Helping detainees in need of medical assistance

Research and Policy

Based on casework and medical visits, Medical Justice carries out research and publishes reports to help to bring about policy change and improve health care for detainees. Since publication of some of our reports there have been significant changes, in particular for children and pregnant women and greater recognition of the damage detention does to health, especially mental health.

Adults at Risk Policy Explained

The Adult at Risk policy was introduced to protect vulnerable people at risk of harm in detention. However, it is now very clear that the policy instead leads to more vulnerable people being detained for longer. This document seeks to explain the history behind the policy, to set out in simple terms how the policy is intended to work and, lastly, to highlight some of the main issues with the policy and explain why it fails to protect vulnerable people from inappropriate detention. We call on the Home Office to review the policy to ensure that it is truly protective, effective and inclusive.

Putting Adults at Risk - A guide to understanding the Home Office's "Adults at Risk" policy and its history

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Use of Segregation

Between 1,200 and 4,800 detainees are segregated each year in immigration detention. Segregation may be used as a form of control, even for those who are mentally ill. It is overused, applied inappropriately and often contravenes the rules. For all detainees putting them in segregation adds to their trauma.   Alarmingly there is little central monitoring of the use of segregation.

The misuse of segregation has been repeatedly criticised by official inspectorates yet the abuses continue. Medical Justice has called for an immediate halt to the use of segregation in immigration detention. The Shaw Report in 2016 highlighted problems and inconsistencies in the use of segregation, especially where it is used in the absence of access to appropriate mental health care.


The Misuse of Segregation in Immigration Detention - a secret punishment

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Segregation of detainees

Mental Health

Mental illness is common among people who are subject to detention, in part due to the stresses in their life that have brought them to this country. Detention increases their mental illness and distress. The indeterminate nature of immigration detention adds to the distress.

Diagnosis and treatment to NHS standards should be available to detainees, but this is not the case. There is a crisis of mental health in detention, as demonstrated by the many Court cases where successful action has been taken against the Secretary of State for the Home Office.

Mental Health in Immigration Detention Working Group: Initial Report. 2013

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Mental health in detention

Pregnant Women

Many women seeking asylum have been victims of rape, torture and trafficking. They already have poorer health outcomes during and after childbirth than their peers. When they are detained the healthcare they receive is often inadequate and falls short of what we expect from the NHS.

Since publication of the report, there is growing support for the end of the detention of pregnant women. Removal of pregnant women is difficult, because there are often medical reasons why a pregnant women is unfit to fly. The Home Office is no longer permitted to use force on them, following a court case in 2013, brought by 4 ex-detainees supported by Medical Justice.


Expecting Change - the case to end the immigration detention of pregnant women. 2013

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Expecting change

Detention of Torture Victims

Survivors of torture are routinely being held in immigration detention centres in breach of the government's own rules. However, the process for identifying and releasing people who have survived torture is ineffective and many torture survivors are still held in detention which causes more trauma - a second torture.

Five detainees and ex-detainees supported by Medical Justice brought a case challenging their detention and submitted our evidence, which the judge described as disturbing. Their detention was found to be unlawful, but the overall problem continues.

See High Court Ruling

Since publication of The Second Torture, a report commissioned by the Home Office (the Shaw Report) has concluded that rule 35, the main safeguard for torture survivors, does not do what it is intended to do and that alternatives should be considered by the Home Office.

"Despite being a torture victim, I was still locked in detention. I was still detained for many months after my Rule 35 reports and my health conditions were deteriorating. It felt like a second torture."  NK

The Second Torture - Detention of torture victims

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The Second Torture

Detention of Children

Medical Justice has documented the harm, suffering, and anguish that the detention of children causes. Children have attempted to end their own lives, and have been left seriously physically and psychologically damaged. Nick Clegg branded the immigration detention of children as a 'state sponsored cruelty' and in July 2010 it was announced that children would no longer be detained in Yarls Wood Immigration Removal Centre. However, children and their families continue to be detained in special accommodation at Cedars. 

State Sponsored Cruelty - Children in immigration detention

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Detainees Living with HIV

Many HIV+ immigration detainees have been denied life-saving medication in detention according to our research. Many suffered disruptions in their medication due to their detention. Missing just one dose of HIV medication can be serious and increases the propensity to HIV related (and non HIV related) illness. Ultimately, this can be fatal. More than three-quarters of the people in our study who were deported, had little or no medication.

Following the publication of 'Detained and Denied, the National AIDS Trust carried out its own survey and published a report, HIV Care in Immigration Removal Centres in 2013. See report.


Detained and Denied - the clinical care of immigration detainees living with HIV

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Detained and denied - the clinical care of immigration detainees living with HIV

Assault During Removal

An alarming number of injuries are sustained by asylum deportees at the hand of private escorts contracted by the Home Office. The report, which was published before the death of Jimmy Mbenga, reveals evidence of widespread and seemingly systemic abuse and that assault claims have largely been brushed off by the Home Office.

"I have seen many serious injuries with long lasting effects; crushing of nerves at the wrist from forceful pulling on handcuffs, limitation of neck movement by patients whose heads were pushed under aircraft seats, numbness of the face after blows around the cheek and eye. I have also seen a dislocated wrist, giant bruises and swellings the size of my fist. I have seen far worse abuses but do not have the patient's permission to reveal confidential medical information. Our report includes evidence from 18 independent doctors. Some of these findings are worse still. They include dislocation to the knee requiring a plaster cast and several people rendered unable to walk for extended periods. Some were denied wheelchairs, pain relief and other essential treatment although in state custody."
Dr Frank Arnold, independent doctor, Medical Justice

Outsourcing Abuse - state-sanctioned violence during the detention and removal of asylum seekers

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Outsourcing abuse - state-sanctioned violence

Complaint Procedures

A civilised society should have a fair complaints process for detainees facing removal back to the country they fled, including victims of torture, trafficking, rape, and political persecution. However, alarmingly low levels of substantiated complaints raise serious concerns about the impartiality of the investigations. Based on clients ' experience Medical Justice has challenged how complaints are investigated and following the publication of the report, 'Biased and Unjust' the Home Office undertook a consultation on the procedure.

Medical Justice has also produced a leaflet on helping detainees and their supporters to make a complaint.

Biased and Unjust - the immigration detention complaints process

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Biased and Unjust - the complaints procedure for detainees

Medical Abuse in Immigration Detention, 2007

This was the first report produced by Medical Justice when the organisation was two years old.

Beyond Comprehension and Decency - a report on medical abuse in immigration detention

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"The strength of a liberal democracy is measured not by how it treats the majority but by how it cares for minorities and those at the margins of society. The best tests for humanity and decency are conducted in its dark places: in prisons, psychiatric hospitals, and in institutions for failed asylum-seekers and other migrants."

(Stephen Shaw, then Prison and Probation Ombudsman)