. The asylum seeker was moved out of the site to a hotel hundreds of kilometres away before the positive test result was received [1].
The Manston site, originally set up as a short term processing centre, has at least eight confirmed cases of diphtheria, the Guardian also reported. The Home Office would not confirm the case of MRSA or the exact number of diphtheria cases.
A Home Office spokesperson told The BMJ, “We are aware of a very small number of cases of diphtheria reported at Manston. Full medical guidance and protocols have been followed.
“We take the safety and welfare of those in our care extremely seriously and are working closely with health professionals and the UK Health Security Agency to ensure the instances are contained and to support the individuals affected.
Stephanie deGiorgio, a doctor who had been working at the centre, told the BBC Radio 4 Today news programme on 1 November that the people she was treating were extremely tired and scared. She said the team had seen cases of diphtheria as well as diarrhoeal illnesses and scabies. “These are people who are living in horrible crowded conditions, and they don’t have enough washing facilities and ability to keep clean, so the risk of diseases is significant.
The Manston centre was designed to be a short term holding facility with migrants held for 24 hours while they underwent checks before being moved into immigration detention centres or asylum accommodation. It is supposed to hold up to 1600 people, but up to 4000 are now being held there. When the chief inspector of immigration visited he found one family that had been there for 32 days sleeping on mats in a tent.
Roger Gale, the Conservative MP whose constituency includes Manston, told the House of Commons on 31 October that the centre had been working efficiently until last month. He accused the home secretary, Suella Braverman, of taking the policy decision not to commission further hotel accommodation to reduce overcrowding. But Braverman has denied blocking the procurement of hotels or vetoing Home Office advice and said the government had been “working tirelessly” to find facilities.
Labour’s shadow home secretary, Yvette Cooper, said that the overcrowded site meant there were risks of “fire, disorder, and infection” and of “outbreaks of violence and untrained staff.” She said these signalled “deeper government failures.”
Charlie Taylor, the chief inspector of prisons, urged the Home Office to “get a grip” on the situation at Manston. In a media statement on 1 November he said, “The current situation at Manston has significantly deteriorated since our July inspection. We are hearing that detainees are now being held in greater numbers and for much longer periods of time in cramped and uncomfortable conditions, often supervised by staff who have not been suitably trained.”
His latest report, which was based on an inspection of Manston in July, found that the centre had improved since earlier inspections but that there were early signs of risks materialising, including weak governance of healthcare processes [2]. It said that the management of controlled drugs was particularly poor and breached standards for safe storage. The care pathway lacked coordination or clinical leadership.
Emma Ginn, a spokesperson for Medical Justice, which works for the health rights of detainees, told The BMJ, “Manston is overcrowded and unsafe, and there is, as appears inevitable in such conditions, an outbreak of infectious disease. The diphtheria outbreak highlights just one of the ways that such overcrowding and inadequate conditions endangers their health.”
She added, “Medical Justice has raised concerns repeatedly that the rates of vulnerability in people who have crossed the channel in small boats are very high, including multiple cases in which we have documented clinical evidence of torture and trafficking. Men, women, and children must be processed efficiently and appropriately accommodated, or the physical and mental health risks of prolonged detention of large groups of people in cramped centres will continue to spiral.”
The Refugee Council said that the crisis was entirely of ministers’ own making and that they must put in place an urgent task force to tackle the growing crisis in the asylum system. Enver Solomon, the council’s chief executive, said, “This is an appalling and inhumane situation, but it can be addressed if ministers are prepared to have focused conversations with organisations such as ours and others. There are ways through this situation, which is causing untold human misery to thousands of vulnerable people fleeing war, persecution, and conflict.
“Ministers have deliberately focused on making the system harsh and austere rather than focusing on putting resources and capacity in place to treat people with compassion and respect.”
From the Helen Bamber Foundation : “Sam is a Vietnamese 20-year-old who was brought to the UK under the promise of a ‘better life’ before being forced to work in a locked cannabis factory for two years. When he finally escaped, he was charged with cannabis production and imprisoned, then after serving his sentence he was put in an immigration detention centre. There his mental health suffered to the point that he was placed on suicide watch.
Eventually Sam was released from detention and referred to the Helen Bamber Foundation (HBF), a charity which supports survivors of trafficking, torture and other extreme human cruelty. The charity’s legal and counter-trafficking team worked to help him get formally recognised as a survivor of trafficking while their doctors diagnosed him with Post-Traumatic Stress Disorder, depression and several physical health problems, all of which had been worsened by his time in detention.
Every day, HBF sees cases where people who have been trafficked have not been identified and have been treated as criminals rather than victims. Detention is not only re-traumatising but also prevents survivors from receiving the support they need to recover from their experiences and from helping the police to catch and prosecute their traffickers.
A new report from HBF, and other NGOs Medical Justice, Anti Trafficking and Labour Exploitation Unit and Focus on Labour Exploitation, highlights the government’s failures to address this problem – and that it has deliberately put in place a system in which more trafficking victims will be locked up. The number held in immigration detention each year has tripled from 500 in 2017 to over 1600 last year. Even when identified as possible victims of trafficking, people are not being released and are detained while waiting for a final decision in their case, when the average time for making these decisions is a staggering 17 months.
The Home Office frequently claims that people ‘abuse’ the system by claiming to be trafficked to secure their release from detention. But over 90% of cases are confirmed to be genuine victims of trafficking. There is no evidence of a process being abused – rather, people who have already been exploited and mistreated are experiencing further abuse by an immigration system that is not fit for purpose.
This report makes practical recommendations for improving that system and calls for an urgent comprehensive review of the process for detaining confirmed or possible victims of trafficking.
“Horrified” leading medical bodies call to abandon Rwanda removals on ethical and medical grounds
The British Medical Association and leading medical bodies in the UK have today jointly written to the Prime Minister expressing concern about the severe impact that the decision to remove asylum seekers to Rwanda is already having on people’s health and wellbeing.
“We are horrified by the UK Government’s plans to forcibly deport people seeking protection in the UK to Rwanda, with no option to return. We urge you abandon this policy of forced expulsions to Rwanda, or any other country.
It is cruel and unconscionable on ethical and medical grounds and has already caused severe damage to individual’s health and wellbeing. The evidence from Medical Justice’s casework makes it clear that the prospect of removal to Rwanda is already exacerbating existing mental health issues for people seeking safety in the UK.
No individual should be forcibly removed to another country for seeking safety and protection in the UK. In addition, the current screening process fails to identify people with specific vulnerabilities, including health conditions.”
A recent report by Medical Justice has documented the experiences of 36 people with whom they have worked and who have been targeted for removal to Rwanda. The 36 include men, women, age disputed children / young people, and some who have family in the UK. Many of these asylum seekers have a history of trafficking, torture and trauma, and have serious mental health conditions, including Post Traumatic Stress Disorder (PTSD) and psychosis. Some have self-harmed and/or expressed suicidal ideation whilst in detention, including one person who attempted suicide twice whilst in detention.
The letter signed by ; British Medical Association Faculty of Public Health International Child Health Group Royal College of Obstetrics and Gynaecologists Medical Justice Doctors of the World Freedom from Torture Helen Bamber Foundation Medact
Vacancies at Medical Justice – a doctor and a psychologist
We have two exciting opportunities to join the Medical Justice team as soon as possible as a Clinical Assessor – Doctor, and as a Clinical Assessor – Psychologist.
Download the Job Description and Application Form for the roles below
Clinical Assessor – Doctor
£11,560 per annum per day (for 1 to 4 days a week; £57,800 per annum pro-rata)
Clinical Assessor – Psychologist
£8,974 per annum per day (for 1 to 4 days a week; £44,872 per annum pro-rata)
Reports to: Clinical Advisor
Responsible for: Volunteer clinicians who may accompany your clinical assessments in a training/observer role
Job purpose: To carry out assessments for people detained in immigration removal centres (IRCs). To write Medico-legal reports in accordance with the Istanbul Protocol.
Working hours: 1 to 4 days a week depending on the candidate’s availability.
Where based: The post-holder will carry out work at Immigration Removal Centres (IRCs) to visit people in detention, and may do some assessments remotely. They will write up their assessments remotely, or from the Medical Justice office in Finsbury Park. The post holder will be expected to attend occasional team meetings, trustees’ meetings, training events and other gatherings as required. Remote attendance at these is often possible.
Length of contract: Six months (we will consider a minimum of 3 months). Renewal may be possible based on project funding.
Terms: Pro rata 24 days per annum holiday, plus statutory bank holidays and 4 additional days’ holiday associated with bank holidays which may be decided on by your manager (usually associated with the office closure during Christmas and New Year).
Closing date: Tuesday 4th October 2022
Interviews: Monday 10th & Tuesday 11th October 2022
To apply: Please read the Job Description and complete the Application Form. Email your completed application form and your CV to Anthony at a.omar@medicaljustice.org.uk
Only undercover reporting has exposed the true nature and scope of the abuse. It has taken a public inquiry to compel witnesses including – for the first time – senior officials of the Home Office and its contractors, plus extensive disclosure of documents and camera recordings, to enable all the dots to be joined up and the causes and contributing factors to be properly investigated.