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, 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 

September 18th, 2024

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 

 

  

*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. 

Annual review of GPS tagging in the immigration system, 2023

Government doubles down on experimental surveillance tech to track migrants

‘Constantly on Edge’, the latest report on GPS tagging in immigration bail, has found that the Home Office has increased its use by 56% in the last year and is now using newer, experimental mobile fingerprint scanners to monitor migrants on bail, without effective safeguards in place.

Users of the new ‘non-fitted’ scanner devices – supplied to the Ministry of Justice by Buddi under a £6 million contract – described the experience as a “type of torture” and spoke of feeling “constantly on edge”.

The research comes a year after Public Law Project, Bail for Immigration Detainees, and Medical Justice published ‘Every move you make’ which revealed the ‘psychological torture’ caused by fitted GPS tracking devices.

Interviewees told researchers that the newer, non-fitted devices vibrate up to 10 times a day at random intervals, sometimes into the evening. If users are unable to scan their finger within a window of ‘around a minute’, they are considered to be in breach of their electronic monitoring bail condition. That breach is then reviewed by the Home Office.

Researchers found that an automated system – the Electronic Monitoring Review Tool (EMRT) – is used to decide which device type will be issued and for how long the person will be required to use it. Authors Dr Jo Hynes and Mia Leslie of the Public Law Project say there is not enough transparency around how the EMRT works to be sure that the process is free of bias.

The report found that reviews of decisions to impose GPS devices – a key safeguard in the process – are not being conducted in sufficient volumes.  As of July 2023, 622 quarterly reviews were overdue.

Author of the report Dr Jo Hynes said:

“These devices are utterly dehumanising. It is hard to imagine the vigilance required to be ready to scan your finger immediately at random times throughout the day, or risk  breaching your bail conditions. Our interviews with migrants show how oppressive this system is and the impact that constant watchfulness has on their daily lives and wellbeing.

“This level of surveillance is not only harmful, it is unnecessary. The rate of absconding from immigration bail is tiny. In 2021 it was 2.7% and in the first six months of 2022 it was 1.3%. Millions are being spent on a system to address a problem that is not evidenced, and which causes psychological harm to people already made very vulnerable by Home Office policies.

“With a pilot study having recently concluded, it seems likely that Government may look at rolling these devices out to people who arrive by ‘irregular’ means i.e. by small boat. Given what we know about the potential harm these devices can cause, such a move would be highly inappropriate.

“The systems around this surveillance regime are opaque and dysfunctional. There is limited transparency around the automated decision support tool used to decide which device type will be issued and for how long the person will be on it. In addition, in breach of its own guidelines, the Home Office has a significant backlog of reviews to complete, leaving many at risk.”

Testimony from people interviewed for ‘Constantly on edge’

Interviewees taking part in the research who have been required to use the non-fitted devices report feeling “constantly on edge” and “like a lower type of human”. Another described it as “a type of torture”.

“If you have to go to the bathroom or to use the toilet, everywhere that thing’s with you.” – Interviewee

“I felt like someone is always following me, behind me. It’s like, imagine you’re walking outside and someone is like walking behind you. Following you, like wherever you go that person is following you. You will start to panic. You shouldn’t be harming the person you are watching. That is really very bad, like I said, being watched is horrible.” – Interviewee

 

‘Constantly on edge’ was written with the support of Bail for Immigration Detainees (BID) and Medical Justice.

Pierre Makhlouf, Legal Director of BID, said:

“GPS tagging is a punitive measure that is unnecessary and generates fear of authority. Its use is disproportionate, entailing 24-hour surveillance and control of individuals, while being supported by policies that interfere with an individual’s right to privacy. Its use needs to be ended now.”

Emma Ginn, Director of Medical Justice said:

“Having already established that electronic monitoring carries a high risk of causing deterioration in existing poor mental health, Medical Justice is saddened that the Government has significantly increased its use. Reports of severe detrimental effects on mental health, including to the point of suicidal ideation, therefore come as no surprise.

“Many of our clients have experienced immense suffering before they reached the UK and are retraumatised by immigration detention here. Being tagged on release can impede their recovery.  Though they may have left detention, intense surveillance and control continues, with the associated risk of harm.”

 

Key findings:

• In 2023, there has been a 56% increase in the number of people GPS tagged as a condition of immigration bail.
• Non-fitted tagging devices were introduced from November 2022. These fingerprint scanner devices request periodic biometric verification from the user (vibrating at random times) and collect the person’s location data at all times.
• Between 1 January 2023 and 2 November 2023, 3,335 people have been subjected to fitted devices and 543 people subjected to non-fitted devices as a part of an electronic monitoring bail condition.
• Reviews of decisions to impose a GPS tag (a key safeguard) are not being conducted in sufficient volumes. As of July 2023, 622 quarterly reviews were overdue.
• An automated system – Electronic Monitoring Review Tool (EMRT) – is used as part of the process for deciding which device type people will be subject to, if they should be moved from a fitted to a non-fitted device, or if their monitoring is to be discontinued.
• The extent of the EMRT’s role in decision-making is opaque, making it difficult to assess the extent of automation bias in the decision-making process.
• The length of advised time people spend on devices is vast, ranging from 3-24 months on a fitted device to 18 months to indefinitely on a non-fitted device
• Buddi Limited was given £6 million to make these devices. The contract comes to an end on 30 December 2023.

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.

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 to deteriorate 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.

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.  One of our greatest concerns is the government’s plans to increase detention, despite the ongoing abuse, raises fears it is ignoring BHI findings.

Research published by Bail for Immigration Detainees, Medical Justice and Public Law Project 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.

A new report from the Helen Bamber Foundation, Medical Justice, the Anti Trafficking and Labour Exploitation Unit and Focus on Labour Exploitation, highlights the government’s failure to protect victims of trafficking in immigration detention – and that it has deliberately put in place a system in which more trafficking victims will be locked up. The number held in immigration detention each year has tripled from 500 in 2017 to over 1600 last year. Even when identified as possible victims of trafficking, people are not being released and are detained while waiting for a final decision in their case, when the average time for making these decisions is a staggering 17 months.

The Home Office frequently claims that people ‘abuse’ the system by claiming to be trafficked to secure their release from detention. But over 90% of cases are confirmed to be genuine victims of trafficking. There is no evidence of a process being abused – rather, people who have already been exploited and mistreated are experiencing further abuse by an immigration system that is not fit for purpose.

This report makes practical recommendations for improving that system and calls for an urgent comprehensive review of the process for detaining confirmed or possible victims of trafficking.

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.

The Medical Justice “Harmed Not Heard” report 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 14^th 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 14^th 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.or.uk

 

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