Removals Without Adequate Provision of Anti-Malarial's - What Can Be Done

Risk of malaria infection, including potential death of children
Many detainees, including children, get malaria in their home country having been removed from the UK without having been provided with adequate or any anti-malarials. People lose their immunity after about 3 months of being away from their home country where malaria exists.

Once infected, a child's condition may deteriorate quickly and children can die within 48 hours after the first symptoms appear.

If untreated, malaria can lead to severe anaemia, organ damage, convulsions, coma and death. An estimated one million people in Africa die from malaria each year, 90% of these deaths occur in sub-Saharan Africa. 71% of all deaths from malaria are in children under 5. A child's most vulnerable period begins at six months, when the mother's protective immunity wears off and before the infant has established its own robust immune system. Malaria kills a child every 30 seconds. 300 to 500 million clinical cases of malaria are documented each year worldwide, 90% of them in Africa.

See The Global Fund

Non-provision of adequate anti-malarials

February's Immigration Law Practitioners Association (ILPA) mailing to its members ;
"The Medical Justice Network is an organisation comprising of doctors, lawyers and other volunteer all committed to improving the provision of medical care to immigration detainees. We would welcome the assistance of any ILPA members able to provide their time to assist this cause and suggest they contact: This email address is being protected from spambots. You need JavaScript enabled to view it. . We would also like to draw members' attention to the issue of removals of pregnant women and small children to Malarial areas - in particular Sub-Saharan Africa. Such individuals, according to guidelines prepared by a committee of medical staff throughout the Immigration Services detention estate, should be provided with chemoprophylaxis against Malaria. Despite these guidelines the Immigration Service continue to refuse to provide any assistance".

Since then the Secretary of State when prompted has in a few cases offered prophylaxis but nonetheless numerous removals have been successfully challenged on written application to the Administrative Court or telephone application to the duty High Court Judge either owing to the Immigrations Service's inadequate provision of anti-malarials or a complete refusal to provide them.

In JN (CO/9371/05) 17th Jan 2006, Collins J stated:
'I cannot believe that the Secretary of State would countenance the removal of pregnant women to a serious risk of malaria when the prophylaxis is readily available. Accordingly, I propose to direct that removal cannot take place until that prophylaxis is provided - it is only a question of giving her the necessary tablets.'

While some may view this form of action as merely delaying the inevitable, Medical Justice are in contact with a family with older children, two of whom were hospitalised with malaria shortly after arrival in Uganda and who were assisted only through the intervention and provision of financial support from family friends in the UK. It should be noted that natural immunity to malaria is lost after 3 or 4 months outside the malarial region and that the strain in sub-Saharan Africa is potentially fatal, and as such we believe that prophylaxis ought to be administered at least to all small children and pregnant women who have been in the UK for greater than 3 months. 

Similarly although the detention Healthcare Committee make no reference to this, a number of practitioners within Medical Justice advocate the provision of treated bednets again at least to all small children and pregnant women but ideally all those being removed to malarial areas. The costs are insignificant (approx £15) when compared with the overall cost of removal and such nets provide a significant further barrier to infection.

The effect of stopping a removal
Small children, both born and unborn, must properly protected against a potentially fatal disease. However, this may not stop Immigration attempting removal again later, possibly within days - either with or with providing adequate anti-malarials. Stopping a removal on the basis of non-provision or inadequate of anti-malarials will not result in a detainee being given leave to remain in the UK.

During any days between stopping a removal and Immigration attempting another removal, a solicitor may be able to review other aspects of a detainee's case and find other additional ways to fight their case. Of many cases known to us, the detainee is still in the UK, enabling them to seek further legal and campaigning advice. Some detainees have been released from detention.

Solicitors' views
Because stopping a removal on the basis of inadequate provision of anti-malarials will not progress an asylum claim, some solicitors say it's not a good use of their time.

Other solicitors believe it is everyone's right to be treated with some level of dignity and a child's life should not be put at danger for the sake of a number of tablets.

Time-frame of removing families
Most family removals are usually scheduled within a few days of being detained - so there is little time to act.

What a detainee could do
The detainee could ask for appropriate anti-malarials for themselves and any other family members due to be removed from the UK to a country with a high incidence of malaria. A verbal request to the detention centre's medical centre should be backed up with a written request, which should be faxed to the solicitor.

What the detainee's solicitor could do
The solicitor should make representations for stopping removal based on inadequate provision of anti-malarials, followed by Judicial Review if necessary, and an Injunction if necessary. The attached Grounds and Order from Justice Collins should help the solicitor. We can provide names of some barristers who have successfully represented in Judicial Reviews on grounds of inadequate provision of anti-malarials.

What happens if the detainee is given anti-malarials ?
There are various type of anti-malarials and sometimes an inappropriate one is given considering the detainee's age and country they are being removed to, and the dosage and/or intervals between doses are also inappropriate. There have been successful Judicial Reviews based on inappropriate / inadequate provision of anti-malarials.

What if the detainee does not have a solicitor ?
Supporters could try and find a solicitor who will fight on the basis of non-provision of anti-malarials and look at other aspects of the detainee's cases when removal has been stopped.

Essential information the detainee / supporter must supply to a solicitor
* Copy of attached Grounds if the solicitor needs them
* Have any young children or pregnant woman been offered any anti-malarials ?
* Name of any anti-malarial provided
* How many tables were administered, when and on how many occasions
* Weight of young children
* If pregnant woman involved - how many weeks pregnant
* Has the detainee requested anti-malarials
* Name, gender, and date of birth of all family members
* Nationality
* Home Office and Port Reference numbers
* Which immigration office is dealing with the case
* Where the detainee / family is being held, phone number / extension number, fax number
* Name of last solicitor, firm, fax and phone number
* Details of the removal directions (and fax copy to solicitor)
* Detainee must sign and fax a new solicitor authority to act

A brief understand of the detainee's immigration history is required: date entered UK, using which type documents, date claimed asylum, date asylum refused by Home Office, date of refusal of any appeal by an immigration judge, date of refusal of any Reconsideration, Judicial Review or any other legal challenge.

A copy of immigration judge's determination and all papers ref any further legal challenges should be faxed to the solicitor as soon as possible.

Campaigning
Campaigners can help the detainee establish an anti-deportation campaign, lobby the airline, etc., as usual.

Useful links
http://www.fitfortravel.scot.nhs.uk/