The British Medical Journal
Published 01 November 2022

Outbreaks of diphtheria and scabies and a case of meticillin resistant Staphylococcus aureus have been reported at the overcrowded immigration processing centre in Manston, Kent.

MRSA was identified in an asylum seeker who initially tested positive for diphtheria, the Guardian newspaper reported. The asylum seeker was moved out of the site to a hotel hundreds of kilometres away before the positive test result was received [1].

The Manston site, originally set up as a short term processing centre, has at least eight confirmed cases of diphtheria, the Guardian also reported. The Home Office would not confirm the case of MRSA or the exact number of diphtheria cases.

A Home Office spokesperson told The BMJ, “We are aware of a very small number of cases of diphtheria reported at Manston. Full medical guidance and protocols have been followed.

“We take the safety and welfare of those in our care extremely seriously and are working closely with health professionals and the UK Health Security Agency to ensure the instances are contained and to support the individuals affected.

Stephanie deGiorgio, a doctor who had been working at the centre, told the BBC Radio 4 Today news programme on 1 November that the people she was treating were extremely tired and scared. She said the team had seen cases of diphtheria as well as diarrhoeal illnesses and scabies. “These are people who are living in horrible crowded conditions, and they don’t have enough washing facilities and ability to keep clean, so the risk of diseases is significant.

The Manston centre was designed to be a short term holding facility with migrants held for 24 hours while they underwent checks before being moved into immigration detention centres or asylum accommodation. It is supposed to hold up to 1600 people, but up to 4000 are now being held there. When the chief inspector of immigration visited he found one family that had been there for 32 days sleeping on mats in a tent.

Roger Gale, the Conservative MP whose constituency includes Manston, told the House of Commons on 31 October that the centre had been working efficiently until last month. He accused the home secretary, Suella Braverman, of taking the policy decision not to commission further hotel accommodation to reduce overcrowding. But Braverman has denied blocking the procurement of hotels or vetoing Home Office advice and said the government had been “working tirelessly” to find facilities.

Labour’s shadow home secretary, Yvette Cooper, said that the overcrowded site meant there were risks of “fire, disorder, and infection” and of “outbreaks of violence and untrained staff.” She said these signalled “deeper government failures.”

Charlie Taylor, the chief inspector of prisons, urged the Home Office to “get a grip” on the situation at Manston. In a media statement on 1 November he said, “The current situation at Manston has significantly deteriorated since our July inspection. We are hearing that detainees are now being held in greater numbers and for much longer periods of time in cramped and uncomfortable conditions, often supervised by staff who have not been suitably trained.”

His latest report, which was based on an inspection of Manston in July, found that the centre had improved since earlier inspections but that there were early signs of risks materialising, including weak governance of healthcare processes [2]. It said that the management of controlled drugs was particularly poor and breached standards for safe storage. The care pathway lacked coordination or clinical leadership.

Emma Ginn, a spokesperson for Medical Justice, which works for the health rights of detainees, told The BMJ, “Manston is overcrowded and unsafe, and there is, as appears inevitable in such conditions, an outbreak of infectious disease. The diphtheria outbreak highlights just one of the ways that such overcrowding and inadequate conditions endangers their health.”

She added, “Medical Justice has raised concerns repeatedly that the rates of vulnerability in people who have crossed the channel in small boats are very high, including multiple cases in which we have documented clinical evidence of torture and trafficking. Men, women, and children must be processed efficiently and appropriately accommodated, or the physical and mental health risks of prolonged detention of large groups of people in cramped centres will continue to spiral.”

The Refugee Council said that the crisis was entirely of ministers’ own making and that they must put in place an urgent task force to tackle the growing crisis in the asylum system. Enver Solomon, the council’s chief executive, said, “This is an appalling and inhumane situation, but it can be addressed if ministers are prepared to have focused conversations with organisations such as ours and others. There are ways through this situation, which is causing untold human misery to thousands of vulnerable people fleeing war, persecution, and conflict.

“Ministers have deliberately focused on making the system harsh and austere rather than focusing on putting resources and capacity in place to treat people with compassion and respect.”


  1. Taylor D, Walker P. MRSA reported at Manston in migrant who tested positive for diphtheria. Guardian. Oct 2022.

  2. Short term holding facilities at Western Jet Foil, Lydd Airport and Manston. Nov 2022. HM Inspectorate of Prisons.