We found the following:
The Home Office 'Operational Enforcement Manual' states that "where there is independent evidence that they have been tortured", people should normally be considered suitable for detention in "only very exceptional circumstances". This is because incarceration of torture victims is known to constantly re-traumatise people psychologically. More than 20 detainees seen by Medical Justice (MJ) doctors gave a history of torture and had physical signs "consistent with" or "typical of" torture, by the definitions of the Istanbul Protocol on the Reporting of Torture. In no case were these patients aware of any effort by the Home Office to investigate this, even when it had been appropriately reported to Home Office officials and doctors.
Three of four women who had been receiving anti-retroviral drugs in the community, had an unplanned disruption to their treatment in detention, because of problems in arranging appropriate and timely hospital care. Some detainees were not given the results of their positive HIV test until taken to the airport for deportation. Some rape survivors have been denied an HIV test.
After some months of UK residence, refugees who come from areas where malaria is prevalent lose their natural immunity. Despite this, children and pregnant women with removal directions to high risk malarious areas in the past year have not been offered prophylaxis or bed nets. These patients include six who developed laboratory confirmed falciparum malaria following their forced return to sub-Saharan Africa.
Eleven patients were first seen during or shortly after being on hunger strike. Six were in imminent danger of organ failure. According to the medical notes, four had not been examined by a doctor for extended periods. The Home Office appears to have no policy to guide detention centre staff dealing with the well documented dangers of recommencing food intake after prolonged starvation, despite the fact that hunger strikes are common in detention centres.
Depression and suicide
At least 33 patients seen by MJ doctors fulfilled ICD10 criteria for Post-Traumatic Stress Disorder or depression. Many had either harmed themselves or made determined attempts at suicide. Official guidance that people with serious health problems including mental illness, should not normally be detained, was not followed by the Home Office for these patients. Indefinite detention is particularly damaging to people's mental health: the constant threat of being sent back to a place one mortally fears, with no end in sight, leads to high rates of depression and suicidal behaviour. There is a whole system in place, so called "SASH" (suicide and self-harm), in each detention centre, to try to manage and contain the high levels of suicide risk among detainees.
Three patients were found to have tuberculosis. In one case diagnosis was delayed. He also suffered side effects which were not adequately explained to him. Another, who is believed to have had multi-drug resistance, had treatment disrupted during his detention for over one month. He was also prevented from keeping hospital appointments for specialist management of his TB and three other medical conditions.
Harm on Removal
Many detainees allege assault during the removal process. In cases handled by civil action lawyers, injuries have ranged from swellings and bruises, to a fractured finger, nerve damage from handcuffs, sexual assault, urethral/groin damage, cracked shoulder, serious head injury and exacerbation of mental health problems. In December 2004, the Medical Foundation for the Care of Victims of Torture, published a report: "Harm on Removal: Excessive Force against Failed Asylum Seekers", detailing that out of 14 cases they examined, there were indications that 12 asylum seekers had been subjected to excessive and/or gratuitous force in the removal process. Photo left: as described by a female detainee at Yarl's Wood Removal Cenntre
Denial of treatment and access to hospital
Many detainees are denied treatment for serious medical conditions and access to Removal Centre doctors. Many are not given test results and denied urgent medical investigations. Detainees are often denied hospitalization and when taken to hospital are usually handcuffed to guards, which breaches the patient's basic right to confidentiality.
Children in Detention
The UK is the only EU country to indefinitely detain children. At Yarl's Wood Removal Centre, children have been referred to by staff as "child male" and "child female". The charity, Bail for Immigration Detainees, published a report in May 2005 on the cases of 13 adults and 3 children who had been held in immigration detention for between 40 and 720 days (an average of 250 days). A 13 yr old boy, detained together with his father, was released after his father killed himself within hours of being taken to Yarl's Wood. The UK government currently detains more than 2,000 children, including babies, in immigration detention centres every year. One child was held for 268 days.
"The children were sick in detention. My daughter Sylvie said she was going to kill herself in there. She was crying all the time...She would be sucking her fingers and saying 'I'm going to kill myself'" - 'Fit to be Detained? Challenging the detention of asylum seekers and migrants with health needs' by BID, including a report by Médicins Sans Frontières
Unmet health needs are a major problem among immigration detainees. Moreover, detention itself is frequently damaging to the health of detainees, sometimes profoundly so. Detention of torture survivors, children and those with physical or mental ill health is unjustifiable, contrary to the Home Office's own policy, and should cease.