How the UK’s “one in one out” scheme knowingly harms and forcibly removes torture and trafficking survivors to France

Medical Justice press release 21 January 2026 for immediate release

Medical Justice today publishes “Politics over people? How the UK’s “one in one out” knowingly harms and forcibly removes torture and trafficking survivors to France”, the first comprehensive analysis of the backgrounds, experiences and mistreatment of 33 clients detained in immigration removal centres (IRCs) under the ‘one-in one-out’ UK-France Treaty since August 2025. These clients are men, women and age-disputed young people whose nationalities include Eritrean, Iranian, Palestinian and Sudanese.  

Independent clinicians from Medical Justice who assessed 20 clients in detention found that all 20 had clinical evidence of a history of torture, ill-treatment and/or trafficking, and all 20 had serious mental health conditions. Our clinicians document the clinical consequences of the use of force and segregation to facilitate removals.

A Medical Justice spokesperson said: 

“Medical Justice has been documenting the harm experienced by people held in immigration detention for two decades – what sets the mistreatment of clients detained under this scheme apart is the combination of an especially high proportion of trafficking and torture survivors, alarming levels of suicidality, and the fact that almost all of them experienced dysfunction of the clinical safeguarding system, exposing them to the severe harm detention in the UK is known to cause. 

The number of people released by the Home Office in response to safeguarding reports from healthcare units inside IRCs is so low that it risks rendering the whole process of clinical safeguards meaningless. 

We fear the government wants to remove these people come what may. 

The scheme should be scrapped and all people be allowed to have their asylum claims processed in the UK.” 

Medical Justice found:   

• Of the 20 clients our clinicians assessed, only two had an appointment with a GP at the IRC within 24 hours of arrival there as they should have done. 

• Only three had a report by the IRC GP identifying those who are likely to be injuriously affected by detention as they should have done. Those who did not have one of these reports included people whose health had already deteriorated in detention, one of whom had been hospitalised.  

• 12 out of the 20 people our clinicians assessed had suicidal thoughts. One person attempted to take their own life and two self-harmed in detention. Five were identified as being at risk of self-harm and/or suicide by the IRC, with one put on suicide watch (“constant supervision”), yet only one had a safeguarding report as they should have done from the IRC to flag suspected suicidal intentions to the Home Office who should review if detention is to be continued.  

• We had access to 14 Home Office responses to safeguarding reports – in only one case was the person released.  

• Clients were detained for between one month and over three and a half months. 16 of the 33 clients were released in the UK, with several subsequently re-detained for removal. Some have been forcibly removed to France.   

• Many clients have not been able to access adequate and timely legal advice.       

Based on expert medical evidence, the report details the harm and distress caused and compounded by detention, as well as by the accelerated process of forced removal and the anticipation of removal. Many clients described having experienced severe violence and highly traumatic events in France – including witnessing the violent death of another person at the hands of traffickers, and being threatened by traffickers that they would be killed if they returned to France. Some clients had suicidal thoughts when thinking about being returned to France and expressed intent to die by suicide if they were to be removed. 

Clients describe being arbitrarily selected after arriving by small boat to be in the scheme. Neither their claims for asylum nor their risks of harm from detention in UK IRCs were considered when they were ‘selected’ for detention – they were instead subjected to inherently harmful detention. At the time of publication, the Home Office had decided to remove six clients, including an age-disputed child, from the inadmissibility procedure and they are now able to process their asylum claim in the UK. 

Successive governments have been continuously warned by their own monitoring bodies, by Medical Justice, and in a public inquiry, of the danger and harm of detention in the UK, yet is knowingly harming torture and trafficking survivors and age-disputed young people by subjecting them to this scheme and locking them up in detention.   

Hamid* was detained under this Treaty and had clinical evidence of a history of torture. He  describes the excessive force and violence he was subjected to during a removal attempt to France. Hamid told Medical Justice:

“The belt that was tied around my shoulders got stuck in my throat. I started screaming and saying I want to die, untie the belt from my neck, but they thought I just wanted to be let go. After a few minutes, I became dizzy, and my voice became weak and my strength was limited to just tears. They saw me struggling for air and honestly, my eyes were turning white and my breathing was difficult. I said in a low voice, I can’t breathe, and I thought to myself, Oh, my God.”  

A Medical Justice clinician documented evidence of Hamid’s physical injuries and psychological harm. Hamid has since been removed. 

This report comes shortly after a group of more than 80 people detained under the scheme at Harmondsworth IRC spoke out about the psychological distress, fear and harm they are suffering, and just days after reportedly passive protests by more than 100 asylum seekers at two IRCs. A video circulated of protesters being dispersed by officers using riot shields, PAVA spray and dogs.

*Not his real name  

Medical Justice’s annual review, published for the first time today, highlights how failures in clinical safeguards continued to put vulnerable people at unacceptable levels of risk and failed to prevent harm in immigration detention during 2024.  

Medical Justice Annual Review: The state of healthcare and harm in UK immigration detention in 2024 draws on a detailed statistical analysis of clinical and other evidence from 73 clients detained at immigration removal centres (IRCs) who were assessed by independent clinicians working with the charity and who received completed medico-legal reports in 2024. It documents the prevalence of factors that are likely to make Medical Justice clients particularly vulnerable to suffering harm in detention. These factors include having a history of torture, trafficking and other trauma, as well as mental and physical health conditions. The review also considers health deterioration while detained, levels of suicidality, and available healthcare provision in detention. 

A deep dive into the functioning of available safeguarding mechanisms reveals worrying failures in implementation – including of the initial healthcare screening undertaken by IRC healthcare staff, medical examinations mandated by Rule 34 of the Detention Centre Rules, reporting of vulnerabilities under Rule 35, and Assessment Care in Detention and Teamwork (ACDT) – a process intended to manage the risk of self-harm and suicide. The review also highlights the inappropriate use of segregation and of force on vulnerable detained people. 

The findings are stark: 

• 82% of the clients included in this review were survivors of torture and 63% reported a history of trafficking. However, healthcare screenings on arrival largely failed to identify these critical vulnerabilities – missing 77% of the survivors of torture and 89% with a reported history of trafficking. 

• 99% had a diagnosis of at least one mental health condition, including post-traumatic stress disorder, according to the Medical Justice clinician. Many of these were new diagnoses that had been missed or not explored by healthcare in detention. 

• The mental state of 97% of clients deteriorated while in detention and 74% had an increased risk of suicide since they were detained. 23% of clients self-harmed in detention and three people attempted suicide. 

• Only 6% of clients that Medical Justice clinicians assessed had been harmed by detention had a Rule 35 (1) safeguarding report as they should have had. This is the report IRC GPs are required to complete to alert the Home Office that they suspect a detained person is likely to be injuriously affected by detention and which triggers a detention review.  

• Clients with mental health conditions were put in segregation for extended periods. More than half of these clients (53%) were not visited daily by the IRC GP, as required by the Detention Centre Rules. 

• Force was used on 16 clients, with force applied to two clients’ head and neck.  

• 90% of clients were eventually released, calling into question the justification for their detention in the first place. 

“These findings highlight not only the scale of unnecessary harm that indefinite immigration detention causes vulnerable people on a daily basis, but also the ongoing systemic failure of safeguarding mechanisms that are supposed to protect them,” said Ariel Plotkin, Researcher at Medical Justice.  

“We know only too well that ineffective safeguards can lead to life-or-death situations. Yet rather than addressing the failings that we have repeatedly warned them about, the government plans to increase detention capacity and speed up removals, including with the arbitrary and dehumanising new ‘one in, one out’ deal with France. Under these arrangements, more people will be detained and even more pressure will be added to an already broken, dangerous and harmful system.”  

Medical Justice recommends that immigration detention must end and the government should also consider credible community-based alternatives. 

In the interim, the risk of further mistreatment and abuse can be reduced by promptly implementing all 33 recommendations of the Brook House Inquiry and ensuring that the review of the Adults at Risk in Immigration Detention policy currently underway strengthens the available protections rather than further weakening them. 

For more information and to arrange media interviews, please contact: 

Emma Ginn, Director, emma.ginn@medicaljustice.org.uk 

“You’ll see the outside when you’re in Rwanda”: Mistreatment in UK detention and mass round ups for forced removals 

Medical Justice press release for immediate release September 2024

Click here to read the report

We publish our report today analysing the devastating experiences of those rounded up en masse, held in immigration detention and threatened with forced removal to Rwanda in 2024. We do so marking the anniversary of the publication of the report of the Brook House Inquiry, the public inquiry revealing conditions that led to disturbing levels of inhuman and degrading treatment in detention. Detained people are still being subjected to the failures underlying these conditions today, across all UK detention centres. 

Our report comes a few weeks after the new Labour government announced plans for a “large surge in enforcement and return flights” and to expand immigration detention by opening Campsfield and Haslar Immigration Removal Centres (IRCs) and days after Keir Starmer said he was “interested” in learning about Italy’s offshoring scheme in Albania.  

Detention conditions have recently been described by inspectors to be the worst they have seen, and safeguards meant to protect vulnerable people in detention have been weakened. This report shines a light on the brutal reality of immigration detention to facilitate removal and the harm that is set to be repeated by a large surge in flights and expansion of detention. 

Ahead of forced removal charter flights, people are rounded up en masse and locked up in large numbers in detention. This often includes many vulnerable people with histories of torture, trafficking and trauma, who are fearful of the country they are being forcibly sent to. Holding them in detention, an environment that is inherently harmful, causes distress and avoidable suffering. The threatened forced removals to Rwanda in 2024, the subject of this report, is the latest example of this.   

Analysing the casefiles, experiences and clinical evidence, of 30 clients who were rounded up and detained for forced removal to Rwanda between 29 April and 4 May 2024, this research has found:   

• People were handcuffed and detained with no warning, resulting in shock, fear and confusion, as well as suicidal thoughts and self-harming. Those detained included men and women, whose nationalities included Syrian, Eritrean, Ethiopian, Afghani, Iranian and Sudanese. 

• All were seeking asylum. None had a criminal conviction. 80% of the cohort had histories of torture and/or serious ill-treatment, trafficking and mental health conditions, which made them particularly susceptible to suffering harm as a result of detention and also as a result of the threat of removal to a country which they feared.  

• During the round up, two clients were recorded to have lost consciousness or collapsed during the process of being detained including one woman who fainted. Both were transferred to A&E and then on to an IRC. 

• 10 did not have any legal representation at the time of their detention and receiving their Notice of Intent for removal to Rwanda. 

• Trafficking survivors likened their trafficking experience with detention for removal to Rwanda. 

• There were alarmingly high suicide risk levels and deterioration; Medical Justice clinicians assessed 11 clients, all of whom were found to have mental health conditions, including Post-Traumatic Stress Disorder, and all 11 deteriorated in their mental state. 9 of had suicidal thoughts, 2 had self-harmed and 1 attempted suicide shortly after they were detained. 8 expressed that they will or would take their own life if they were forcibly removed to Rwanda. 

• With a surge of people arriving into detention who have complex healthcare needs a, the dysfunction of detention safeguards was acutely evident, failing to identify, protect and route vulnerable individuals out of detention. None of the 30 people had a Rule 35 (1) or (2) safeguarding report completed as should have happened, including for those who were suicidal.  

• People were held in detention for up to 50 days which the Home Office justified by stating that a flight was planned within a “reasonable timeframe” even though flights were not imminent in reality and never took off.   

• The harm caused by detention continued after clients were released back into the community. 

 This picture of harm is what has characterised many mass round-ups for highly publicised charter deportation flights. 

Ahmad*, a torture survivor, was in bed when four people entered his room. One was carrying a shield, another carried what he thought was a gun.  He was handcuffed and taken by force from his bedroom. For Ahmad, this was a terrifying trigger of past experiences of being tortured. For the Home Office, it was an opportunity to film and broadcast Ahmad’s ordeal (what Ahmad thought was a gun was in fact a video camera) and to publicise the cruelty inflicted on those targeted for deportation to Rwanda. 

Mark* told Medical Justice after he was released that he is “terrified” to report as required to the Home Office that he will be re-detained.   

Serena* asked when she will be able to leave and was told “you’ll see the outside when you’re in Rwanda”. 

“This dossier evidences the predictable and severe harm caused by the 2024 mass round-up for the Rwanda charter flight – it’s nothing short of a tragedy that it’s so similar to our last dossier on round-ups for deportation charter flights. The new government should abandon its plans to expand detention and ramp up deportation flights that will cause more harm, knowingly – harm that is avoidable, and indeed not accidental. 

We agree with the British Medical Association that IRCs should be phased out.  Meanwhile, increasing detention before any of the Brook House Inquiry recommendations have been implemented is simply an afront to human decency.” – Ariel Plotkin, Medical Justice Researcher 

Available for interview : Dr Rachel Bingham, Medical Justice clinician 

Contact : emma.ginn@medicaljustice.org.uk / 07786 517379 

*Not their real names 

Download the report “You’ll see the outside when you’re in Rwanda”: Mistreatment in UK Detention and Mass Round Ups for Forced Removals” 

Notes 

1. Only 1 of 33 of the Brook House Inquiry’s recommendations has been agreed by the Home Office 
2. Medical Justice is the only charity that sends independent volunteer clinicians to visit clients detained in IRCs to document their scars of torture, deterioration of health and injuries sustained during violent incidents.  Each year we assist more than 500 people held in immigration detention each year. We publish research, undertake policy work and strategic litigation, and act as the secretariat for the All-Party Parliamentary Group on Immigration Detention. Medical Justice was appointed as a Core Participant of the Brook House Inquiry (BHI) due to its extensive first-hand experience of the clinical safeguarding and healthcare failures in IRCs .  Our comprehensive evidence submitted to BHI was pivotal in demonstrating a causal link between the complete failure of clinical safeguards and the violent abuse uncovered. 

Medical Justice press release 12 January 2024 for immediate release

In a judgment handed down on 12 January 2024 the High Court allowed a judicial review brought by the charity Medical Justice to a policy which allowed the Home Office to seek a second medical opinion in respect of vulnerable people in immigration detention when they have submitted an ‘external’ medical report – produced by Medical Justice or another independent medical professional – as to their vulnerability to harm in immigration detention. This delays consideration of the available evidence concerning the likely harm to the vulnerable person of continued detention for several weeks or more.  

Medical Justice was represented by Shu Shin Luh and Laura Profumo, barristers at Doughty Street Chambers, instructed by Jed Pennington, partner in Wilson Solicitors’ Public Law and Human Rights Team. 

Witness evidence was provided by Medical Justice staff Idel Hanley, Policy, Research and Parliamentary Manager, and Dr Elizabeth Clark, Clinical Advisor; Tara Wolfe, Head of the Medico-Legal Report Service at Freedom from Torture; and Dr Juliet Cohen, an independent forensic clinician and former Head of Doctors at Freedom from Torture from 2005-2021. 

What is the Second Opinion Policy and what was Medical Justice’s complaint about it?

The  Second Opinion Policy was first introduced in June 2022 and applies whenever the Home Office receives a medico-legal report submitted by or on behalf of a person in immigration detention which addresses their vulnerability to harm in immigration detention. The policy directs Home Office decision-makers to delay consideration of the report in deciding whether the vulnerable person should remain in immigration detention whilst it seeks a second medical opinion from a Home Office contracted doctor. The process of obtaining a second opinion, even if there are no unforeseen delays, can take “up to 18 working days and significantly more calendar days” (judgment, para 55(ii)). Allowing time for consideration of the report and for a decision on it by the Home Office and for this to be communicated will likely mean vulnerable people in this process being detained for a month or longer in circumstances where prompt consideration of the external medical report – without the delay in obtaining a second medical opinion – would lead to release. 

The core problem with the policy, as identified by Linden J, is that it directly contradicts the approach set out in guidance approved by Parliament pursuant to section 59 of the Immigration Act 2016, the Adults at Risk Statutory Guidance. This guidance requires Home Office officials to decide vulnerability (both whether the person is in principle vulnerable and if so which of 3 evidence levels they fall into) based on the available evidence. The evidence levels crucially determine the strength of the presumption against continued detention. The higher the evidence level, the weightier the immigration factors required before the Home Office can discharge its burden to justify continued detention. Medical Justice also argued that the guidance on how differences of opinion between the two medical opinions should be dealt with is likely to lead to the downgrading of the evidence level of risk than would be the case if the external medical report were assessed on its own terms, and therefore may result in a person remaining in detention when they would otherwise have been released in view of the assessment of their vulnerability in the external medical report. 

Medical Justice’s other principal complaint was that the Second Opinion Policy was introduced without any form of consultation and that this was contrary to established practice of consulting with Medical Justice and other expert interested groups on policies and operational guidance concerning the detention and treatment of adults at risk.  

What did the Court decide?

The Second Opinion Policy was unlawful because it contradicted the Adults at Risk Statutory Guidance 

Linden J decided that the Second Opinion Policy contradicted the Adults at Risk Statutory Guidance, essentially because it purports to authorise Home Office officials to depart from the approach in the Statutory Guidance of assessing vulnerability based on available evidence. This meant that, following recent UK Supreme Court jurisprudence (R(A) v SSHD [2021] UKSC 37, [2021] 1 WLR 3931) the policy was unlawful: 

[78] “…Perhaps the simplest way of expressing the point is that the Statutory Guidance was required by section 59 of the Immigration Act 2016 to be approved by Parliament, albeit by the negative resolution procedure, and was approved by Parliament. It therefore was not open to the Defendant to contradict or undermine it without the approval of Parliament.” 

[79] “…in my view this is a case in which the Defendant has undermined the rule of law in a direct and unjustified way by issuing a policy which positively authorises or approves unlawful conduct by caseworkers in that the terms of the Second Opinion Policy require or encourage them to act contrary to the Statutory Guidance approved by Parliament…” 

Unlawful failure to consult 

As to consultation, Linden J accepted that Medical Justice’s evidence, supported by Freedom from Torture, demonstrated an established practice of consultation on Adults at Risk detention policies that was “so consistent as to imply clearly, unambiguously and without relevant qualification that it will be followed in the future” (para 158). This evidence was “effectively uncontradicted by evidence” from the Home Office (para 159). This meant Medical Justice had a legitimate expectation that it would be consulted in relation to the Second Opinion Policy. It was common ground that there had been no consultation, leading the judge to decide that the failure to consult Medical Justice had been unlawful: 

[161] “…the key point for present purposes was that policy matters relating to adults at risk in detention were within the expertise of the Claimant and, on the evidence, the Claimant was consistently consulted in relation to material issues arising in this area, regardless of who else was.” 

[162] “…To my mind the key point is that the evidence establishes a clear pattern of seeking the views of the Claimant in relation to policy proposals and changes in the area of adults at risk, the Claimant providing those views, the views being taken into account by the Defendant and a decision being taken…” 

[165] “I therefore uphold Ground 3 on the basis that the Claimant had a legitimate expectation of consultation about the Second Opinion Policy, no real attempt to explain or justify the failure to consult having been put forward by the Defendant in the context of the Claim…” 

Relief 

The Court ordered that the Second Opinion Policy be quashed and made a declaration that the failure to consult Medical Justice had been unlawful. 

What does the Court’s decision mean for people in immigration detention?

The Court’s decision means that the Home Office cannot apply the Second Opinion Policy to people currently in immigration detention and will need to be withdrawn. This will mean that vulnerable people – potentially hundreds annually – who would otherwise have been detained because of the application of the Second Opinion policy will be released where the available medical evidence and the application of the Adults at Risk Statutory Guidance requires this. 

People who have had the Second Opinion Policy applied to them since it was introduced in June 2022 should seek advice on whether they have claims for unlawful detention based on the application of the unlawful policy, and any failure to decide vulnerability and whether they should remain in detention based on a medico-legal report submitted by them or on their behalf. 

Is it possible for the Home Office to reintroduce the Second Opinion Policy in future?

Potentially, but it would first be required to carry out a fair consultation and it would need to seek Parliament’s approval of the policy under section 59 of the Immigration Act 2016. 

Idel Hanley, Policy, Research and Parliamentary Manager at Medical Justice said:  

“Downgrading important safeguards, as was done by introducing the second opinion policy, without meaningful consultation or parliamentary scrutiny, is an affront to the rule of law and risked causing serious harm to detained people.

Immigration detention is known to be extremely damaging to people’s mental health and wellbeing. Those with histories of torture, trafficking, and trauma, as many detained people have, are at particular risk of deterioration in their mental health. In requiring a second assessment by a Home Office contracted doctor, this policy by design, risks retraumatising already vulnerable people and prolonging their detention. This policy’s provision that the second assessment could be carried out purely on the basis of documents, without the Home Office doctor ever meeting the detained person, and then lead to the downgrading of medical evidence, was also problematic.

The Home Office’s attempt to undermine the weight of external medical evidence in this way is unacceptable.

As immigration detention is set to expand, this judgment is an important reminder for the Home Office to conduct meaningful consultations and act in accordance with the law.”

Jed Pennington, Partner in Wilson Solicitors Public Law & Human Rights Team said:  

“Fair consultation and compliance with the law made by Parliament are fundamental requirements of this country’s democratic process and the rule of law. The Home Office subverted these requirements by introducing the Second Opinion Policy without consultation and without seeking Parliament’s approval. Today’s decision by the Court should make a real difference to vulnerable people held in immigration detention.”

Sonya Sceats, Chief Executive at Freedom from Torture said:  

“We know from our specialist therapy services across the country how profoundly damaging detention is for survivors of torture. As outlined in our expert evidence, this unlawful policy risked retraumatising vulnerable people and prolonging the devastating impacts of detention. This is a stark reminder of how important protective safeguards are and it’s shameful how the Home Office downgraded them. The bottom line is survivors of torture should never be detained.”

Contact: Emma Ginn on emma.ginn@medicaljustice.org.uk / 07786 517379 

Notes

Background:

Immigration detention is known to cause harm to those held there. It has been found to cause mental health illnesses, exacerbate existing mental health conditions and have a re-traumatising effect for many. Detained people often have histories of torture, trafficking and trauma, rendering them at a particular risk of harm in detention. Healthcare in detention is inadequate and inquests have found that neglect has contributed to deaths. 

Clinical safeguards designed to protect vulnerable people and route them out of detention have never functioned effectively. The clinical safeguards and detention healthcare have most recently been found to be inadequate and part of a system resulting in mistreatment, by the public inquiry into Brook House Immigration Removal Centre (IRC), the Brook House Inquiry, which found 19 instances of inhuman and degrading treatment in a 5-month period. 

Medical evidence is essential in documenting an individual’s health, deterioration and suffering caused by detention. It can make the difference between someone being detained or released. Medical Justice is the only charity to send independent doctors into all IRCs to conduct clinical assessments to this effect and write medico-legal reports (MLR). Such assessments can take 4 to 5 hours and require significant levels of trust from the detained individual. They take considerable time to analyse medical records prior to the assessment, to draft the report following the assessment, and to undergo a rigorous review process. The second opinion policy is an affront to this.  

Prior to the second opinion policy being introduced, Home Office caseworkers would have had to review the person’s detention on receipt of an external MLR. A full MLR, completed in accordance with the required standards, finding that the person was at risk in detention, would weigh very significantly against continuing detention. The second opinion policy however directs caseworkers to delay reviewing a vulnerable person’s detention on the basis of the information contained in an independent MLR and instead to refer them for further assessment, by a Home Office contracted doctor.  

However, in comparison to MLR assessments, assessments for second opinion reports may be comparatively cursory due to a lack of time, trust and disclosure. We are concerned that some people in detention will not perceive the Home Office contracted doctor as independent, and therefore will not trust them. This could prevent full disclosure of the extent of their history or symptoms. This could result in the second opinion reports being more likely to underestimate the person’s symptoms, leading to a downgrading of the medical and thus individuals remaining in detention. 

Medical Justice is the only charity that sends independent volunteer clinicians to visit clients detained in IRCs to document their scars of torture, deterioration of health and injuries sustained during violent incidents. It has handled 3,589 referrals for people in detention since the 2017 BBC broadcast. We publish research, undertake policy work and strategic litigation, and act as the secretariat for the APPG. Medical Justice was appointed as a CP due to its extensive first-hand experience of the clinical safeguarding and healthcare failures in IRCs.  Our comprehensive evidence submitted to BHI was pivotal in demonstrating a causal link between the complete failure of clinical safeguards and the violent abuse. 

Medical Justice press release 11 December 2023 for immediate release

Click here to read the report

Medical Justice today publishes ‘“If he dies, he dies”: What has changed since the Brook House Inquiry?’. This research, a comprehensive analysis of clinical evidence from 66 clients detained in Immigration Removal Centres (IRCs), visited by Medical Justice independent doctors between June 2022 and March 2023, demonstrates how unsafe and harmful immigration detention can be.

Undercover footage disclosed to the Brook House Inquiry revealed guards saying “if he dies, he dies” in 2017. The justification that this was part of the culture and a joke was found by the Inquiry to be “not only callous and unacceptable but betrays the extent of desensitisation to detained people’s health issues and vulnerabilities, and the dehumanisation of detained people by some staff”.

The experiences of the 66 people in this report shows that many of the same circumstances that were behind the mistreatment evidenced by the Brook House Inquiry, continue to exist across the UK’s IRCs.

The Brook House Inquiry provided a forensic analysis of how the abuse uncovered by Panorama in 2017 occurred. It found how the dangerous use of force, a wholesale failure of safeguards and a culture of dehumanisation led to 19 instances of inhuman or degrading treatment, breaching Article 3 of the European Convention on Human Rights (ECHR), within a 5-month period at Brook House IRC. It exposed failures, mistreatment and indifference at every level; from nurses and doctors, IRC staff, to Home Office civil servants. Light was shone on the structural deficiencies in detention safeguards and processes around use of force, segregation and responses to self-harm and suicidal thoughts.

Medical Justice has consistently evidenced the harm and dysfunctional safeguards to the Home Office. This report is the latest iteration of this work, which has stretched back over the past 18 years. All the failings documented in this report have taken place after the Inquiry’s public hearings, across the detention estate.

The Brook House Inquiry unequivocally places responsibility on the Home Office, urging action at the highest levels of government. There has been a failure to learn lessons from previous reviews; such a failure is described by the Inquiry’s Chair as a “dark thread” throughout her report. The Home Office publicly state their commitment to learning lessons to ensure that the mistreatment uncovered in Brook House never happens again. Yet, such abuse can only be avoided if there is meaningful change – which has been sorely lacking after previous investigations and reviews over the last two decades. The Inquiry made 33 recommendations which need to be urgently addressed.

The Home Office does not seem to acknowledge the severity of harm ongoing in detention and turns a blind eye to the failures over which it presides. They suggest that these are issues of the past. This ignores the important findings of the Inquiry that many of the factors which allow for mistreatment to occur, are unchanged to date. The Inquiry reached these conclusions after hearing evidence from current Home Office, custodial and healthcare staff and reviewing recent reports from His Majesty’s Inspectorate of Prisons (HMIP), the Independent Chief Inspector of Borders and Immigration (ICIBI) and the Independent Monitoring Board (IMB), as well as from Medical Justice.

This Inquiry cannot be another one for the bookshelves. Our report demonstrates how many of the issues in the Inquiry are still ongoing today, across the detention estate. Action could not be more urgent as the government plans to significantly expand detention and implement the provisions of the Illegal Migration Act, knowing the harm that is still being caused. This ongoing harm is apparent from our evidence, , the death of Frank Ospina in March this year reportedly by suicide, and another recent death in November this year of an Albanian man following a reported attempted suicide, a ‘multiple mass suicide attempt’ and the continuing failures of the Home Office safeguards, including the identification of people at risk of self-harm or suicide.

Client:

“The experience in detention is a living hell. I had a constant feeling of panic. The place is a place of despair. I would not wish it on my worst enemy. The healthcare was careless, the officers were racist and would laugh at your face. The staff were abusive and used abusive language. There was a lot of violence inside from the staff, I saw one man be thrown to the floor by his neck in front of everyone. I felt I was never listened to, a mental health nurse laughed in my face when I tried to explain my pain. The worst for me was witnessing a suicide and a couple of suicide attempts. One man did not succeed and tried it again. I am still living with that.

The message I would send is that in the world and in this detention system, I see human beings but no humanity. Don’t treat humans like animals in detention”.

Idel Hanley, Policy, Research and Parliamentary Manager, said:

“This research yet again demonstrates what Medical Justice has evidenced for years; immigration detention causes unconscionable harm and distress to vulnerable people. Medical Justice agrees with the British Medical Association that immigration detention should be phased out.

Our report shows that the immigration detention of a population with high rates of vulnerabilities in a prison environment, risks causing harm through damage to their mental health, inadequate safeguarding procedures, use of force, clinically inappropriate use of segregation, and experiences of dismissive and derogatory attitudes. Ultimately, immigration detention remains a wholly unsafe environment.

It is a travesty that this has been ongoing across all UK detention centres since the Brook House Inquiry held its public hearings. The fundamental frameworks are still the same as they were in 2017.

The lack of any significant or material improvements, especially in light of a public Inquiry finding evidence of inhuman and degrading treatment, suggests indifference and an unwillingness to change. This level of desperation, despair and abuse is at risk of rising even higher with detention for removal to Rwanda.”

 Key findings

This research has found that of the case set of 66 clients:

• 84% had evidence of a history of torture and/or trafficking.
• 95% had a diagnosis of at least one mental health condition, with a high proportion diagnosed with Post-Traumatic Stress Disorder (PTSD) or some trauma-related symptoms such as flashbacks and nightmares, and/or depression.
• There are alarmingly high suicide risk levels amongst the clients analysed for this report: 74% of the clients in the case set were recorded as having self-harmed, suicidal thoughts and/or attempted suicide in detention. 13 out of the 66 people in the case set attempted suicide and 17 self-harmed in detention.
• There were instances of healthcare failing to identify or to provide adequate treatment in detention for particular mental health conditions, such as PTSD.
• The clinical safeguards in detention – Rules 34 and 35 of the Detention Centre Rules 2001 – are not functioning effectively to identify, protect and route out those at risk of harm, suicide and/or self-harm and those who have a history of torture. The Home Office is failing to release vulnerable people from detention, when brought to their attention through Rule 35.
• Assessment Care in Detention and Teamwork (ACDT), including constant watch, remain custodial tools for staff to “manage” the risk of suicide and self-harm in detention. Neither processes are therapeutic or clinical, nor are they sufficient to deal with those who are actively suicidal or at risk of suicide or self-harm. These processes are not connected to the safeguards in the Rule 35 process.
• Seven people out of 66 in the case set were subjected to use of force and/or restraints in detention; three of whom had injuries attributed to the force used on them requiring medical treatment, documented by the Medical Justice clinician.
• Fourteen out of 66 in the case set were put in segregation during their detention, one of whom was assessed as lacking mental capacity by the Medical Justice clinician. Segregation severely impacted those detained there, including increased suicidal thoughts, self-harming episodes in response and a deterioration in their mental state.

Contact : Emma Ginn on emma.ginn@medicaljustice.org.uk / 07786 517379

Notes

Medical Justice is the only charity that sends independent volunteer clinicians to visit clients detained in IRCs to document their scars of torture, deterioration of health and injuries sustained during violent incidents. It has handled 3,589 referrals for people in detention since the 2017 BBC broadcast. We publish research, undertake policy work and strategic litigation, and act as the secretariat for the APPG. Medical Justice was appointed as a CP due to its extensive first-hand experience of the clinical safeguarding and healthcare failures in IRCs.  Our comprehensive evidence submitted to BHI was pivotal in demonstrating a causal link between the complete failure of clinical safeguards and the violent abuse.

PRESS RELEASE FOR IMMEDIATE USE

Every move you make: the human impact of GPS tagging in immigration bail

Research published today, 31/10/2022, shows that migrants fitted with GPS tags experience significant psychological and physical suffering, despite no clear explanation or evidence from the Home Office that tagging is necessary or cost effective.

Over 2,000 people on immigration bail are currently made to wear the GPS tags 24 hours a day, indefinitely, with cases often taking years to close. The latest figures show only 1.3% of people released from immigration detention absconded in the first six months of 2022.

GPS tagging collects more intrusive data than other electronic tagging, and the Home Office is able to access an individual’s ‘trail’ data in a wide range of circumstances. This includes if they make an immigration application involving the right to a family life under Article 8 of the ECHR.

With first-hand testimony from migrants who have been tagged and clinicians who work with them, Every move you make: the human impact of GPS tagging in immigration bail finds that:

• Wearers of GPS tags experience anxiety, stress, discomfort, and pain.
• Many wearers said they had no idea how to challenge the decision to tag them or indeed how their data was being used by the Home Office.
• People have been tagged despite the Home Office being aware of poor mental health or psychiatric conditions and their previous experience of trauma.
• Tagged individuals have reported increased feelings of social stigmatisation, isolation and avoidance of public spaces and activities.
• Tags affect every aspect of people’s daily life and routine, including the ability to exercise, sleep, work, have relationships and care for their children.
• The tags are used alongside strict requirements to report to the Home Office on a regular basis.
• There are a range of practical problems with the tags themselves, including devices failing or chargers not working.

Annie Viswanathan, BID’s Director, said:

“We work with many people who, after the ordeal of immigration detention, are forced to wear an ankle tag fitted with GPS technology to record their every move. This substitutes one form of imprisonment for another. As we have documented in this report, the people we spoke to felt profoundly dehumanised and degraded by this intense form of surveillance and had suffered a wide range of harms as a result.

Meanwhile the Home Office is quietly harvesting immense volumes of highly sensitive location data that it will use against people in their immigration claims.

GPS tagging, like so much immigration policy in recent years, seeks to insert borders and immigration controls into homes, families and communities across the UK. This draconian form of surveillance has no place in 21^st century Britain.”

Jo Hynes, Research Fellow at Public Law Project said:

“These findings uncover a deeply harmful and inhumane system placing unnecessary restrictions on a group of people who are already more likely to be experiencing physical or mental strain.

“The latest figures show that only 1.3% of people released from detention absconded in the first six months of 2022. Without clear justification for the practice, we are calling for the Home Office to stop their use of electronic tagging of those on immigration bail. Until then, the use of electronic tagging must adopt far more robust and transparent guidelines, with respect for the rights of the wearer embedded in the practice.”

“Where tagging is used in the criminal justice system, it comes with a host of safeguards. But when it comes to the immigration context, these safeguards have not yet been transferred. As a result, GPS tagging is experienced by many as a continuation of the loss of liberty of immigration detention, but with additional personal data protection concerns.”

Dr Kathryn Allinson from Medical Justice said:

“Independent clinicians working with Medical Justice have documented the negative impact of electronic monitoring on the mental and physical health of our clients and have expressed clear concerns that it causes serious harm in a number of ways. Electronic monitoring carries a high risk of causing deterioration in existing poor mental health but in addition can impede recovery. The effect is multifaceted and our experience highlights how harmful electronic monitoring is. The use of electronic monitoring in this particularly vulnerable group of people cannot be justified given the risk of significant harm.

“The impact of electronic monitoring and the Hostile Environment on our clients is devastating. We are working with some of the most vulnerable people in society, who in many cases have already experienced immense suffering and bear the physical and psychological scars. Instead of the safety, stability and space people need to start rebuilding their lives and recovering from trauma they are treated with suspicion and hostility. By pursuing this policy the UK government is contributing to the harm. We urge them to stop, listen and end this cruel and unnecessary practice.”

Public Law Project, Bail for Immigration Detainees, and Medical Justice are urging for the practice to be ended altogether, and for essential safeguards to be implemented until then, including:

• Introducing a strict time limit to the use of GPS tagging.
• Ending the use of mandatory electronic monitoring.
• Allowing and empowering the First-tier Tribunal (Immigration and Asylum Chamber) to decide whether or not electronic monitoring should be imposed as a bail condition.
• Setting strict limits on the processing of data obtained via GPS monitoring, so it can only be processed for the purpose of determining whether an individual has breached bail conditions.
• Ensuring electronic monitoring does not interfere with an individual’s rehabilitation, nor be used when an individual has been identified as vulnerable.
• Providing clear and accessible legal routes to migrants to request removal of their tag.

Those interviewed for the report said the following of their experience of GPS tagging:

“It’s a torture, it’s a torture. I don’t even know how to put it into words. After all the detention and all that they say that’s not enough, you know you have to be on a monitor for life. What for?…”

“I just feel like I’m held over a barrel of fear and intimidation of not really knowing what my rights are.”

“The portable one, it’s not working… So, when I need to charge it, I have to literally plug it into an extension, lie down on the bed… with it plugged in my leg”

“I tried to volunteer at a charity shop, he just looked at my ankle monitor and asked me, “What is that?”… In his mind he already wrote me off. The other job, I had an interview and such but they didn’t contact me back because of the tag on my ankle”

ENDS

Read the 31st Oct 2022 Guardian article here:

“GPS tagging migrants ‘psychological torture’, says report“

Notes to editors

• Contact: Alice Smith, Communications Officer at Public Law Project; a.smith@publiclawproject.org.uk; 07795633770
• Rudy Schulkind, Research and Policy Manager, Bail for Immigration Detainees; rudy@biduk.org; 02074569762
• The report was written and researched by Rudy Schulkind and Woodren Brade, Bail for Immigration Detainees, Jo Hynes, Public Law Project, and Dr Kathryn Allinson, Medical Justice.
• Public Law Project is an independent national legal charity who represent and support individuals and communities who are marginalised through poverty, discrimination, or disadvantage when they have been affected by unlawful state decision-making.
• Bail for Immigration Detainees is an independent charity that challenges immigration detention in the UK by providing free legal advice, information and representation to thousands of people held in detention, and challenging existing detention policy and practice.
• Medical Justice works to uphold the health and associated legal rights of people in immigration detention, and provides medical evidence so the devastating health harms of detention are understood and acted on.

The Human Cost Of The Rwanda Scheme

Read the report here >> 

Medical evidence emerges of the harm inflicted on those targeted by UK government for removal to Rwanda

Medical Justice today publishes “Who’s Paying The Price?: The Human Cost Of The Rwanda Scheme”, a comprehensive analysis of people targeted for removal to Rwanda which details medical evidence of the harm inflicted on them. The policy is damaging in general for anyone, acutely so for such vulnerable torture and trafficking survivors who are already paying a high human cost even before any flights have taken off to Rwanda.

The UK Government has entered a cruel and unconscionable agreement, which will forcibly remove people who have come to the UK seeking safety to Rwanda, with no return to the UK. It has been widely condemned by the UN High Commissioner for Refugees, parliamentary committees, as well as the medical community. It is being judicially reviewed in the High Court, with hearings starting on Monday 5th September 2022, the day the new Prime Minister will be announced. Both Rishi Sunak and Liz Truss have promised more Rwanda-style deals.

The first removal flight to Rwanda was halted. Yet the health and wellbeing of those targeted has already been severely impacted.

“Our clinicians have described the severe impact of the threat of removal to Rwanda on mental health: Experiences of intense fear, anxiety about the future, profound loss of hope, and traumatic reminders of past experiences of powerlessness deprive people of the sense of safety required for careful assessment and recovery. These experiences would be harmful in general, but are made even more acute by their being experienced within immigration detention and by a population with a high rate of vulnerability. 

Our report shows extremely high rates of evidence of torture, trafficking and other vulnerabilities in this group, to whom the government plan to deny assessment or interview before they are forcibly removed. The policy knowingly places people in an extremely damaging situation and should be considered exceptionally harmful. 

As a doctor, what shocks me most is the total disregard for the need to assess the risks of subjecting individual people to this policy. “

Dr Rachel Bingham – Clinical Advisor for Medical Justice

“Medical Justice calls for the immediate and urgent release from indefinite immigration detention of all those targeted with removal for Rwanda, and for the policy to be abandoned.  To not do so, given the medical evidence, means the harm the government is inflicting is premeditated.”

Emma Ginn – Director, Medical Justice

51 people in immigration detention targeted for removal to Rwanda have contacted Medical Justice – detail on 36 of whom is provided in the “Who’s Paying The Price?” report, including Iranian (14), Iraqi (5), Sudanese (5), Syrian (4), Eritrean (3), Vietnamese (2), Egyptian (2), and one Albanian nationals. This report shines a light on the accelerated and unclear process they have been subjected to, plagued by procedural deficiencies, a lack of legal advice and a lack of translated documents. They include men, women, aged-disputed children or young people, people with mental health conditions, and people who have self-harmed and/or have suicidal ideation in detention. They have all come to the UK seeking safety, many also to join family here. There is no specific screening process, despite the government implicitly acknowledging that removal would not be safe or appropriate for all. Where vulnerabilities are belatedly identified, the Home Office justifies continued detention on the basis of potential removal to Rwanda.

Our evidence shows that the prospect of removal to Rwanda is in itself damaging; it is exacerbating detained people’s mental health conditions (including depression, anxiety and post-traumatic stress disorder (PTSD)), causing them to experience fear, confusion, uncertainty about their safety, and a loss of hope. For some, it has increased their risk of self-harm and suicide. For some, it has reduced resilience to the psychological effects of trauma and may interfere with their ability to engage with treatment.

The harms described were experienced by individuals irrespective of whatever situation they would have encountered in Rwanda, and indeed despite their removal not having gone ahead.

Out of 17 people Medical Justice doctors have conducted clinical assessments for, 14 had evidence of torture histories and 6 have indicators of trafficking. 15 had a diagnosis or symptoms of PTSD. One is likely to have a psychotic disorder and lack capacity to even instruct his solicitor. One requires urgent investigations to rule out recurrence of a previous brain tumour. 11 people had suicidal thoughts in detention, including one who attempted suicide twice. Some were clinically considered to be at high risk of suicide if threatened with removal Rwanda.

Following each assessments the Medical Justice clinician shared their concerns, including about the risks of continued detention, with the immigration removal centre healthcare team.

Interviews

Interviews with a Medical Justice doctors and client target for removal to Rwanda are potentially possible.

Contact

Emma Ginn on 07786 517379 / emma.ginn@medicaljustice.org.uk

Web

http://www.medicaljustice.org.uk/