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High Court quashes unlawful policy on vulnerable people in immigration detention

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. 

 

“If he dies, he dies”: What has changed since the Brook House Inquiry?

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.

Brook House Public Inquiry report published

Medical Justice press release 19th Sept 2023 for immediate release

Dangerous use of force, a wholesale failure of safeguards and a culture of dehumanisation led to 19 instances of inhuman or degrading treatment at Brook House – despite the systemic failures continuing, the government plans expansion of detention

 

Today the Brook House Inquiry (BHI) has published its report on its investigation into allegations that people held in immigration detention were subjected to torture, inhuman and degrading treatment following undercover footage as broadcasted by the BBC in 2017.  Medical Justice was appointed a Core Participant (CP) due to its extensive experience of the clinical safeguarding failures and understanding of the inadequate healthcare provision in IRCs.

Key findings of the BHI Report (the Report)

The BHI Inquiry has exposed the inexcusable and unconscionable dehumanising abuse of vulnerable people held in immigration detention by the Home Office. The Inquiry has found the safeguarding system in detention to be “dysfunctional”, resulting in a failure to protect detained people as intended. Vulnerable people were exposed to the risk of mistreatment and were subjected to actual harm; there were 19 incidents of credible breaches of Article 3 of the ECHR, which prohibits torture, inhuman and degrading treatment within a 5 month period.

The “wholesale failure” of the detention safeguards was found likely to have caused actual harm to detained people. As a result, people were found to have been “allowed to deteriorate” in their mental and physical health. Such failures were found to be interlinked with the inappropriate use of segregation and a quick resort to the use of force to manage incidents of self-harm and mental health crises. Healthcare failures put vulnerable people at risk of deteriorating in their health, and of instances of mistreatment. These systemic problems in the adequacy of safeguards have not evolved and remain in place today.

Healthcare staff were found not to understand their safeguarding obligations. There was a tendency to view detained persons as “wilfully disobedient and obstructive instead of countenancing the idea that behaviour may be manifestation of mental anguish or ill health”. Specific findings were made in relation to the acts and omissions of individuals, including some who are still in post who were described as ‘unapologetic’ and ‘intransigent’. The Inquiry has stated that it will provide a copy of the report to the General Medical Council, indicating the severity of such findings.

A “toxic culture” prevailed at Brook House, fuelled by the “prisonisation” of the centre. Brook House was found to be a “breeding ground for racist views” with a routine use of racial stereotyping, abusive and derogatory language by custodial staff. The Chair described this as a “culture of dehumanisation of detained people”.

The Chair criticised how force was used unnecessarily, inappropriately and excessively in widespread cases. Amongst the concerning practices were the use of force on detained people who were mentally or physically unwell, and sometimes used as a way to manage symptoms of mental illness. Unauthorised techniques were being used, including a dangerous technique that had previously led to a death by asphyxiation. Approved techniques were being used incompetently in a way that became dangerous and increased the risk of injury. It has gone without proper scrutiny until the Inquiry, because of a “culture of silence” amongst officers. Body-worn cameras were not turned on without credible explanation as to why.

The Inquiry unequivocally finds the crucial safeguarding responsibility lies with the Home Office, yet that there were a “comprehensive range of failings” spanning detention safeguards, healthcare, the use of force, segregation and the management of a toxic culture. Further responsibility lay with the various contractors:

  • G4S, who were the contractor responsible for the operation of Brook House, failed to comply with their contractual obligations, relevant rules and guidance, at the management and corporate level, not just the individual level.
  • Such failings were found to continue today, despite Serco taking over the contract. The Chair raises concern about several individuals remain in post and more senior roles, casting doubt on how far cultural changes have occurred.
  • The Practice Plus Group, the healthcare provider at a number of IRCs, were found to have made some improvements but not the fundamental changes to the operation of safeguards necessary to protect vulnerable people from suffering likely or actual harm. PPG’s failure to correct the deficiencies in the failure is a “further indication of an abdication of corporate responsibility”.

The Inquiry chair made 33 recommendations for ‘necessary’ changes at Brook House and immigration detention more widely, the vast majority of which are directed to the Home Office or the government more generally. These included:

  • A 28-day time limit on immigration detention given the negative impact of detention on detained person’s health and wellbeing.
  • A fundamental review of the safeguarding framework under Rule 35 of the Detention Centre Rules 2001. The Inquiry found a wholesale failure of the safeguard in 2017 and no significant improvement since.
  • A comprehensive review of the use of force.
  • Training for healthcare staff on their safeguarding role including in relation to the use of force, Rule 34 and Rule 35.
  • Review of range of policies including on segregation, food & fluid refusals.

The inquiry report notes that many of the findings and recommendations ‘closely mirror’ those from previously investigations and reviews and calls for a ‘culture of change’: ‘Lessons must be learned’. It finds that the Home Office had failed to act on ‘serious issues and concerns’ previously, making ‘inadequate excuses’ (including on the complexity of detention and polarised debate on migration) on these fronts ‘where basic issues of human rights and welfare are at issue’.

This comes at a time when the government are planning a large expansion in immigration detention. The Chair notes that ‘any expansion or other change [in immigration detention] should be considered in the context of learning lessons from past failures’.

Emma Ginn, director of Medical Justice:

“The evidence shows that the Home Office has presided over the inhuman and degrading treatment of vulnerable detained people in its care.

This comes as no surprise to us or the Home Office – Medical Justice has been presenting evidence of abuse to the Home Office for the last 18 years.

At every turn the Home Office has reacted with indifference and intransigence.

It’s a travesty that it’s taken a public inquiry for detained people’s harrowing testimony to be taken seriously.  They have at last been vindicated.

Urgent action is needed ; the evidence could not be clearer – the harm and horror of detention is being experience right now in IRCs across the UK.

Despite knowing the harm it causes, the government plans a massive expansion of detention – wilfully allowing the inevitable harm to the hundreds of thousands of men, women and children it aims to indefinitely detain.

This country must take a stand – if we fail to halt this abuse it means we have completely lost our way.

If not now – with this inquiry’s findings- then when?”

Dr Rachel Bingham, Clinical Advisor, Medical Justice:

“This inquiry makes clear what Medical Justice, the medical community, and others have been warning about for a long time – that immigration detention is an intrinsically harmful environment.

Urgent action is needed to protect the health of vulnerable people in immigration detention.

Our experience and our clinical evidence shows that the same circumstances exist in other IRCs, as were behind the abuses in Brook House.

The detention of a population with high rates of vulnerabilities in a prison environment creates conditions which are high risk for people to be harmed, through harm to their mental health, experiences of use of force, clinically inappropriate use of segregation and experiences of racism.

Any high-risk environment requires adequate safeguarding processes, but this was absent from Brook House in 2017 and remains absent, across the detention estate and in Brook House specifically. The perfect storm of detaining highly vulnerable people in prison conditions with inadequate safeguards allows abuse to happen. Our clinical evidence shows that to date there have been no significant improvements. Detention remains unsafe and harmful.

This is not new to the medical community, as medical bodies have consistently called for an end to detention, noting the overriding health harms.”

Valentin, Medical Justice client:

“I felt that I had to reach rock bottom before my mental health was taken seriously- it wasn’t until after my overdose that I felt like I got some treatment and staff called an ambulance. …That was how bad it had to get, that’s how far down I had to go, to get any care. I was in detention for 10 months. It felt like prison. The only fresh air was air that came under the door to my cell. My toilet was inside my cell, it was like a proper prison cell. I was scared. It was so hard in the night-time. People were banging on the walls. I don’t think detention is any place for a human being and it’s not a solution. We are human. We have families. The best value in life is freedom.

Hamish Arnott, Bhatt Murphy Solicitors, representing Medical Justice:

“This inquiry has provided a unique opportunity to see the reality of life in immigration detention centres. Its findings are clearly alarming and show that again and again the Home Office has failed to learn lessons about how unsafe and degrading its detention system is. Of even more concern is that the government, before even considering these findings, has recklessly announced its intention to introduce, on 28th September, statutory powers designed to allow the Home Secretary to detain more people for longer and with less scrutiny by the courts.”

Alison Thewliss MP, chair of the All Party Parliamentary Group on Immigration Detention, Shadow SNP Spokesperson (Home Affairs):

 “Today’s report on conditions at Brook House highlights the urgent need for meaningful change within our asylum system.

The findings of this report are deeply concerning, and it is imperative that the UK Government takes these recommendations seriously.

This report has shown how horrific conditions are in asylum accommodations across the country. It would be completely unacceptable for this UK Tory Government to proceed with their proposed expansion of detention centres.

The UK Government must prioritise reforms and accountability to ensure that lessons are learned from these findings.

If ever there was a time to throw the Illegal Migration Act out the window, this report provides a key opportunity to do just that.”

Medical Justice calls for:

  1. We call on the government to issue an apology to those who experienced abuse in its care at Brook House and elsewhere.
  2. To have any real meaning, an apology must be accompanied by the necessary changes to ensure that no one else is abused or harmed in immigration detention like this again.
  3. Rather than expanding the use of detention, we agree with the British Medical Association that the only solution is to phase out detention and consider credible alternatives (as identified by UNHCR).
  4. If immigration detention is to continue at all, its use should be truly an exception rather than routine. The government must (1) commit to implementing the recommendations from the Brook House Inquiry including introducing a strict time-limit of no more than 28 days and (2) ensure the safety and welfare of detained people, by taking real action on the dangerous use of force and dysfunctional safeguards.
  5. There must be accountability – the inquiry report raises concern about some of those involved in the abuse in 2017 still being in post or having moved to more senior roles. The same is true for Home Office Officials who have presided over this system and failed to take action. Brook House was identified as a ‘breeding ground for racism’. It follows a number of investigation since 2005 finding racist abuse in immigration detention. The risk of racism and racist abuse is inherent in immigration detention, particularly in a hostile political context where migrants are scapegoated and dehumanising rhetoric used in politics and the media. Without fundamental change it appears inevitable that another future undercover report would uncover the same.

Medical Justice publishes today its dossier evidencing ongoing failures in clinical safeguards – our dossier published today includes an analysis of medical assessments by Medical Justice clinicians of 66 people held in Immigration Removal Centres between 1 June 2022 and 27 March 2023.  Three case-studies are also included. Of the 66 clients, 52 had evidence of a history of torture, 29 had evidence of a history of trafficking and 25 had evidence of a history of both torture and trafficking. Detention had already caused the mental state of 64 clients and had caused harm to all 66 clients. 63 had a diagnosis of at least one mental health condition and 49 people were recorded as having self-harmed, suicidal thoughts and/or attempted suicide.   Uses of force included during transfer to segregation, removal from suicide netting and transfer to hospital appointments.

The Illegal Migration Act (IMA) is set to massively ramp up detention  – The Refugee Council estimates that 190,000 people, including 45,000 children could be detained in the first 3 years. The IMA means drastically reduced access to the courts and the Home Secretary, rather than the courts, determining what is a reasonable length of detention.  The IMA disallows most asylum seekers from having their cases considered, and with nowhere to remove most of them, many more vulnerable people are set to languish in detention, deteriorating.

The Home Office has plans to hold 25,000 asylum seekers in quasi-detention sites such as disused military bases and barges.  As these sites have emerged, there have been outbreaks of infectious diseases and people held there becoming suicidal – the harmful conditions and inadequate healthcare provision has become evident.  The IMA means the Home Secretary can define any site she sees fit as a detention facility.

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.

Background information about immigration detention

There are 7 Immigration Removal Centres across the UK.

In the year ending June 2023, Home Office statistics show that:

20,354 people entered immigration detention (of those, 7 were pregnant women and 66 were children)

22% of those held in detention were ‘removed’ from the UK in the year ending June 2023.

1.3% of people released from detention absconded in the first 6 months of 2022 according t figures obtained through Freedom of Information (see page 4 of this report). Home Office data indicates that the average cost of detention per person at the end of June 2023 was £107.71 per day.

Examples of mistreatment / abuse in detention since 2002

2002

  • Yarl’s Wood IRC – a fire destroys half of the centre, which is not fitted with water sprinklers. Detained children, women and men are left locked in the building as the fire progresses. PPO investigation report

2003  

2005  

  • Oakington IRC – BBC undercover reporting reveals “culture of violence, abuse and assaults” against detained people, as well as racism. BBC article | PPO investigation report
  • Yarl’s Wood IRC – Manuel Bravo, detained with his 13 yr old son, commits suicide. Independent article

2009  

  • Tinsley House IRC – detained 10 yr-old Nigerian girl found trying to strangle herself. Guardian article
  • Yarl’s Wood IRC – at least 30 detained people go on hunger strike to protest the detention of children at the IRC and conditions there. Guardian article

2010

  • Campsfield IRC – almost half the detained population, including some who have been detained for more than three years, go on hunger strike to protest their prolonged detention and treatment. Guardian article

2011

  • Removal flight – Jimmy Mubenga unlawfully killed by security escorts on removal flight following the use of a face-forward restraint. Inquest found evidence of pervasive racism amongst security escorts. INQUEST article:
  • Colnbrook IRC – Muhammad Shukat dies of heart attack. Neglect contributed to his death. Guardian article
  • Colnbrook IRC – Brian Dalrymple, with schizophrenia and dangerously high blood pressure dies whilst detained. Neglect found to have “compounded” his death. Guardian article
  • Harmondsworth IRC – High Court finds that a mentally ill man (“BA”) was subjected to ill-treatment so severe that it breached Article 3 ECHR (prohibition on torture and inhuman or degrading treatment) whilst detained at Harmondsworth during 2011. See p.278 of Stephen Shaw’s report

2012

  • Harmondsworth IRC – Ghanaian, Prince Fosu, died 6 days after being detained whilst suffering a psychotic illness. Neglect and multiple failures by every agency involved found to have contributed to his death. INQUEST write up
  • Various IRCs – High Court finds that a mentally ill Nigerian man (HA) suffering from paranoid schizophrenia was subjected to degrading treatment whilst detained during 2010 at various IRCs, breaching Article 3 ECHR  (prohibition on torture and inhuman or degrading treatment). See p.282 of Stephen Shaw’s reportHigh Court judgement

2013

  • Yarl’s Wood IRC – multiple accounts of sexual assault of detained women by IRC staff. Guardian article
  • Harmondsworth IRC – 84 yr-old Canadian man (Alois Dvorzak) with dementia, acute heart disease and diabetes, dies of heart attack whilst shackled to an immigration officer. Independent article

2014

  • Yarl’s Wood IRC – A total of 99 pregnant women detained
  • Harmondsworth IRC – “A depressing, dirty place… has a destructive effect on the welfare of detainees” (IMB)

2015

 

2016

  • Colnbrook IRC – Moroccan, Amir Siman-Tov, with history of mental ill health dies having ingested painkillers the day before. Inquest jury find that “inadequate information sharing” by IRC staff contributed to his death. INQUEST article

2017  

  • Brook House IRC – undercover reporting by BBC reveals abuse and mistreatment of vulnerable detainees. BBC Panorama programme

2018

  • Yarl’s Wood IRC – more than 120 women go on hunger strike to protest conditions and their indefinite detention. They receive letters from the Home Office threatening them with accelerated removal if they continue with their protest. Independent article.

2020

  • Brook House in 2020 –situation at the IRC in the latter half of 2020 was described by the Independent Monitoring Board as amounting to “inhumane treatment of the whole detainee population”, [IMB%20report]IMB report.

2021

  • Various IRCs – During Supreme Court case, Home Office concedes that the treatment of a mentally ill Nigerian national (known as VC) who was suffering from a serious psychiatric illness and was detained at various IRCs between 2014 and 2015, breached Article 3 ECHR (prohibition on torture, or inhuman and degrading treatment). [Medical%20Justice%20article]Medical Justice article.

 

2022

  • Harmondsworth IRC – people are not evacuated from the centre during a power cut, and instead held in the centre without light, running water, toilet facilities etc for 2-3 days. Bail for Immigration Detainees report
  • Various IRCs – People selected and detained for removal to Rwanda under government’s new policy are found to include many highly vulnerable individuals – such as victims of torture, trafficking and those with serious mental health conditions – and to have not been granted adequate access to legal advice and representation. Medical Justice report.
  • Manston Short-term Holding Facility – people, including children and pregnant women, are detained for weeks in what the Independent Chief Inspector of Borders and Immigration described as “wretched” and “dangerous” conditions ; Hussein Haseeb Ahmed dies, possibly of diphtheria, shortly after being detained at the facility. Guardian article.

 

2023

Harmondsworth IRC – Colombian man (Frank Ospina) dies, possibly by suicide, despite “begging” the Home Office to send him home. BBC article:

Colnbrook IRC – Attempted “mass suicide event” occurs shortly after the death of Mr Ospina at next door Harmondsworth IRC. OpenDemocracy.

Research reveals “inhumane” effects of GPS tagging on migrants

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 21st 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.

 

“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.

Read the letter

The group of medical bodies say ;

“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

Who’s Paying The Price? – Report Released

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/

‘Fictional’ process to exclude vulnerable from immigration detention signals little hope for Rwanda deportees

The Medical Justice “Harmed Not Heard” report published today, 25th April 2022, evidences that the Home Office process to identify and release highly vulnerable people in immigration detention is totally and utterly flawed.

The report analyses Medical Justice clinical assessments carried out between July and December 2021 for 45 clients detained in various immigration removal centres (IRCs) across the UK. These clients’ histories included severe trauma, significant mental health issues, and being at risk of suicide. Our findings include:

  • 100% of these clients were assessed as at clinical risk of harm caused by detention and 82% had already experienced deterioration in their mental state by the time they were seen by a Medical Justice clinician. Not a single one of them had a safeguarding report, as they should have done, from the IRC healthcare department to identify them to the Home Office as at risk of harm under a process known as Rule 35(1)
  • 67% had no communication of any type by the IRC healthcare department to the Home Office explicitly addressing the risk to their health from detention, prior to their assessment by a Medical Justice clinician
  • 87% had suicidal and/or self-harm thoughts recorded by a Medical Justice clinician at their assessment – all were deprived of a safeguarding report identifying their risk of suicide (Rule 35(2))
  • 76% were assessed by our clinicians as having symptoms or a diagnosis of Post Traumatic Stress Disorder
  • Only 51% saw a GP within the required 24 hours of admission to the IRC. Where identified as needing a Rule 35 safeguarding report, the average wait for an appointment was 29 days – one person’s appointment took 119 days
  • Home Office case-workers only released 1 of our 45 vulnerable clients when given information about their vulnerability under safeguarding processes, many of whom included torture survivors

My health was getting worse in detention. I felt like I couldn’t live anymore, I didn’t know what to do, it was really really terrible … they knew what was happening to me, that I needed help…. There is no help. Ask healthcare, they blame it on the Home Office, and the Home Office will in turn blame healthcare. It feels like you are buried alive.”
Dr D, torture survivor, detained for 4 months despite deterioration in mental health

“Our medical evidence is that extensive Home Office failures mean its safeguarding processes are so ineffective they are basically fictional. Medical Justice fears torture survivors and people who are mentally ill and suicidal could be sent to Rwanda, given the ongoing gross Home Office systemic failures in safeguards for detained people. The Memorandum of Understanding (MoU) with Rwanda indicates that slavery and human trafficking survivors will be sent to Rwanda by the UK.

The impact on vulnerable asylum seekers could be devastating. Medical evidence of the harm inflicted would be beyond our reach so we would not be able to collate it in reports like “Harmed Not Heard” which are used to hold the government to account. These vulnerable asylum seekers could be ‘out of sight, out of mind’ in Rwanda with little chance of being heard.”
Medical Justice spokesperson

Evidence heard at public inquiry demonstrates extent of the Home Office’s safeguarding failures

The clinical expert appointed by the Brook House IRC Public Inquiry into mistreatment of detained people, Dr Jake Hard, concluded in March 2022 that there was “a complete systems failure” of safeguards to identify and release vulnerable people in detention. The Head of Healthcare, and the lead GP (still both working at Brook House IRC) gave evidence of systemic deficiencies and that they are continuing. Our report shows these deficiencies are not confined to Brook House and apply across the detention estate.

Victims of slavery and human trafficking, and possibly other vulnerable people, set to be sent to Rwanda

On 14th April 2022 the Home Office announced its MoU outlining how asylum seekers will be sent to Rwanda. It commits to undertaking an “initial screening” of asylum seekers before sending them. The evidence from ‘Harmed Not Heard’, and from all our work since Medical Justice was founded in 2005, demonstrates that the Home Office is incapable of effective screening for vulnerabilities. This seems to be anticipated in the MoU which states the UK will take back and “resettle a portion of Rwanda’s most vulnerable refugees” in the UK. The MoU indicates that victims of modern slavery and human trafficking will be sent to Rwanda.

Vulnerable asylum seekers set to be held in quasi-detention in a tiny Yorkshire hamlet within weeks

Also announced on 14th April is an ‘Accommodation Centre’ at RAF Linton-on-Ouse which the Home Office plans to open in a matter of weeks, where it will place 1,500 asylum seeking men. Linton-on-Ouse is village, with 500 residents, according to one of them.

The Home Office has said that Napier Barracks, where a few hundred asylum seeking men are placed, is the ‘pilot’ for ‘Accommodation Centres’. The All-Party Parliamentary Group (APPG) on Immigration Detention considers Napier Barracks to be ‘quasi-detention’ and that asylum seekers placed there “have been subjected to appalling treatment and conditions”.

The APPG found that the Home Office had failed to apply it’s own “suitability criteria” which is meant to screen out highly vulnerable asylum seekers. The “suitability criteria” that the Home Office refers to for Linton-on-Ouse may be the same as at Napier, and as dysfunctional. The Home Office Factsheet for Linton-on-Ouse says “There will be robust processes in place to assess and manage vulnerabilities”, so it’s not clear to what extent, if at all, vulnerable asylum seekers are screened out.

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

Detained and Discarded Report Released

New research published today by Medical Justice shows that Home Office failings have led to the unsafe release of extremely vulnerable and unwell people into the community, without adequate support.

One woman whose delay in treatment “could potentially have life or limb threatening consequences”, struggled to re-arrange an orthopaedic oncology appointment that she missed because she had been detained.  One released Medical Justice client described how he ended up a number of times in Accident & Emergency, having been unable to secure a recommended cardiology appointment.

Some released from immigration detention had pre-existing vulnerabilities and medical conditions exacerbated by their time in detention, whilst others had attempted suicide, self-harmed or suicidal thoughts in detention.

Read the report here >> 

 

“These unsafe practices lead to greater unmet health needs, and to more serious health consequences, requiring more and longer treatments once people are able to access care. In the year reported on, over seventeen thousand people were released, despite the stated purpose of their detention being to remove them, indicating the senselessness of exposing people to these negative health consequences”

Dr Rachel Bingham, Clinical Advisor at Medical Justice

 

“I was getting prepped for major surgery when I was detained for 6 months. The healthcare at the Immigration Removal Centre was appalling. They failed to manage my condition and in the end had no choice but to release me. Although my health had deteriorated rapidly and the surgery was more urgent than ever, I was discharged without so much as a referral or medication. It was as if the centre was more concerned about washing their hands of me so they would not be held liable than they were about my aftercare. It was an awful experience and the whole time I was afraid for my health, and very, very anxious and emotionally distressed. I felt like nobody cared if I lived or died. It is unacceptable and inhuman in a first world country to treat people like this and it has to stop. Thankfully for me, my GP was very supportive and referred me back to the surgical team – I eventually had the surgery 7 months later.”

Ms A

 

Thousands of people are released from detention into the community every year. Between 1 October 2020 and 30 September 2021, 81% of the 21,362 people detained were released back into the community [1]. 2,239 were considered to be ‘Adults at Risk’ whilst in detention by the Home Office [2], however Medical Justice believes there to be far more vulnerable people in detention due to the systematic failures of the Adults at Risk policy to identify vulnerable people. With thousands released into the community every year, the impact of releasing those individuals in a medically unsafe release cannot be overstated.

The report Detained and Discarded: Vulnerable people released from immigration detention in medically unsafe way found that release from detention is often unplanned, chaotic and medically unsafe.


 


Medical Justice sees repeated cases of vulnerable people released into the community without adequate care plans, with little or no information and support about entitlement and how to access a GP, and rarely with referrals to community support services such as local mental health teams. This has included people who had very recently attempted suicide in detention.

One client said: “When I was told I was being released, no clinician or nurse gave me advice, my medication or any help with healthcare outside.”

Mohamed [3], who was prescribed medication due to severe stomach pain and vomiting, was not provided with an adequate supply of his prescribed medication upon release and was not given his full medical records. As he did not have information or support about seeing a doctor in the community, he explained: “I experienced a long wait to see a doctor, meanwhile I was suffering during that time and I had no attention from anyone”.

Many experienced several of these issues at the same time, with a domino effect of one barrier leading to another. Additional difficulties were experienced with navigating the healthcare system in the community, as a result of their unstable immigration status and language barriers.

Abbas [4], who suffers from physical health issues, including with his heart, and from depression and PTSD, struggled to see a cardiologist upon release. Despite having been recommended to see a cardiologist whilst in detention and by an A&E doctor in London after being released, it took over a year and a half for him to see a cardiologist. Abbas described multiple barriers he faced. For example, after being dispersed to outside of London, he explained: “Because of the language barrier and I had difficulty to go to London, I couldn’t go to the appointment.”


 


The report raises concerns about the Home Office’s application of its own policies on the safe release of vulnerable detainees as the unsafe release of people from detention persists.

Information obtained through Freedom of Information (FOI) requests suggests that the experiences of Medical Justice clients may be illustrative of a wider problem in the immigration detainee population. Shockingly, the Home Office revealed that only three people recorded as ‘Adult at risk’ had onward care plans arranged upon their release across three IRCs between January 2019 and June 2021.

The Home Office has further confirmed, in response to another FOI request, that it does not have any guidance or template letters for Home Office staff in IRCs to “advise individuals with health problems or those at risk of self-harm and/or suicide” at the point of release how to access health services in the community.

Immigration detention causes severe harm to those held there and can cause rapid deterioration over time. This is particularly true for those who have a history of mental health issues or a history of trauma. The Home Office failed to deliver on their responsibilities in accordance with their duty of care towards vulnerable individuals leaving detention and continues to toy with the lives of vulnerable people by releasing them in such an unsafe and dangerous way.


[1] For statistics for September 2020 to September 2021, see Home Office National Statistics. 2021. Immigration Statistics, year ending September 2021. [Last accessed on 18 January 2022] Available at: https://www.gov.uk/government/statistics/…. and Home Office Detention Summary Tables. 2021. Immigration Statistics, year ending September 2021. [last accessed on 18 January 2022] Available at: https://assets.publishing.service.gov.uk/government/uploads... Does not include those who were returned or those classed as ‘other’ which includes people who have returned to criminal detention, those released unconditionally, those sectioned under the Mental Health Act, deaths and absconds. It also does not include those held in Pre Departure Accommodation (PDA). See Home Office Detention Summary Tables. Immigration Statistics, year ending September 2021.

[2] Data extracted from statistics provided in Home Office response to FOIA 68200 received 22 February 2022. The number of Adults at Risk in PDA and those identified under column ‘other’ is not included. See Annex 1 for Home Office responses to Freedom of Information Access Requests.

[3] Mohamed’s name has been changed to protect his identity.

[4] Abbas’ name has been changed to protect his identity.

 


 


 

“Every day is like torture”

Solitary confinement & Immigration detention

New research published today by Bail for Immigration Detainees (BID) and Medical Justice documents the devastating impact upon immigration detainees in prisons of conditions amounting to indefinite solitary confinement.

People held for immigration reasons (including torture survivors and those with serious vulnerabilities) are locked in their cells for over 22 hours a day, most often 23.5, with people sometimes being held in their cells for days at a time and unable to take a shower. Some are self-harming, attempting suicide and unable to sleep or eat. They report existing in a state of endless despair. Physical symptoms include involuntary shaking, memory loss and physical pain. As one man told us:

“I didn’t enter prison with mental health problems but I’m not the same person I was. My mind is not the same. I’m not sure if what has happened to be can be repaired.”

Another said:

“It just feels illegal because of what it’s doing to my mind and body. If this isn’t breaching my rights, then what will? It’s as though I’ve fallen into a crack that the Home Office opened and I can’t get out.”

The research released today is based on interviews with 5 immigration detainees and on medico-legal reports produced by doctors, as well as reviews of case files that argue for the release of people held in prolonged confinement – either solitarily or with a cell-mate.

 


Read the report here


 

Key findings:

Five disturbing statements describe people being pushed to the limit of what a human being can be expected to endure. Two people described the experience as torture. Their statements are distressing to read but they have been included in this report.

The medico-legal reports illustrate severe impact on health including the exacerbation of pre-existing mental health conditions and the onset of new conditions. The severe harm caused is reflected in the literature on the impact of solitary confinement on health. It can cause long-term and even irreversible harm and may increase the risk of suicide. Prolonged solitary confinement is prohibited by the United Nations and can amount to torture or cruel, inhuman or degrading treatment, according to the UN Special Rapporteur on Torture.

The report also finds that in individual cases and in official correspondence the Home Office has failed to engage with the issue of prolonged solitary confinement in prisons.  It appears that severely restrictive prison conditions are not being considered when assessing the proportionality of immigration detention.


Detention in prisons

Immigration detention is an administrative rather than criminal or punitive process, and people can be detained in prisons or detention centres. There are currently 577 immigration detainees held in UK prisons. People who may have strong ties to the UK such as those who grew up here or who themselves have children here, are held under immigration powers after having completed a custodial sentence, with no release date, facing possible deportation. They may be required to take proactive steps to challenge their detention, which is almost impossible for those locked in a cell 23 hours per day. Many have pre-existing mental health conditions, making the use of prolonged confinement particularly dangerous. Meanwhile the purpose for which they are being detained – removal from the UK – may be little more than a remote possibility.


Quotes

Bail for Immigration Detainees director Annie Viswanathan said:

“It is impossible not to be horrified at what is being done to people in the name of immigration control or to imagine the profound frustration and distress that people experience when trapped in a cage for most if not all of the day, not knowing when it will end.  That it leaves people with enduring mental and physical health problems is hardly surprising and exactly why it has been banned under the UN’s ‘Mandela Rules’. 

I hope this report causes the people with the power to take stock and reflect on the continuing use of a  barbaric practice that shames our society. This cruelty needs to end and people should be released so that they can be supported in the community.”

 

Medical Justice director Emma Ginn said:

“It is profoundly disturbing that immigration detainees are being locked up indefinitely, many in solitary confinement, despite clear evidence from Medical Justice clinicians of the predictable, devastating effect.

That this imprisonment extends beyond a criminal sentence means severe harm is being inflicted during, and because of, a period of entirely unnecessary and purely administrative detention – we need to question if this is civilised or in fact gratuitous.  It is certainly the biggest scandal most people have never heard of.

This inhuman practice is a reflection on our society. Let this not be who we are.”

 

Dr Josanne Holloway, Chair of the Faculty of Forensic Psychiatry at the Royal College of Psychiatrists, said:

“This important research highlights the detrimental impact of immigration detention on health and wellbeing, including an increased risk of mental illness and suicide.

“Detention in prison is clearly not right for these vulnerable people and solitary confinement is psychologically harmful and shouldn’t be used.

“Asylum seekers experiencing mental illness should not be detained. Instead, they should receive the mental health support they need, either in the community or in an inpatient setting.”


Contacts:

Annie Viswanathan, Director, BID annie@biduk.org, 02074569751

Emma Ginn, Director, Medical Justice emma.ginn@medicaljustice.org, 07786 517379

Brook House Immigration Removal Centre (IRC) is a COVID-19 outbreak centre

After guidance from Public Health England, Brook House IRC has been deemed as an outbreak centre of COVID-19

We fear this could be calamity starting to unfold – one which was entirely avoidable ; Medical Justice warned in March that IRCs are high risk for clusters of COVID-19, and that staff provide a conduit for infection to and from the community.

Serco, who runs Brook House, distributed a letter to detainees informing them that the IRC has been deemed an outbreak centre and to stay in their rooms due to the risk.  Some of our clients did not understand the letter and it hadn’t been explained to them.

The letter says “new arrivals will be housed onto C & E wings that are at present not in isolation” – any staff moving between the various wings could pose an infection risk and any new admissions into any IRC would be utterly reckless.  Clearly, the Home Office’s measures up to now regarding COVID-19 have not worked.

Our clinicians are worried about our clients in immigration detention who have COVID-19 co-morbidities, putting them at risk of severe illness if infected.

It is extremely concerning that at Brook House IRC ‘Rule 35’ reports to flag up particularly vulnerable detainees, such as those at risk of serious illness, to the Home Office have been suspended.

Having persisted in detaining torture and trafficking survivors at Brook House Immigration Removal Centre with all the known risks means the Home Office have knowingly endangered vulnerable people who came to this country to seek safety.

The rush to detain and remove 1,000 migrants who arrived on small boats across the Channel by 31st December may have exacerbated an already dire situation.  The vast majority of these migrants are removed by chartered flights from Brook House IRC. Some of our clients there have been told their ‘removal directions’ have been cancelled due to the COVID-19 outbreak.  As most wings at Brook House IRC are in isolation, and with just a few weeks to go, it is possible that the Home Secretary’s plan to remove 1,000 migrants in this way by 31st December lies in tatters.  The financial costs may be considerable but ultimately detainees may pay the heaviest price with their health.

Since it was founded in 2005, Medical Justice has never before seen such high numbers of extremely vulnerable detainees being rushed so quickly through the process.  The current need and ongoing risks are unprecedented.

The Home Office now urgently needs to do the right thing and release detainees as soon as is safe in accommodation in the community can be arranged – this does not include in army barracks.

 

Further Reading

The Independent : Home Office forced to cancel deportations due to coronavirus outbreak in removal centre