Emma Ginn of Medical Justice speaks to Jon Ironmonger of BBC Look East and calls for the Home Office to release all remaining detainees

“They have already realeased hundreds of people, they have shown that’s possible, they should get on and release the rest.”

A detainee recently released from Brook House Immigration Removal Centre (IRC) says people who have been granted bail are being kept in centres and a detainee currently in Yarl’s Wood IRC speaks about the stress and confusion she and others are experiencing.

Content warning : use of force scene

07/05/2020 | BBC

Chief Inspector David Bolt says he is ‘disappointed’ at ministers’ lack of action to improve controversial policy

Continue reading “Home Office progress to protect vulnerable people in removal centres ‘too slow’, says immigration watchdog” →

Medical Justice operations during the Coronavirus pandemic

The Medical Justice team has had to make a few adjustments to ensure we do our best to protect the health of our staff, volunteers, clients and that of the wider community.

Medical Justice knows that many immigration detainees are particularly worried at this time.

Immigration detention is not part of any criminal sentence; it is purely for the administrative convenience of the Home Office.  By continuing to hold immigration detainees, the Home Office is risking public health, including that of detainees and immigration removal centre staff, for its own administrative convenience – this is unconscionable, and we continue to challenge it in every way we can.

Continue reading “Update on our work and office during the COVID-19 pandemic” →

Neglect contributed to the death of an immigration detainee died naked and emaciated in ‘strip cell’ – others remain at risk

Prince Fosu died on 30th October 2012, 6 days after being detained at Harmondsworth Immigration Removal Centre (IRC). He suffered undiagnosed, untreated psychosis and related bizarre behaviour, dehydration, malnourishment and hypothermia. He died alone, on the concrete floor of a ‘strip cell’ in segregation with no mattress, having had little if any food, fluid or sleep.  He was naked, emaciated, and covered in debris.

Prince Fosu had been found running down a street with no clothes on. He was arrested and sent to Harmondsworth IRC.  There was a complete failure by guards and doctors contracted by the Home Office to recognise that Prince was mentally ill, to follow immigration detention policies and to properly document and monitor his wellbeing. Where they existed, records included noting Prince Fosu’s “non-compliant” behaviour and that he “declined” food, fresh air, showers and to see doctors.

The scale of the collapse of all ‘safeguards’ cannot be overstated. It happened at every turn, within Harmondsworth, the Home Office, healthcare, and the Independent Monitoring Board who acknowledge that Prince Fosu died “in plain sight”. None took purposeful steps to prevent Prince Fosu dying “in plain sight”. During the inquest many were unable to explain why they acted as they did; others gave explanations that were difficult to fathom.  3 doctors working for Harmondsworth have been reported to the General Medical Council for review.

Had proper assessment been undertaken and appropriate treatment provided, Prince Fosu may have lived.

Verdict / Cause of death:

Record of death: Sudden death following hypothermia, dehydration and malnourishment in a man with psychotic illness”

Further findings: “The failure of Primecare staff to effectively see, assess and provide healthcare to Mr Fosu is inexplicable … Doctors contracted by the Jersey Practice showed insufficient professional curiosity throughout Mr Fosu’s detention.  This lacking in professional curiosity resulted in an absence of any kind of medical intervention which in turn contributed to Mr Fosu’s deterioration … GP  record keeping was inconsistent where notes did appear, there was a failure to record anything meaningful … there was gross failure across all agencies to recognise the need for an provide appropriate care in a person who was unable to look after himself or change his circumstances … this was in part due to the failure to address, recognise, monitor and respond to Mr Fosu’s deteriorating condition.  Neglect contributed to the cause of death.”

Emma Ginn, Director of Medical Justice said:

“Prince Fosu was dehumanised. The failure of individual professional responsibility in this case was staggering. IRC doctors, Home Office officials and guards treated Prince Fosu’s life with casual contempt and effectively watched him die right in front of them.  There is nothing to prevent it happening again tomorrow.

 Policies were clearly not protective enough, and the training and supervision of staff was wholly ineffective.  On top of this the culture of disbelief pervading immigration detention had a fatal consequence.

 One IRC doctor said they did not regard detainees in segregation as patients and that they were only there to ‘fulfil a Home Office legal obligation’. It seemed they stopped acting like doctors when they stepped into the IRC.

 7 years on from Prince Fosu’s death, lessons have not been learned ; our independent volunteer doctors still see mentally ill detainees held in segregation who have become psychotic, suicidal, stopped eating and drinking, and lost mental capacity.  Furthermore, the Home Office argued to the end of the inquest that Prince Fosu may have died of natural causes.

 Many detainees experience a potentially lethal cocktail of medical mistreatment, severe deterioration of their already vulnerable health, and dangerous conditions. Since Prince Fosu’s death, some Home Office policy changes have made detention more harmful and 30 immigration detainees have died, including 4 at Harmondsworth.   

  Immigration removal centres should be closed before another detainee dies.” 

Mr V (detained in 2019 and previously held in segregation in Harmonsworth IRC) said:

 “The inquest into Prince’s death just brings back the feelings of neglect, lack of empathy, lack of care and the sheer practice of brutality in the most open form with no repercussions. Having experienced this myself first hand I feel like Fosu’s death could easily have been my death. “

Quotes from Prince Fosu’s father, Mr Obeng, and his solicitor as well as INQUEST and more details of the case can be found in INQUEST’s press release here.

Available for interview: Mr V, and Medical Justice staff – Emma Ginn, Kris Harris and Dr Mary Kamara.

Contact : emma.ginn@medicaljustice.org.uk

Notes

1. Prince Fosu was a 31 year old Ghanaian. He is survived by his wife, child and parents.
2. Prince Fosu’s father had a valid passport and an airline ticket for his son. He asked that he be allowed to send his son to Ghana and was willing to be escorted to the airport. But the Home Office refused.
3. The Home Office seems incapable of learning lessons – they have not learned from previous deaths, including that of Brian Dalrymple who died in Colnbrook IRC having been transferred there from Harmondsworth IRC just a few days earlier. His death involved many of the same staff, and the inquest uncovered strikingly similar failures in recognising and responding to signs of mental ill health and distress, clinical record keeping, effective checks in segregation, and doctor unaware of the existence of the Detention Centre Rules.
4. A key Home Office witness in both inquests seemed to not remember the Brian Dalrymple case. When the barrister for Prince Fosu’s father put it to her, she said that Prince Fosu’s was her first and last case of death in custody.
5. The General Medical Council must investigate at why none of the doctors, despite saying they were in an unfamiliar environment, not knowing about the rules, took any steps to fulfil their obligations to recognise and work within the limits of their competence. Their failures included basics such as writing proper notes (or any notes) and recognising detainees as potential patients.
6. Harmondsworth staff deemed Prince Fosu to be on a ‘dirty protest’. The Home Office and IRCs continue to fail to recognise that some ‘dirty protests’ and food & fluid refusal are rooted in mental illness. Many detainees who are mentally ill and/or at risk of self-harm or suicide are inappropriately put in segregation.
7. Medical Justice has flagged up fatal system failures in healthcare to the Home Office since 2005 but rather than welcome our evidence, it is all too often disregarded or rejected.
8. It is contemptible that it took until the day the inquest opened for the Home Office to publish amendments to its Segregation policy limiting the removal of bedding from cells – we estimate that over 6,000 detainees will have been exposed to that risk since Prince Fosu died.
9. Medical Justice doubts any policy improvements will prevent another death ; immigration detention in and of itself can be severely damaging, plus the prevalence of medical mistreatment, combined with two decades of consistent, proven Home Office failure to learn lessons.
10. The doctors involved in Prince Fosu’s case worked at Harmondsworth for several months. They did not know of the existence of key policies protecting detainees that they alone could operate – so none of those fundamental protections against unlawful detention could be operated at the very least for those months. This calls into question how many cases where the Home Office said detentions were lawful because there were protections in place.
11. The only way to end immigration detainee deaths is to end immigration detention. Medical Justice agrees with the British Medical Association that immigration removal centres should be phased out.
12. The inquest – A long awaited decision to bring criminal charges against the private companies responsible for Prince Fosu’s care was reversed in October 2018.
13. The family of Prince Fosu was represented by INQUEST Lawyers Group members Kate Maynard of Hickman and Rose solicitors and Nick Armstrong of Matrix Chambers.
14. Other Interested persons represented are GEO, The Home Office, The Chief Constable of Northamptonshire Police, the Independent Monitoring Board, Jersey Practice, Dr Wesley Joseph, Dr Sharif, Dr Singh, Dr Navqi, Central and North West London NHS Foundation Trust, Mitie.
15. About immigration detention : Previous inquests have concluded that neglect contributed to detainees’ deaths and the courts have made a number of findings that detention amounted to “inhuman and degrading treatment”. It is now widely accepted that immigration detention can exacerbate existing medical conditions and can be the cause of mental illness.
16. Immigration detention is arbitrary and indefinite. It is not the consequence of any criminal activity nor is it judicially sanctioned yet 25,000 people are detained every year.
17. About Medical Justice : Medical Justice is a charity that sends volunteer doctors into IRCs to assist detainees, documenting their scars of torture, medical conditions, and injuries sustained during removal attempts, and to challenge instances of medical mistreatment. With our medical evidence, we quantify the endemic extent and severity of harm suffered by immigration detainees.  We identify systemic healthcare failures to the Home Office and NHS England and where discussion fails, we may undertake strategic litigation.
18. Some Medical Justice clients were eventually sectioned to a secure psychiatric unit – some were released into the community after many months, others were sent back to an IRC. We have seen an increasing number of clients who have eventually been released due to their mental illness but later detained again.
19. Data on deaths of immigration detainees – There have been deaths in every single year since Prince Fosu died. There were 11 in 2017 alone. Since 2000 there have been XXX deaths of immigration detainees in IRCs, prisons, during deportation, or within four days of leaving detention.
20. Recent inquests into deaths of immigration detainees identified: Carlington Spencer, 38, who died as a consequence of a stroke – a series of failings which possibly contributed. Bai Bai Ahmed Kabia, 49, who died as a result of a brain haemorrhage – missed opportunities that could possibly have prevented his death. Marcin Gwozdzinski, 28 – serious failings which contributed to his death. Amir Siman-Tov, 41, who died as a result of ‘misadventure’ – a critical narrative conclusion. Tarek Chowdhury, 64, was killed by another detainee experiencing serious mental ill health who had been inappropriately placed in immigration detention – numerous other critical failings. Michal Netyks, 35, died a self-inflicted death – serious criticisms of the immigration deportation process. Branko Zdravkovic, 43, died a self-inflicted death – serious failings, with the coroner writing a critical report to prevent future deaths.
21. INQUEST information on “Deaths of immigration detainees”
22. Medical Justice report : “Death in immigration detention”
23. Medical Justice report : “A Secret Punishment ; The Misuse of Segregation in Immigration Detention”

‘Gross failures’ contributed to man’s death in immigration centre…The Guardian 02/03/2020

Record Of Inquest For Prince Fosu

A Nigerian woman was today cleared of assaulting guards UK during a violent attempt to remove her from the UK.

The Guardian today includes distressing footage of the incident in which the woman sustained multiple injuries at the hands of the guards :  “Woman cleared of assaulting Yarl’s Wood guards during struggle“

Emma Ginn, Director of Medical Justice said ;

“The judge concluded that the lead guard in a use of force briefing was going to use force “come what may”.

The Home Office is clearly still outsourcing abuse. Continue reading “Yarl’s Wood detainee cleared of assault against guards” →

Medical Justice has agreed to ‘stay’ its case against the Home Office in the High Court of Justice regarding the definition of Torture in the ‘Adults at Risk’ policy.
 
This is the second successful challenge that Medical Justice has brought against the definition of torture in relation to this policy.
 
Following the introduction of the Adults at Risk policy we started to see that the new narrower definition of torture was excluding some victims of torture from the protection of the policy – for example, those tortured by traffickers.
 
As a matter of urgency, we lodged a judicial review against the Home Office. We collected evidence from our casework, and from medical professionals to support our argument. The judicial review contended that the definition of torture was unlawfully restrictive, and had no rational justification concerning the identification of those particularly vulnerable to harm in immigration detention. A year later, in October 2017, the judge ruled in our favour finding the definition of torture used at that time was unlawful.
 
The updated definition was still unsatisfactory as it still served to exclude some victims of torture at increased risk of harm in detention from protection, it still laid the evidential burden on detainees and increased the threshold for release from detention. Following the introduction of the new definition of torture we continued to see cases where torture survivors had been detained counter to the stated intention of the policy, including detainees who were deemed to have been victims of torture under the old definition but were re-evaluated under the new policy and found no longer to qualify under the new definition.
 
Again we lodged another Judicial Review on the grounds that the new torture definition was contrary to the purpose of the policy, and there had been no fair and lawful consultation.
 
Medical Justice was granted permission to file a judicial review on all grounds. Rather than go back to the courts, the Home Office made concessions and a consent order was agreed with Medical Justice.  This included policy changes such as an amendment to the Adults at Risk Caseworker Guidance; a review of and consultation on the Detention Centre Rules when the new Detention Centre Rules are laid before Parliament; and finally that an equality impact assessment is carried out as soon as reasonably practicable.

“We see this as a significant win for the protection of already vulnerable people in detention. By making these concessions, the Home Office is admitting that more needs to be done to protect survivors of torture – we just have to wait and see how significant those deeds will be.”

– Emma Ginn, Director

23/09/19

We welcome the opportunity to feed into the consultation on the draft Removal Centre Rules (RCR). We are concerned about a number of aspects of the draft RCR. As the rules are long and complex we have provided a summary of our primary concerns here.

This death is a tragedy and is acutely felt by detainees left behind, locked in immigration removal centres.  

We have clients, including vulnerable torture and trafficking survivors, who have witnessed self-harm by fellow detainees and become immensley distressed by the experience.  After a death in detention, some of our clients call us, frightened, in severe distress and inconsolable. 

Medical Justice sends volunteer doctors to visit immigration detainees to document scars of torture and challenge instances of medical mistreatment. The continued detention of a number of our clients has been found by the High Court to have amounted to inhuman and degrading treatment. Inquests have found neglect contributing to other deaths in immigration detention.

Indefinite detention, coupled with inadequate healthcare can exacerbate detainees’ existing medical condition and be the cause of mental illness.  The Home Office is well aware of the issues – our report “Death in Immigration Detention” documents that year after year investigations into deaths in immigration detention reveal ongoing systemic healthcare failings. 

Each death occurring in immigration detention is avoidable as immigration detention is optional.  The majority of detainees are released back into the community, making this damaging practice all the more senseless. 

The ever-rising death toll and suffering is the human consequence of the UK’s dehumanising and unjust detention system. We agree with the British Medical Association’s call to phase out immigration detention otherwise the deaths and harm will continue.

Read more: The Guardian

We released our Annual Review 2018-19 in July, at our AGM.

In the week the report went to print, 7 of our clients were scheduled to be removed from the UK (one of them twice). None of them ultimately were. Two had been released by the end of the week. Most of them are likely to be granted leave to remain eventually. This is an indication of the effectiveness of our casework and fantastic volunteer doctors and interpreters, carrying out assessments and writing up reports at all hours. It also indicates how many people the Home Office attempts to remove who are medically unfit to fly or who have scars of torture which they have not had the opportunity to documented until they got within days of being removed.

Our clinicians remain troubled by the inadequate healthcare in detention and the risks to people’s lives that are taken – for example, delays in obtaining clinical results and a failure to share them with the patient, including cases of inadequate monitoring for cancer of the blood, anticoagulant medication, and diabetes. Another of many examples is a reluctance to transfer patients to hospital as an emergency when this is indicated.

A volunteer visiting an immigration removal centre for the first time said “I have been a doctor for over 10 years and am used to seeing patients who may be vulnerable or are suffering physically or mentally. But there was helplessness, despair and fear most apparent in these patients that was totally alien to me. It is hard to see how the environment would not adversely affect any person’s physical and mental health, let alone the most vulnerable.”

In his second Home Office commissioned review of the detention of vulnerable detainees, Stephen Shaw found that 44% of detainees were classed as Adults at Risk. Identifying people as being at risk without releasing them is indefensible in our view. Shaw noted : ‘Every [immigration removal] centre manager told me they had seen no difference in number of vulnerable detainees and in some cases it had increased’. Clearly the Home Office’s incongruously named “Adults at Risk” policy is failing to protect vulnerable people.

Medical Justice successfully challenged the “Adults at Risk” policy, again. Detainees previously acknowledged by the Home Office as a torture victim were later not accepted as such using the newer definition.

We intervened in the Supreme Court case of KV, a Sri Lankan who had scars ‘highly consistent’ with having been burnt with hot metal rods. Lower courts said the scars could have been ‘self-inflicted by proxy’ and that the medical expert had ‘trespassed beyond their proper remit”. The Supreme Court questioned the ‘self-infliction by proxy’ reasoning and reasserted the role of the medical expert in documenting torture scars.

We initiated a legal challenge of the “no-notice” removals policy which enabled the Home Office to refuse a migrant’s case and forcibly deport them, within hours and in many cases without access to legal representation.

Medical Justice was quoted 30 times in the media, including by the Times, the Huffington Post, the International Bar Association, the British Medical Journal, the Independent, the Guardian, BBC News and Channel 5 News.

We ended the financial year with an uplifting agreement from parliamentarians that establishing an All Party Parliamentary Group was apt, and that Medical Justice is well placed to act as the secretariat.

Read the full report.