2nd May 2007
Negotiated Agreements and Policy changes on medical issues ref. immigration detainees
Medical Justice has negotiated several agreements and policy changes with the Home Office that may assist anyone advocating for the welfare and rights of immigration detainees: visitors, supporters, independent doctors, legal representatives, as well as detainees themselves. These negotiated agreements which - if honoured - will improve the health and humanitarian care of detainees.Medical Justice encourages everyone to make use of the negotiated benefits where relevant and appropriate. As ever, there may be a harmful gap between the negotiated benefit and how the detainee is actually treated in practice, which should be challenged and reported to Medical justice who may be able to assist, depending on our very limited resources.
Over the past 18 months, Medical Justice has had several meetings with senior Home Office personnel and their agents in detention centres, including Lin Homer (Chief Executive, Border and Immigration Agency (BIA, formerly known as IND), Stuart Hyde (formerly Strategic Director Enforcement, BIA) and Brian Pollett (Detention Services, BIA). We are grateful for advice, assistance and support from friendly organisations including the Helen Bamber Foundation, Medical Foundation for the care of victims of torture, Bail for Immigration Detainees (BID) and Crossroads Women's Centre during these discussions.
1. Access to Detention Centre for Medical Visits by Independent Doctor
A protocol issued in December 2006 clarifies the role of, and facilitates access of detainees to, independent doctors. For example, it mandates that Detention Centre medical centres keep a standard form for detainees to use to authorise medical visits by an outside independent doctor of their choice, and that the independent doctorshould have automatic access to complete medical notes (with the consent of detainee).
2. Detention of those claiming to be survivors of torture
DSO (Detention Services Order) 2007/1 reiterates the requirement for detention centre clinicians and managers to report to BIA the presence of detainees who claim they have been victims of torture using “rule 35” reports. To date, this requirement has almost exclusively been ignored and/or brought no outcome for the detainee. Stuart Hyde (formerly Strategic Director Enforcement and Removals, BIA) has agreed to audit the process by which BIA has, so far, largely failed to respond to such “rule 35“ reports. At the time of writing, Medical Justice is promised, but have not yet received the full details of the audit, which (from information received so far) appears to be seriously flawed in our opinion.
3. Use of handcuffs on medical escorts (e.g. detention centre to hospital)
DSO (Detention Services Order) 2007/2 prohibits the use of handcuffs unless a “risk assessment” carried out by the detention centre mandates, using a “balanced judgement”, their use despite the clinical needs of the detainee. It also requires, in the event of handcuffs being used, that they be removed during any medical consultation or treatment unless “the original risk assessment dictates otherwise”. Although not mentioned in the DSO, it would be a gross violation of medical ethics if the detainee were not allowed privacy - i.e. guards being removed from the consultation - unless the doctor considered there was a danger to themselves or others.
4. Provision of Evidence of unfitness for detention by independent doctors
It has also been agreed that independent doctors should be assisted (by onsite BIA officers) to ensure that evidence of unfitness for detention (by reason of age, medical, psychiatric or torture history) is brought to the notice of BIA caseworkers responsible for continuing detention.
5. Detainee access to test results from Bedford Hospital
Yarl's Wood removal centre management have specified - in total contradiction to statements by 7 detainees - that access to results of tests at Bedford hospital is facilitated, not obstructed, by escorts, Yarl's Wood staff and Yarl's Wood health centre. Please see the below letter from Yarl's Wood management which you may be able to use in challenging any hindrance in a detainee gaining access to their test results.
6. Timely provision of appropriate anti-malarials
Many detainees contract malaria and other easily preventable diseases following removal to sub-sahran Africa. The natural immunity to malaria of those being removed from the UK is lower than for those who live in the countries. Many deportees are destitute on return to their country of origin and face great risks to their health in the weeks following removal. Medical Justice has campaigned for pregnant women and children (who are at particular risk) to be provided with chemoprophylaxis against malaria and bed nets before removal. Medical Justice has brought several dozen legal cases challenging the removal of pregnant women and young children. The Home Office ultimately settled all but one case. In that case the Home Office illegally removed a mother and five children in breach of a High Court injunction.
The revised policy - "Feb/07 - Immigration Directorates' Instructions - Section Contents - Chapter 1 Section 8 - Medical" - go to section 5.7 onwards to see the new policy on "Malaria Prophylaxis"
The new policy is not perfect, but it does entitle detainees to expect to be treated with some dignity before being removed to circumstances in which their lives are at risk. The number of instances of the Home Office not providing appropriate anti-malarials has reduced since implementation of the revised policy - however, problems remain and Medical Justice has still had to act to enforce Home Office compliance with its own policies.
7. Ensuring detention healthcare staff have access to "The Medical Documentation of Torture"
Follwoing Medical Justice negotiations with the Home Office, in July 2007 BIA detention Services have required all detention centres to obtain a copy of the standard text book "The Medical Documentation of Torture". It is now up to the detention centres to read and act onn this information.
8. Independent doctors allowed digital cameras on Medical Visits to document torture scars
In July 2007, at the request of a Medical Justice volunteer psychiatrist, the Home Office has issued a Detention Services Order (DSO) which permits independent doctors to bring digital cameras into a detention centre in order to photograph and document scars of torture. This has already contributed to the release of one woman with cigartette burns. Medical Justice is prepared to offer a service in advising on any such photographs. It is essential that the detainee concerned gives written permission for any such images to be communicated to Medical Justice.
These hard-won agreements and policies are of no value unless they actually enforced
These hard-won agreements and policies are of no value unless they are actually followed by BIA and Detention Centre staff. Medical Justice has hard evidence of frequent violations, e.g.
A. Detention centre / health centre claims that particular detainees who have signed forms for medical visits have not done so or cannot be found.
B. Detention centre health centre failure to provide complete set of medical notes.
C. Persistent Home office claims that the receipt of “rule 35” reports by BIA result in referral by BIA to the Medical Foundation. (This misinformation was repeated to the House of Lords by Baroness Scotland on January 8, 2007.)
We invite all individuals and organisations advocating for the health of immigration detainees to join us in monitoring these, and future agreements, negotiated with the Home Office.
Where you detect a violation of such an agreement we urge you to complain by email to Brian Pollett (
) with a copy to
. Medical Justice suggests that a short summary highlighting the key facts in the case in a clear and succinct letter is likely to be more effective than a long, rambling message. Medical Justice suggests that where details of an individual case are to be included, this must be with the consent of the detainee concerned. For further advice, contact Medical Justice.
Medical Justice's capacity for negotiating further Agreements and Policy changes
Medical Justice continues to work on negotiating more Agreements and Policy changes to make Home Office policies less harmful to immigration detainees. For exGetample, we are working on further amendments to the policy on prevention of malaria of those who are deported, and on detention centre medical management of hunger strikes.
However, Medical Justice is limited in its capacity as we have no paid staff and no funding - we are a network of volunteer medics, legal representatives, visitors, ex-detainees and others. We rely solely on membership fees of our volunteers. Medical Justice urgently needs more medics to volunteer. We also need donations to fund costs like the travel expenses of volunteer ex-detainees who manage the many referrals we receive.
Thanks for your support!
Last Updated on Tuesday, 28 August 2007 02:01