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Medical Justice was founded in 2005
Medical Justice was founded in 2005 by an immigration detainee on hunger-‐strike, and the independent volunteer doctor who visited him at Harmondsworth IRC at the request of a detainee befriender. Even though the detainee was on the verge of organ failure, the Home Office refused to transfer him to hospital until a High Court judge ordered them to. After being discharged from hospital, he and other ex-‐detainees, befrienders and doctors formed Medical Justice. We started to get other doctors in to visit detainees. In 2006 we negotiated a protocol with the Home Office to formalise access for doctors. We registered as a company in 2007, got our first funding grants and hired our first employee in 2008, and got charity status in 2009. Medical Justice : FY2015 (01/02/14 – 31/01/15)
Today we have 7 paid workers who liaise with volunteer doctors and a network of lawyers, campaigners, and ex-‐detainees. We handle over 1,000 case inquiries a year. In the 2014-‐5 financial year 75 volunteer doctors visited 10 IRCs to document detainees’ scars of torture and other medical conditions, as well as challenge instances of medical mistreatment. We assist detained men, women and children whose histories may include being victims of torture, trafficking, and rape. Some detainees have lived in the UK for decades, and have spouses,
children and grandchildren here. Parents and children are often separated by detention and deportation. Many of those detained are desperate and traumatised, having survived war, detention without charge or trial, torture, or rape in their own country. Many endure perilous journeys only to get unexpectedly detained in the UK, where they may relive past traumas of imprisonment. Some have serious physical and mental conditions. We use medical evidence to expose and challenge medical mistreatment of detainees and document the toxic effect of indefinite detention. We hold the government to account and campaign for lasting change through policy work, strategic litigation, public and parliamentary awareness raising, and mobilising medical professionals. We have a waiting list of sick detainees, including trafficking and torture survivors. Some get deported before we can reach them. We need more health professionals to volunteer with us, and more funding to hire additional staff. After 10 years of visiting sick detainees, our Vision remains unchanged -‐ that the harm being caused by IRCs is so widespread that the only solution is to close them down. In time we will succeed in that aim. In the interim, we work to reform the institutions and to stand up for the rights of those incarcerated within them.
Photo on front cover credit : The Guardian
Immigration detention & healthcare Immigration detention in the UK is arbitrary and indefinite. It is not part of any criminal sentence nor is it ordered by a judge, yet about 30,000 men, women and children a year are criminalised in this way, locked up in immigration removal centres (IRCs), mostly run by private companies, and in mainstream prisons. Many detainees have mental and physical scars of torture and other forms of persecution. Detainees’ medical conditions are often exacerbated by, and some caused by, prolonged detention and inadequate healthcare. Issues in immigration detention include:
• Torture scars and medical conditions are often not properly documented and considered in detainees’ cases.
• Instances of hospital appointments being cancelled, sometime repeatedly
• Since 2005, 21 people died in IRCs or shortly after release-‐ including an 84 year old Canadian
• One man was held in isolation for a virtually continuous period of 22 months.
• High Court judges have found “inhuman and degrading treatment” of mentally ill detainees five times.
• Inappropriate or no provision of anti-‐malarials for pregnant women and children
• Injuries during deportation attempts include fractured bones, a punctured lung, a dislocated knee.
• One man, the father of 5 British children, was unlawfully killed on a British Airways plane during deportation.
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Chair’s report
It has been inspiring and humbling to watch Medical Justice develop and grow up over the last 10 years. When I joined in 2007 I was a new convert to the horrors of detention and the asylum process. The organisation I joined was an extraordinary group of talented, energetic and committed lawyers, doctors, ex detainees and campaigners. The core activity then, as now, was getting doctors into detention centres and this was achieved on a totally voluntary basis. Much has changed since those days. The transition from a voluntary organisation run by volunteers to one run by a professional staff team is a major one. It requires a new role for trustees and the introduction of rigorous governance arrangements required as a charity and a Company. It is a tribute to all the volunteers and staff that we have made this transition without diluting our core purpose. The shared vision of staff and trustees, their abilities and hard work has brought us to where we are now. Gill Butler, who died in 2013, played a key part in setting up Medical Justice and we still miss her wisdom and kindness. Absolutely fundamental is the support and work of volunteer doctors, health professionals and interpreters. Working with immigration detention is particularly tough. It is time consuming as it is not just the interview with the patient or report writing; there is travel to distant places where detention centres are, waiting around to be processed often in a hostile environment. This is a significant sacrifice for those already busy in full time employment, with family commitments or study, or
those who are meant to be enjoying retirement. Also there is the personal cost of dealing with the distressing and horrific stories that detainees can tell. Sometimes we can help but sometimes we cannot. If we fail, asylum seekers who have been tortured, may be returned to where they were tortured. For some detainees our success is a matter of life or death. Without volunteers' willingness to take on all these obstacles and frustrations Medical Justice could not have achieved what it has. A great strength of Medical Justice is that it has remained focussed on the health of the individual detainee. All the other activities we can now do -‐ policy and strategic litigation are based on the casework. The effectiveness and commitment of our staff team and all the volunteers give me great confidence in our future.
Christine Hogg Chair “What is the impact of Medical Justice ?”
“At a recent assessment visit with Medical Justice, our team summed up the work of this small NGO as; ‘An inspiring and impactful organisation, working in the harshest areas of rights abuses, linking individual casework to advocacy, and getting results.’
This has been our view for a number of years. … Medical Justice mixes technical nous, strong relationships across the health sector with savvy campaigning techniques. The final ingredient is an unwavering determination to secure lasting change. Medical Justice brings hope to individuals in the dark and hidden recesses of immigration detention.
The organisation fulfils a unique role and I dread to imagine how much worse things would be without this inspiring group of staff and volunteers shining a light across the detention estate. Put simply, we are proud to be associated with the work of Medical Justice.”
Michael Pitchford -‐ Joseph Rowntree Charitable Trust
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Co-‐ordinator’s report
19th November 2001 was the day I first visited Yarl’s Wood Immigration Removal Centre, the day it opened. It was clear right then that detainees did not have access to the healthcare they needed and they were at the mercy of the guards. In those days, campaigners like me felt useless
– all we had was our suspicions, a smattering of esoteric research, and lots of uncorroborated detainee accounts. Some lawyers, journalists and parliamentarians were sympathetic but campaigners and befrienders couldn’t articulate or evidence the issues well, hence the lack of litigation, parliamentary attention, and public debate. In 2005, Medical Justice was founded and this changed the game completely. Abuses and medical mistreatment still occur, but Medical Justice’s oversight means the Home Office and its private contractors cannot enjoy completely unbridled impunity like before. The main achievement of Medical Justice has been to establish a broadly held acknowledgment that medical mistreatment of detainees exists, and that it is endemic. This has enabled brilliant lawyers, campaigners, non-‐governmental organisations, journalists and parliamentarians to act. As well as achieving some measure of systemic change, importantly, Medical Justice has helped thousands of detainees to challenge their treatment. And it is the detainees’ courage to survive that we are inspired by, and their brave support of fellow detainees, even after they have been released themselves. Medical Justice staff are supremely motivated by the selfless volunteering of all our clinicians and interpreters. To top it all, we continue to be touched that funders trust and support us, enabling us to continue and grow. Back then I thought it might take 6 months to convince the government that it had made a terrible mistake with Yarl’s Wood. Oh dear. Well, I am truly sorry to be writing a report ‘celebrating’ 10
long years of challenging instances of medical mistreatment in immigration detention. Though packing up is not an option, and in fact, we feel encouraged to continue. The transfer of commissioning healthcare to the NHS has not brought all the benefits we had hoped for, yet. But it has the potential to, and that means we must do everything within our abilities to contribute our medical evidence and expertise towards that. Emma Ginn Co-‐ordinator
Detained for over 2 years, released June 2014
Claim for Unlawful Detention Succeeds -‐ Judgement Xue v SSHD : “The Claimant was detained administratively for over two years. The longer her detention went on, the more vulnerable she became. Her physical health has been significantly compromised, probably permanently. Her mental health also declined in detention. She eventually fell down a stairwell and broke her back. But she is a foreign national. She has no right to be here. … She is only entitled to nominal damages up until … the date when she was returned to detention from hospital after her fall. “ “What is the impact of Medical Justice ?”
“… Medical Justice has been fearless in speaking up against the abuse and ill-‐treatment of persons in immigration detention. It has brought to this work the professionalism and care that it brings to its work with individual patients in detention. The organisation has motivated, supported and coordinated volunteers who have been extraordinarily generous in the commitment that they have shown to immigration detainees. Without Medical Justice many individuals would have lacked for the evidence necessary to support their case. They have benefited also from the considerable reassurance that being in touch with the organisation provides.
Medical Justice’s research is of high quality and can be relied on in submissions to and discussions with government. As attested to by repeated judgments, it can be relied upon by courts and tribunals. The organisation has not flagged in its enthusiasm for working to protect immigration detainees and continues to inspire those lawyers who work with it both on individual cases, on public interest litigation, and in advocacy.”
Alison Harvey -‐ Legal Director, ILPA
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Casework
The most rewarding aspect of working for Medical Justice is being able to see the impact that our work has on the detainees we work with and I feel privileged to have been able to see that in hundreds of cases in the last 6 years, since I started as Casework Manager at Medical Justice in 2009. During this time I have come across an enormous amount of misery – but I have also been able to witness hundreds of detainees being released, many eventually being recognised as refugees, beginning to rebuild their lives, studying, archiving university degrees, having families and some returning to the dreaded places of their detention as volunteers to help others. What we are able to do for detainees is all thanks to our amazing volunteer clinicians. Since 2013 we have additionally began recruiting and training volunteers interpreters. Our team of interpreters now covers 29 languages, but we are still looking for more volunteers, mainly for Amharic, Albanian, Lingala, Persian (Farsi), Tamil, Tigrinya, Urdu and Vietnamese. In June 2014 we employed a new caseworker, Charlotte Mathysse. Having a second full-‐time person working on casework has allowed us to increase both the number of people we support and the amount of support we offer our clients. We see detainees for a number of different reasons: The largest group is survivors of torture who require their medical evidence of torture documented. Despite Home Office policy not to detain those who have independent evidence of torture, we receive more referrals for this group than we can accept. We also see detainees who have immediate health problems and need an independent assessment of their health and treatment needs, and detainees who report that they have been assaulted while in detention or during attempted removals from the UK.
Almost all of the detainee we see fall into at least one of the vulnerable groups described in Home Office policy as ‘normally unsuitable for detention’ (Enforcement instructions and Guidance 55.10 -‐ tinyurl.com/o549ybb): we have seen elderly people who require social care, pregnant women, people with significant disabilities, severely mentally and physically ill people whose treatment cannot be provided in detention and survivors of trafficking and torture. In the last year about a third of the detainees we have seen were held on the Detained Fast Track, an accelerated process intended to determine straight-‐forward cases quickly.
Photo : Charlotte Mathysse, Caseworker
The Fast Track process has been found by the courts to be so unfair as to be unlawful – a finding that is reflected in the cases of our clients. Just to give one example, a number of detainees assessed by our clinicians were found to lack capacity to participate in their asylum case because of a cognitive impairment. Nevertheless they had been detained for fast-‐tracking of their claims and had been considered ‘not credible’ by the Home Office-‐ some
because of inconsistencies in their account, one because his decision-‐making had not been considered ‘plausible’ by the Home Office, and some because of ‘non-‐compliance’ with the asylum process.
In FY 2015 we handled 916 referrals and sent 75 volunteer clinicians to visit detainees in all the IRCs.
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Clinical Advisors Report
Photo : Dr Naomi Hartree, Clinical Advisor
When Medical Justice started, the clinical roles were filled entirely by volunteers. In 2012 we employed our first Clinical Advisor and now we have two doctors on the staff after Dr Sarah Chin joined in January 2015 as Medical Reviewer. Medical Justice has an amazing set of volunteer clinicians who visit detainees as independent clinicians. With dedication and generosity they somehow manage to fit IRC visits and report writing into their busy lives. Having started out with only volunteer doctors, our volunteers now include clinicians from a range of specialties, including midwives, psychologists and most recently, nurses – and at different career grades from doctors’ ST1 through to GPs, consultants and those retired from NHS work. We are privileged to have a high caliber of volunteers -‐ clinicians who are busy and well respected in their other roles -‐ so why is the Clinical Advisor role needed? The Clinical Advisor provides vital support for the volunteer clinicians. Mainly because of the differences between ordinary clinical work and medico-‐legal assessments, an area not covered in most doctors’ training. Also, the standard demanded of medico-‐legal reports has been raised over the years, and reports come under close scrutiny by the courts, adding to the need for our reports to be clearly written and accurate. Because of the nature of the work, often dealing with distressed clients, including many with histories of torture or abuse, clinicians may need to ‘debrief’ and talk through the clinical and emotional issues raised. So in addition to the clinical advice role,
Medical Justice now arranges for an in-‐house counselor to be available for volunteers and staff. Another part of the Clinical Advisors’ role is to obtain an overview, through our own reports and those of volunteers, of patterns and trends in the medical needs and healthcare of detainees. Over the last 10 years Medial Justice clinicians have seen various medical needs not being met by the in-‐house IRC healthcare system, and this continues. Detainees are supposed to receive healthcare equivalent to that available in the NHS in the community, but our experience is that in many cases the care offered has been substandard. Examples include: pregnant women not being offered important antenatal screening tests; delayed psychiatric assessments of patients who were psychotic, acutely confused or highly traumatised; delays in hospital appointments or transport for patients whose symptoms would warrant a “soon” or “urgent” specialist assessment; and IRC GPs having to manage patients with complex medical needs such as prolonged food refusal in a primary care setting. It is not surprising in this context that some detainees have suffered long term complications including neurological damage, and that there have been deaths in IRCs where poor healthcare was found to have contributed. We also see cases where the IRC doctor has expressed a concern about a detainee but this has been ignored by the Home Office who continue the detention. Though not a representative sample the severity of case we see mean the situation is worrying even if everyone else detained was healthy. Detainees are a diverse population with varying health needs – what unites them all is lack of choice: if the IRC healthcare does not meet their needs they cannot, say, take themselves to an A&E department or register with another GP. Medical Justice continues to receive large volumes of referrals – to the extent that we have a waiting list for visits and have to prioritise the most ill or vulnerable. We are concerned to see that paradoxically, it is often the most vulnerable detainees who are least able to access help, e.g. if they are so mentally ill as to be placed in segregation, if they have language or educational barriers or if they are too traumatised to communicate effectively. The procedures designed to spot vulnerability, such as healthcare screening on arrival and Rule 35 reports, are in many cases manifestly ineffective.
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Photo : Dr Sarah Chin, Medical Reviewer
So there is ongoing need for more medical volunteer work. We give presentations about Medical Justice’s work to GPs and hospital doctors. Over the last year, we have presented to most of the GP training schemes in London, and also to doctors at an asylum seekers’ hostel (Barry House), psychiatrists at Addenbrooke’s Hospital in Cambridge and the Newham Hospital ‘Grand Round’. Over the last year 89 places were booked for our training events. We hold quarterly Basics training days for medics interested in volunteering. For medics who are currently volunteering we hold 6-‐monthly Advanced training days and monthly peer support group meetings. 82% of attendees rated the training Excellent with comments included: “The course was very useful and covered the issues which I felt I need to improve in -‐ medical report writing, calibrating the evidence, formulating observations -‐ I gained a lot! Thank you.” And “I found Aisha's account of her experience very moving and re-‐affirmed my enthusiasm for being involved” As always, none of the clinical work could happen without the dedicated team of volunteers plus the rest of the Medical Justice team, who triage referrals, book visits and interpreters, proofread reports, liaise with legal representatives and manage the office. This supports the volunteers, and helps to maintain an independent role for the visiting clinician which is key to medico-‐legal work.
Detention has a disastrous effect on the health of many of these people: One detainee who we saw in the last year had just arrived from his country of origin which fresh marks from torture. He claimed asylum on arrival at the airport thinking he had finally arrived to safety and found himself detained at Harmondsworth detention centre: a prison-‐like place that reminded him of the prison he had only so recently escaped from. He was seen by a Medical Justice doctor who diagnosed Post Traumatic Stress Disorder and recommended his release, warning that continued detention as likely to lead to a deterioration in his health. He was not released and when he was assessed again by one of our doctors a few months later his mental health had deteriorated to the extent that he lacked capacity to instruct his solicitor, did not understand where he was, and thought he was about to be tortured again. “What is the impact of Medical Justice ?”
“To be a detainee is already very hard. Now, to be a detainee who has been mistreated is even harder. But when organisations like Medical Justice exist, for detainees this is translated in "Hope". A lot of the detainees does not have any support in terms of a legal representative, the resources to find one and for some of them the language is a big barrier making them to feel isolated, specially when they have been locked and not able to see their family and friends. To feel completely alone and scare is a normal feeling when you are inside. And to be locked, even for couple of weeks, can be very detrimental in the wellness specially for the mental health.
People will never understand what is to be locked and detained until you actually experience it. But over the past 8 months, since I first made contact with Medical Justice, I have seem them to support and help so many, so many detainees. The amount of work, effort and dedication Medical Justice puts into fight injustices is to be applaud!!! … Medical Justice changes life's and granted second chances for detainees who was been treated in an unfairly way. “
Ms MG – ex-‐detainee
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Office Support management
Photo : Lisa Incledon, Office Support Manager
Arranging for volunteer doctors to visit detainees has always been the central role of Medical Justice for the past 10 years. This year we arranged 158 visits and visited all of the IRCs. To carry out proper clinical assessments, we need proper rooms and facilities. In 2006 a protocol negotiated with the Home Office included the need for appropriate facilities and that visits should generally take place in healthcare rooms. This protocol is an important acknowledgment of what is required and we continue to refer to it if problems accessing facilities arise, as they continue to do periodically. For example, we had to correspond with Harmondsworth IRC to get access to appropriately equipped room available in the visits area. Also during the last year, we had difficulty arranging a visit at Yarl’s Wood, when we were told a member of Yarl’s Wood staff should be present in all visits. We wrote to Yarl’s Wood and got the detainee’s representatives involved, and this was retracted the next day.
It is essential to obtain detainees’ medical records and key documents from their legal cases so our caseworkers can assess whether and how we can assist detainees, and for volunteer doctors, when they are preparing reports for detainees.
We frequently request medical records from IRCs and obtaining them quickly is important to progress detainees’ cases. The average time to receive requested records is around a week, although in some instances they have taken 3-‐4 weeks or more. In the last year it took longer at a number of IRCs when new providers took over after the transfer of commissioning, particularly at Yarl’s Wood, where it
took over a month for some records. The situation has now improved somewhat. On occasion, for example when removal is imminent, we need records urgently – some IRCs are unable or unwilling to reduce their standard timescales.
We need documents from legal cases which are sent to us by detainees, their representatives, or supporters. Where documents are not available, we might make subject access requests under the Data Protection Act to obtain detainees’ files from the Home Office who should send them within 40 days. There are sometimes delays. One file arrived after 140 days and only after we had complained to the Information Commissioner’s Office.
We take direct referrals from detainees by phone but encourage everyone to use our online referral facility which allows attaching copies of documents. It processes referral information directly into our datasystem, reducing data entry time. Our datasystem is the central hub for our work and enables us to securely record referrals, casework activity and documents. It enables us to look more closely at issues identified by our casework. “What is the impact of Medical Justice ?”
“As is now being increasingly recognised, the UK regularly detains immigration detainees, especially those with mental illness, in highly distressing and inappropriate circumstances which are in breach of UK and international law, whilst at the same time achieving little or nothing in terms of advancing immigration control. Medical Justice has been at the forefront in brining such abuses to light. Just as importantly, the assistance it has given to individuals in such cases has been of the greatest importance to those people, and it has helped to prevent even worse abuses than those which have come to light. Its work is invaluable. I am delighted that it is now celebrating its 10th birthday.”
Tim Buley, barrister, Landmark Chambers “What is the impact of Medical Justice ?”
"Many congratulations to Medical Justice on the occasion of their 10th anniversary, and for all that they have achieved over those 10 years. Whereas the use of immigration detention has continued to expand over that period, its harmful and in several cases truly shocking impact upon the people subjected to it have been more greatly and incisively exposed by reason of Medical Justice's hugely important work. All involved should be proud of that, and I wish them a very happy birthday!"
Steve Symonds -‐ Amnesty International
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Medical Justice in the media / round-‐up of events FY 2015 4th Feb 2014 -‐ The New Internationalist : “The promise to end child detention in the UK – and how it was ruined”-‐ “…As Emma Mlotshwa, Co-‐ordinator of Medical Justice said, Barnardo’s collusion: ‘ruined the campaign to end the detention of children, which campaigners felt was achievable as the government had already promised it.’ 15th March 2014 -‐ Bedfordshire on Sunday : ”Medical Justice charity calls for end to pregnant women being detained at Yarl's Wood …” – “According to the charity Medical Justice, which was contacted by the women between April and January this year, although 18 have since been released, none have actually been deported.”
20th March 2014 -‐ Crown Prosecution Service : announce that there is sufficient evidence and it is in the public interest to prosecute 3 G4S guards for manslaughter following unlawful killing of Jimmy Mubenga. 24th March 2014 -‐ HMP The Verne fills with immigration detainees but remains an HMP : meanwhile detainees do not benefit from the Detention Centre Rules. 27th March 2014 -‐ European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) – Report on UK visit : concerns were raised about the handcuffing of detainees during medical consultations in hospitals, Rule 35 and indefinite detention. 30th March 2014 -‐ Guardian : "Yarl's Wood immigration centre detainee dies" – “Emma Mlotshwa, co-‐ordinator of the charity Medical Justice… "Any death in immigration detention is avoidable as immigration detention is optional.” 31st March 2014 – Home Office statistics issued : the number of people detained in the year ending March 2014 increased to 30,113. The proportion of detainees being removed declined to 56%. There were 4,416 enforced removals of people who had sought asylum at some stage. There were 47 charter flights on which 2,463 migrants were removed from the UK ; 2,290 men and 173 women. The flights were to Afghanistan, Pakistan, Nigeria, Ghana, Jordan, Suriname, Kosovo and Albania. The total cost was £12,664,191. 1st April 2014: assisted voluntary return scheme scrapped for those in detention
3rd April 2014 -‐ Guardian : "Yarl's Wood death: family and fellow detainees tell of shock and despair" -‐ "On the day that Case died the women in Yarl's Wood staged a sit-‐down protest in the corridor …"We have all been crying and wondering if we will be the next one to die here," said one woman. "It's not dignified to die in detention, to be returned to your parents in a coffin.“ ... Emma Mlotshwa, co-‐ordinator of the charity Medical Justice … said: "We are mindful that concerns have been identified in the past by the prison and probation ombudsman … We are anxious for the outcome of the inquest”
Photo : Flowers at Yarl’s Wood gates next to a photo of Christine Case who died 30th March 2014 13th April 2014 – UN Special Rapporteur on Violence Against Women denied entry to Yarl’s Wood – The Home Office admitted to the office of Alistair Burt MP that “Her request to visit Yarl's Wood was declined on the basis that it was felt alternative visits would be more appropriate given her role.”
26th April 2014 -‐ Al Jezerra : “In limbo: Inside Britain's detention system” -‐ Theresa Schleicher of Medical Justice : "We see a lot of people that have been tortured, raped or trafficked… Detention works like an inverse care system, whereby the most vulnerable are failed the most”. 4th May 2014 – the Independent : “Asylum detainees stage hunger strike over poor treatment” -‐ 100 detainees staged a hunger strike amid growing anger about the fast-‐track process. 15th May 2014 – Bhatt Murphy Solicitors : “Unlawful detention of a pregnant woman” – “The Home Office has admitted falsely imprisoning a pregnant woman at Yarl’s Wood immigration detention centre. The Claimant was over six months pregnant when she was released. …This case follows a June 2013 report by the charity Medical Justice, Expecting Change.”
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Photo : Theresa Schleicher with medical notes ! 17th May 2014 – Guardian : “MPs to Investigate Serco Over Sex Assault Claim at Yarl's Wood IRC – The report details an investigation into the claims of a woman that she was sexually assaulted three times at Yarl's Wood by a Serco health worker. Also that a Serco guard who appeared to believe the claims made by the detainee be given "guidance" to assist her "objectivity" in future, and that Serco believed the detainee lacked credibility because her allegations were deemed too consistent and detailed. 24th May 2014 – The Observer : “Serco whistleblower's Yarl's Wood sex claim” -‐ The whistleblower also claimed that another alleged case of sexual assault by a Serco member of staff occurred in August 2012, involving a particularly vulnerable detainee with profound psychological issues. It is understood she has since been deported. He also claimed that a Serco female officer had told him of a "blind spot" inside Yarl's Wood, which was not covered by CCTV and was a well-‐known location for trysts and where an officer had previously made a woman detainee pregnant. 30th May 2014 -‐ Guardian : “The UK must rethink its immigration detention centres” -‐ “… Torture survivors are only supposed to be detained in exceptional circumstances, but research from charities such as Medical Justice has identified that this rule, known as Rule 35, is routinely flouted.” 19th June 2014 -‐ R(AA(Sudan) -‐VS-‐ SSHD : “It is chilling to hear what the Home Secretary says … that she has insufficient resources to monitor and review the administrative detention of foreign nationals even when those detainees have clear evidence of being victims of torture. Our client has over 260 scars including burning, cutting and
branding. How many torture victims is the State detaining unlawfully because it lacks resources to monitor detention?” -‐ Toufique Hossain, Duncan Lewis. A medico-‐legal report from a Medical Justice volunteer doctor was key evidence. 24th June 2014 -‐ BBC Radio 4 File on 4 investigation into healthcare at Yarl’s Wood -‐ a 40 minute programme with interviews including with ex-‐detainees, Dr Naomi Hartree from Medical Justice, Harriet Wistrich from Birnberg Peirce & Partners, the ex-‐detainee who was sexually abused by the Yarl’s Wood male nurse, and Richard Fuller MP. 24th June 2014 the – The Guardian : “Serco apologises after dismissals related to Yarl's Wood allegations” -‐ 10 staff were dismissed in relation to allegations of improper sexual contact with detainees. Appearing before the Commons home affairs committee, Serco executives said that the dismissals related to eight separate cases – out of a total of 31 which had been investigated” 15th July 2014 -‐ The “Residents Test” has been successfully challenged ! : ‘Unauthorised, discriminatory and impossible to justify’ -‐ the Divisional Court gives judgment on the Lord Chancellor's civil legal aid residence test. The test would withhold legal aid from recent, lawful migrants and irregular migrants. The test case was brought on behalf of the Public Law Project. 23rd July 2014 – Guardian : “Isabella Acevedo: the immigration minister's cleaner stuck in Yarl's Wood” – “Isabella Acevedo was snatched by immigration officials from her own daughter's wedding and now faces deportation, while Mark Harper, who resigned when it emerged he employed her for less than £10 an hour, is back in government. “ 25th July 2014 -‐ Guardian : “Lowest cost matters most in Britain's immigration detention centres” – Emma Mlotshwa is the head of Medical Justice… told me that the system was making people sick.“ 22nd August 2014 – Guardian : “Private firms 'are using detained immigrants as cheap labour” – “G4S and Serco saving millions by paying detainees as little as £1 an hour to cook and clean” 1st September 2014 – commissioning of healthcare transferred to the NHS
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Photo : Banner remembering Jimmy Mubenga, held by members of the family of Rubel Ahmed who died at Morton Hall IRC 7th September 2014 – Guardian – “Call for inquiry into death at Morton Hall immigration detention centre” -‐ Ahmed's cousin Ajmal Ali said "Rubel was an incredibly shy, quiet and reserved person, he always helped everyone. He was a very good hearted young man and it was a pleasure and an honour to know him.” 6th September 2014 -‐ Plans to double the size of Campsfield : The Home Office held a Public exhibition (they withdrew the application in March 2015) 24th Sept 2014 -‐ HMP The Verne : became an IRC September 2014 – Home Office statistics : 3,378 people in immigration detention, excluding those held in prisons. 425 immigration detainees were being held in prisons. The longest length of detention was 1,701 days (over 4 and a half years). 11th September 2014 -‐ Prison & Probation Ombudsman 2013-‐14 annual report -‐ "Our investigation established that the escort staff had refused to remove Mr Z’s handcuffs and leave him alone with a doctor during a medical appointment at an outside hospital and that, as a result, the consultation did not go ahead … We found that there was no evidence that a risk assessment had been conducted …that escort staff appeared to be completely unaware of policy on the use of restraints on detainees. “ 18th October – the Observer : “Home Office ‘chaos’ over asylum appeals” -‐ officials have been set targets of turning down 70% of asylum appeals, and have been offered gift vouchers, cash bonuses and extra holiday if they hit them. 21st October 2014 – HM Inspector Prisons
Annual Report Immigration Detention England and Wales 2013-‐14 “[Harmondsworth] where a sense of humanity had been lost in the use of handcuffing on detainees who were dying.” 9th November 2014 – the Independent – “Serco: Fresh Allegations Over its Running of Yarl's Wood IRC” – The National Audit Office is looking into allegations over the way Serco has run Yarl's Wood, inflated certain figures and failed to carry out mental health assessments for groups of detainees. 11th Nov 2014 -‐ BMJ article : “Inadequate mental healthcare in immigration removal centres” – by Theresa Schleicher of Medical Justice and others -‐ “Doctors must not be complicit in a system that prioritises deterrence over protection of refugees and asylum seekers ….. We now call on NHS England to ensure that detainees are screened for mental health ….” 16th Nov 2014 -‐ The Independent : “Yarl's Wood: Undercover tour of detention centre with dreadful reputation for its treatment of asylum seekers” … Medical Justice… says: “We are deeply concerned about the failures by detention centre healthcare units to identify vulnerable detainees” 19th November 2014 – HM Inspector of Prisons : monitoring of 2 charter deportation flights-‐ “… the practice of overbooking flights and placing some detainees on a reserve list without their knowledge, hence the detainee, having gone through the distress and anxiety of preparing to leave, found at the last minute that they were never likely to have travelled.” 23rd November 2014 -‐ Bedfordshire on Sunday : “Pressure mounts to end detention of mentally ill women amid further cutbacks at Yarl’s Wood” -‐ “… Prior to the takeover there were two counselors on hand to help women suffering with mental health issues for 140 hours a month. Since the health contract changed hands however, there is now only one counselor available for 24 hours a month. The news of the cutbacks emerged at a meeting of Bedford Borough Council's Yarl's Wood sub-‐committee … Dr Naomi Hartree, who carries out assessments of women at Yarl's Wood on behalf of the charity Medical Justice, told the committee there is a 'culture of disbelief' in the immigration system which leads to poor healthcare being provided.” 24th November 2014 – The Independent : “Serco Given Yarl's Wood IRC Contract Despite 'Vast Failings'” – The decision to pay £70m to operate Yarl’s Wood over the next 8 years was attacked.
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1st December 2014 -‐ Parliamentary Question response : £14.3 Million Damages for Unlawful Immigration Detention in 3 Years -‐ The amounts paid by the Home Office in compensation: 2011-‐12 £4.5 million. 2012-‐13 £5.0 million. 2013-‐14 £4.8 million. 14th December 2014 – the Observer : “Yarl’s Wood: Labour pledges to investigate claims of sexual abuse” – “Yvette Cooper is promising an independent inquiry and says she would ban the holding of pregnant women and trafficking victims” 15th December 2014 – Bedford Times & Citizen : “Husband’s anger at Yarl’s Wood as detainee wife falls ill and is unconscious in intensive care” – is the woman is unconscious in intensive care at Bedford Hospital. 16th December 2014 – The Guardian : “G4S guards found not guilty of manslaughter of Jimmy Mubenga” – “The court had heard how fellow passengers said they heard Mubenga cry out: “I can’t breathe” as he was pinned down in his seat, despite already being handcuffed from behind with his seatbelt on. The guards said in court that they had not heard him say he could not breathe and had not pushed his head down and forward towards his knees in a position known to risk asphyxia. They said they had been restraining him to stop him hurting himself or other passengers on the plane.” (The jury was not told of the many racist jokes on the mobile phone of the 3 guards, or that the inquest verdict was ‘unlawful killing’.) 18th December 2014 -‐ Medical Justice Festive Awards Party : Awards were presented to ; Mary Keniger (doctor), Hugh Grant-‐Peterkin (psychiatrist), Heather Jones (befriender), Latifa Chentouf (interpreter), Mark B (interpreter) and Leoni Hirst (barrister).
Photo : Placards at Yarl’s Wood 8th January 2015 -‐ The Independent : “Immigrant children still being detained, figures show” – More than 600 children, the majority under 12 years old, have been detained in the four years since the Government claimed to have ended the detention of children. But pre-‐departure accommodation centres “are ‘merely ‘detention by another name’,” said Theresa Schleicher, of the Medical Justice charity.” 9th January 2015 -‐ Medical Justice challenge to the new removals regime introduced by the Immigration Act 2014 -‐ Treasury Solicitors responded to a pre-‐action letter from Medical Justice, suspending the new policy with immediate effect while considering replacement guidance. 14th January 2015 -‐ Women for Refugee Women publish “No dignity for women in Yarl's Wood” -‐ a report claiming that women in Yarl's Wood are constantly watched by men in intimate situations such as in bed, on the toilet, while naked or while showering. The Home Office stated last year: 'Male staff would not supervise women showering, dressing or undressing.' This report suggests that the Home Office either has no understanding of the day to day operation of Yarl's Wood or has misled the public. 20th January 2015 -‐ “Doctors Against Torture” conference organised by Amnesty, the British Medical Association and Freedom From Torture ; designed to identify the challenges and ethical dilemmas that arise for forensic health professionals involved in the identification, recording and reporting of torture and its consequences.
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Transfer of healthcare commissioning to the NHS
Photo : Channel 4 -‐ Yarl’s Wood IRC
Since it was founded in 2005, Medical Justice has been campaigning for the transfer of healthcare commissioning in IRCs from the Home Office to the NHS in a bid to secure equivalence with NHS healthcare in the community. The transfer finally happened on the 1st of September 2014 for the majority of the IRCs (Morton Hall IRC followed on the 1st of April 2015, Campsfield IRC is due to transfer on the 1st of April 2016, and Dungavel IRC is still commissioned by Home Office as it falls outside of scope of NHS England). The transfer means detainees will have the same rights as other NHS patients. Medical Justice seeks to influence what healthcare gets commissioned, and how delivery and monitoring structures are shaped. This is the single biggest opportunity for improvements in healthcare for immigration detainees including ;
• Raised standards of healthcare
• Improved record keeping, comparability and inspection regime
• Increased independence from Home Office NHS England commissioning started with tenders for the provision of services over 5 years (optional 2 year extension) to a value of £32.5 – 37 million. The process specifically excluded past performance from consideration leading many of the known actors such as G4S and SERCO with a record of human rights breaches to be re-‐commissioned. The tendering was based on poor service specifications that were closely based on the prison specifications, and do not adequately take into consideration the unique position of detainees in IRCs. Initially the specifications included a reference to the involvement of medical staff in punitive sanctions – this was later removed on the urging of Medical Justice. The service specifications omit vital safeguards such as Rule 35 and they were not subject to a formal consultation. There have been other difficulties such as staff shortages, problems getting security clearance for essential staff and key positions left unfilled. Four out of 11 IRCs now have healthcare services provided by NHS Trusts and we
remain hopefully about the impact of more NHS Trusts in service provision. We continue to work with NHS England to try to improve the specifications. Some things have improved, like the introduction of SystemOne, a computerised online patient management system, across IRCs (except Campsfield, Morton Hall and Dungavel) which should contribute towards comparability. However, other areas remain highly problematic and some have become worse -‐ for example, at Yarl’s Wood, where G4S took over the new contract, the Independent Monitoring Board (IMB) noted “a serious deterioration in the service to detainees” and described healthcare staff as ‘dismissive’. The IMB said there had been a 20% cut in GP services. According to Home Office statistics, the number of Rule 35 reports dropped by more than half at Yarl’s Wood. Counselling services are no longer provided at Yarl’s Wood. Healthcare services still fail to live up to community equivalence in many of the IRCs. In addition, the transfer boasted very high staff retention rates which in many cases meant new lanyards but much of the same old attitude. NHS England has a statutory responsibility to consult service users and stakeholders in the planning and provision of services and Medical Justice will continue to play an active part in this process. As the only non-‐governmental organisation in the UK with a significant base of medical evidence about healthcare in immigration detention, Medical Justice is uniquely placed to take on the new challenge of influencing the transfer of commissioning and the development of benefits including robust monitoring arrangements to ensure equivalence of care in the community. We will continue to provide feedback and insight which can help NHS England in developing independence from an overreliance on a Home Office perspective. We are encouraged that NHS England is now meeting with us regularly. “What is the impact of Medical Justice ?”
“Medical Justice has worked tirelessly in exposing failures of health care in immigration detention centres and the harmful effects of immigration detention. As well as Medical Justice’s work on individual cases its ability to collect and publish findings based on first-‐hand experience has been essential in litigation and as part of the campaign that alternatives to detention must be found for very vulnerable groups.”
Mark Scott -‐ partner, Bhatt Murphy Solicitors
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Influencing the inspectors
Photo : Channel 4 -‐ Yarl’s Wood segregation unit
“…away from public scrutiny, it is all too easy for even well intentioned staff to become accepting of standards that in any other setting would be unacceptable” -‐ HM Chief Inspector of Prisons, Nick Hardwick Immigration removal centres are closed institutions with limited public insight. Journalists and the public are not allowed in except on the invitation of the Home Office and the centres are often located in remote and inaccessible places far from the public consciousness. In recognition of the fact that unrestricted power and lack of oversight in closed institutions can easily lead to the normalisation of abuse and poor practice Medical Justice has been working concertedly with the Inspectorates that have ‘keys’ to IRC and the ability to carry out inspections. There are currently three main bodies that could inspect healthcare in IRCs – HMIP and CQC who carry out regular unannounced inspections of all IRCs at least once every three years – and Local Health Watch, who have the power to ‘enter and view’ healthcare provision in IRCs but who currently have no established tradition of exercising this power. Care Quality Commission
Medical Justice met with representatives from the Care Quality Commission (CQC) to discuss their new inspection requirement in IRCs post transfer of commissioning to NHS England. CQC already inspects prison healthcare but need to understand that IRCs and immigration detainees are different. CQC and HMIP are planning on implementing a joint inspection regime to avoid duplication of effort. In relation to this we attended a stakeholder meeting on the 24th of November 2014 and a follow up
meeting specific to the IRC setting on the 12th of January 2015. Medical Justice submitted a response to the consultation on the draft joint framework, we are a member of their online forum to discuss IRC issues and have been consulting with the CQC on a proposed themed report on women in detention. HMIP
In addition to the work done jointly with HMIP and CQC we met with HMIPs healthcare specialist inspector with the aim to drill down in detail on methods and standards, the conclusions reached and how we can best feedback. As a result Medical Justice has established excellent channels of communications with HMIP and CQC and have fed into recent inspections by making inspectors aware of current on-‐going issues at the IRC and by putting them in touch with detainees and also with ex-‐detainees who may be able to speak more freely of their experiences. HEALTHWATCH
Healthwatch England is a statutory subcommittee of the CQC that has statutory powers to monitor all local health and social care services, including the care provided within IRCs, and to meet detainees to obtain their views about their experiences of care services. The Home Office has written to Healthwatch saying that they are 'committed to facilitating visits by local Healthwatch groups to IRCs' and even encourage the use of complaints advocacy. A current barrier to more involvement by LHW is a lack of knowledge within these organisations about IRCs. Medical Justice and Healthwatch jointly wrote a report outlining the issues around immigration detention to try and develop knowledge. In addition, Medical Justice presented to a Healthwatch conference on the 30th of October 2014. The two organisations met with HMIP together to try and establish a framework for LHW to become part of the inspection regime in some form.
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Research
Photo : Kris Harris, Research & Policy Worker
Research is a vital part of Medical Justice’s work and often links casework and policy work or strategic litigation. Everything Medical Justice does is based on our one-‐to-‐one work with clients. Once we notice a trend we may investigate in detail either in the form of a research dossiers, briefings used for policy work, or a witness statement for strategic litigation. Having a strong evidence base derived directly from our clients ensures that we have a solid basis from which to argue for change when engaging in policy discussions with the Home Office, individual IRCs or NHS England. It also forms a unique resource for lawyers and for developing public awareness of detention condition. Looking back at the last 10 years the Evidence Matrix (presented in this report) demonstrates the intimate link from case work, to research, to policy change. With our growing database of thousands of cases, Medical Justice is in an exclusive position to demonstrate shortcomings in healthcare in IRCs. Over the years this evidence has been instrumental in the widely accepted recognition of medical mistreatment in IRCs to the point where the existence of such mistreatment is now a fact established by robust evidence and objective court judgments. This year Kris Harris joined us as research and policy worker. Kris most recently worked as the Programme Manager for Project:London, a busy Doctors of the World clinic and health advocacy project for migrants in east London. She completed a PhD in Public Health with the London School of Hygiene and Tropical Medicine (LSHTM), conducting an ethnographic study of the implementation of leprosy services in an urban Indian setting. Kris has a background in control of infectious diseases and anthropology. Unfortunately there has been no shortage of issues to address this year either.
Mis-‐use of Segregation
Our main focus this year has been on the mis-‐use of segregation in immigration detention and our findings will be published in a research report later this autumn. The report will focus on a sample of case studies which highlight inappropriate prolonged segregation of vulnerable detainees, the mis-‐use of segregation as a form of punishment or as a means of managing behaviour rooted in mental health issues. The report will look at the lack of robust guidelines for the use of segregation, the poor systematic centralised overview of its use and the use of de-‐facto segregation in IRCs. We continue to see extremely vulnerable detainees placed in an environment which is wholly unsuited for those in crisis and the impact of such mis-‐use of segregation on the individual can be devastating. In addition to the main research focus Medical Justice has continued to tackle issues as they arise and to respond to calls for evidence at local, national and international level and to forge strong links with related organisations. All Party Parliamentary Group (APPG) on Refugees and APG on Migration joint inquiry into detention
Medical Justice submitted three papers focused on failings in general health provision in IRCs, Mental Health and the Rule 35 process. The Medical Justice Clinical Advisor, Dr Naomi Hartree, participated in the Oral Evidence Session on the 6th of November 2014, outlining the difficulties faced by detainees and the failures of health care at IRCs in identifying and adequately treating health issues. She gave evidence alongside Dr John Chisholm (chair of the BMA Ethics committee). The findings of the inquiry were published on the 3rd of March 2015 and largely echoed what Medical Justice has been saying for 10 years. Bedford Borough Council Health Overview & Scrutiny Committee inquiry
When Bedford Council’s Health Overview and Scrutiny committee announced their intention to investigate healthcare provision at Yarl’s Wood IRC, Medical Justice submitted a dossier setting out the main healthcare failures at each stage of a detainees journey through detention. The report was richly illustrated with case studies to help make the topic understandable for councillors with little prior knowledge of IRCs. Medical Justice attended two of the committee’s public meetings to provide evidence and critical insight. Most of the councillors were unaware of the reality of the situation in Yarl’s Wood and seemed shocked by the evidence. The
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committee is set to publish its findings this later this year. This inquiry is the first of its kind and it provides the impetus and format for similar exercises to be carried out by other local authorities with IRCs across the UK. BMA report on immigration detention
The BMA Medical Ethics Department is writing a report on health and human rights in immigration detention. The dual aims are providing guidance for IRC health care providers and making recommendations to policy makers and commissioners. In line with BMA policy, which calls for an end to the detention of asylum seekers, it will also address the issue of whether the most vulnerable individuals should be detained at all. Medical Justice has been advising the BMA on on-‐going healthcare issues in IRCs. We were also able to facilitate a visit with a detainee at Yarl’s Wood IRC. The BMA report is due to be published later this year or early next year. Other various submissions
24th March 2014 – Medical Justice made a submission to the Public Bill Committee considering the Criminal Justice and Courts Bill. July 2014 – Medical Justice responded to the UK’s submission to the period inspection by the Human Rights Commission commenting on the UK’s compliance with the International Covenant on Civil and Political Rights (ICCPR) in relation to immigration detention specifically.
November 2014 -‐ Medical Justice prepared a summary briefing on Rule 35 of the Detention Centre Rules for the Home Affairs Select Committee.
“What is the impact of Medical Justice ?”
“Medical Justice has made a huge impact in the past ten years – both in highlighting abuses by guards and escorts, which its work in IRCs makes it uniquely qualified for, and in the day-‐to-‐day help provided to detainees whose medical needs have gone unaddressed in detention. The ground-‐breaking report ‘Outsourcing abuse’ which it co-‐authored led to an official inquiry and put the issue of abuse of detainees firmly in the public domain, while its successful challenge to no-‐notice removals was vital in restraining an executive which increasingly prioritised its own interests over those of justice and fairness. Medical Justice makes a massive contribution – to detainees’ welfare and to the rule of law.”
Frances Webber -‐ former barrister, currently vice-‐chair of Institute of Race Relations
“What is the impact of Medical Justice ?”
“At BID we feel the benefits of Medical Justice’s existence on so many levels and on a daily basis. … they are vital allies for us in holding government to account and in speaking out against the appalling treatment or lack of care meted out to people in detention. … It’s hard to imagine how things would be without Medical Justice. Their care, concern and commitment for their clients shines through and is at the forefront of their work … Medical Justice is unafraid to advocate loudly and clearly for what is right and to condemn the system of immigration detention. On this, the occasion of their 10th birthday, we are proud to call them friends and colleagues and congratulate them on their incredible achievements in such a short space of time. Long may they continue! “
Bail for Immigration Detainees – Celia Clarke, Director
“What is the impact of Medical Justice ?”
“When I first became aware of immigration detention in the UK, I was shocked to learn that people not serving any criminal sentence can be deprived of liberty indefinitely. … Through becoming involved with Medical Justice, I learned that there is a way to reach through the barbed wire fences and provide detainees with an independent medical assessment and report. … It seems awful to say that Medical Justice has been a “success”. It isn’t possible to place a value on the care of each individual detainee -‐ Medical Justice helps people in situations of desperation that most of us could never imagine.
Uncertainty, helplessness, separation from family, relentless fear and anxiety are factors that will harm the health of the strongest and most resilient person. On top of this detainees may be disbelieved or undertreated when it comes to medical needs or medical evidence. … As a volunteer doctor carrying out medical assessments of detainees, I have seen the devastating effect that immigration detention can have on mental health.
We are all looking forward to the day when Medical Justice is no longer needed and may disband. Paradoxically, Medical Justice itself is an organisation that offers me some hope that one day this will be possible.“
Dr Mary Keniger – Medical Justice volunteer doctor
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Mental Health
Drawing by Rhiannon Hughes 10 year overview ; Throughout the existence of Medical Justice, mental health has been the biggest health issue for detainees. Several of the Medical Justice volunteers are psychiatrists and psychologists, which has enabled us over the years to help many individual detainees with problematic mental health. After what is for many a difficult life journey prior to detention, detainees find themselves in circumstances which conspire to induce and aggravate mental illness. Safeguards the authorities claim are there to identify and manage mental illness and distress are just not working. The high rate of mental illness is well documented, as is the detrimental impact of detention itself, especially long or indefinite detention. Controversially and without any consultation at the time, in 2010 the Home Office amended their policy making it easier for them to detain people with more serious mental illness. This has been the subject of much debate ever since, including key legal judgments. Medical Justice was involved in an intervention in the case of HA in 2012, one of the 5 cases in mentally ill detainees where detention has been found to amount to ‘inhuman or degrading treatment’ and intervened (jointly with Mind) in the case of Das. A statement for the key case of Das was provided by the Royal College of Psychiatrists on the conditions such as Post Traumatic Stress Disorder which they said cannot be satisfactorily
managed within detention. The judgment in this test case clarified for example that severe mental illness does not need to imply a need for hospitalisation, and that exceptional circumstances for continued detention need to be at the level of the risk of committing murder. However, Home Office policy and IRC healthcare practice appears little changed. This financial year (i.e. Feb 2014 to end Jan 2015)
In view of the known prevalence of mental illness, we are able to help only a small proportion of the mentally ill (we need more volunteer psychiatrists, psychologists and mental health nurses so we can help the many mentally ill detainees on our long waiting list). A poster on mental health in immigration detention was presented to a meeting of the Royal College of Psychiatrists in July 2014. An editorial in the BMJ in November 2014 authored by the Royal College of Psychiatrists Working Group on Asylum Seekers, some members of which are Medical Justice volunteers, outlined the issues based on members’ experience with mentally ill immigration detainees. At long last the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) reported on its UK visit in September 2012. They had negative comments about the treatment of mental health at Colnbrook and delays in transfer out to hospital psychiatric units for treatment. The CPT noted; 'It goes without saying that persons with a severe mental illness should not be detained in an Immigration Removal Centre'.
Photo : volunteer psychiatrists Dr Helen McColl and Dr Hugh Grant-‐Peterkin with the Medical Justice poster at a Royal College of Psychiatrists event
After formal pressure including in a Court judgment, the Home Office eventually subjected their policy with the 2010 word-‐change on mental illness to an ‘equality consultation’. The Mental Health in Immigration Detention Working group (MHIDWG)
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submitted detailed evidence in March 2014, as did others. The resultant Policy Equality Statement (PES) from the Home Office at the end of November 2014 appeared to ignore all the submitted evidence. There has been concern for years about the many problems of severely ill detainees who end up being sectioned under the Mental Health Act. After transfer to an external hospital for treatment, which can be compulsory, the practice has been to return them to the detention setting, even though this can have provoked deterioration in mental health in the first place and detainees who are so ill should never have been detained in the first place. In September 2014, the MHIDWG responded to a consultation of the Code of Practice on the Mental Health Act, pointing out the special issues as they affected detainees. The response appeared to pay only lip service to the issues, and the basic problems for ‘sectioned’ detainees still remain. The clinical staff at one IRC have said they have been shocked at the extent of severe mental illness among detainees, including in those transferred there from other IRCs with inadequate diagnoses, as demonstrated by the high number of ‘sectioned’ detainees now being seen from this IRC. One of the rulings in 2014 relating to the Detained Fast Track (DFT) recognised the especial difficulties of the vulnerable including mentally ill in marshalling their evidence in the expected time-‐frame.
“What is the impact of Medical Justice ?”
“Last month Medical Justice asked me to represent a young man who has had a leg amputated due to cancer (undiagnosed whilst he was in prison). He had been in detention for over a year and was unable to access physio appointments to get a prosthesis so was stuck in a wheelchair. Without Medical Justice’s intervention he would still be in detention. He is now living in east London, starting to get a prosthesis and hopes to be working again soon. Last month I met an ex-‐detainee, who proudly told me that he was planning to complain about his inadequate treatment in detention, not to an Ombudsman, but to Medical Justice because he felt that was the ultimate sanction for UKVI’s inaction! … But it doesn’t stop with care for the individual clients, it spreads and shares knowledge between doctors, lawyers and NGOs …. Medical Justice is simply unique.”
Deighton Pierce Glynn Solicitors -‐ Sue Willman, partner (photo below, right)
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Pregnant women in detention
Photo : “Expecting Change” dossier launch at the House of Commons with speakers from Royal College of Midwives and of Obs & Gynecologists
Medical Justice published a research report, ‘Expecting Change’, in 2013 analysing the cases of 20 pregnant women who had been assessed by our clinicians. We concluded that the detention of pregnant women was ineffective in meeting its intended aim – removing the woman from the UK -‐ as only 5% of the women were removed (one took voluntary return and all others were released). Additionally we found that it was damaging to the health of the women, and that healthcare was often substandard. Our recommendation to end the detention of pregnant women was backed by the Royal College of Midwifes, The Royal College of Obstetricians and Gynecologists and the Working Group on Asylum Seekers at the Royal College of psychiatrists as well as over 300 other organisations. Our findings have been championed in parliament by the MP for Bedford, Richard Fuller. 7th April 2014 Medical Justice meeting with the Immigration Minister
Richard Fuller MP (Conservative) facilitated a meeting with the Minister who said he “did not recognise” the statistics from our research about how few pregnant women are removed. He and the Home Office were, however, still unable to offer their own statistics. The Minister asked us to provide case-‐studies of pregnant detainees who were willing to be named. 4 women bravely gave consent for their case-‐studies to be highlighted to the Minister. After many months delay Richard Fuller MP received a letter from the Minister simply saying that Serco had asked an “independent Medical Director” to review the 4 cases and that the conclusion was that there were no issues with the women’s medical care at Yarl’s Wood IRC. Medical Justice has asked for a copy of the report by the “independent Medical Director” but not received a response.
Healthcare for pregnant women remains of great concern
Since the publication of ‘Expecting Change’, we have worked with a further 54 pregnant women. Of those, one took voluntary return, two remain in detention at present and all others have been released. Not a single one was removed. Their care was interrupted when they were detained, and often again for a second time when they were released (many were sent to places in the UK where they had not lived before), and then for a third time when they were moved from initial accommodation to their more permanent dispersal accommodation. A number of the pregnant women were made homeless or threatened with homelessness after being released because the Home Office granted accommodation for one form of release but then released them under another provision.
A large number of the women have complicated pregnancies -‐ many have histories of torture, trafficking or domestic violence and many have pre-‐existing mental health problems when they entered detention. Some have complicated obstetric histories or physical health problems. Despite this, women frequently describe to us that they feel their concerns were being dismissed by healthcare staff without further investigation or explanation leading. Medical Justice midwifes and doctors have frequently raised concerns about women they had seen that worrying symptoms were often not being properly investigated, pain relief and other symptomatic treatment not always provided, scans missed and mental health problems not recognized.
Medical Justice findings vindicated by Yarl’s Wood IMB and Channel 4 news
The 2014 Annual Report from the Independent Monitoring Board (appointed by the Secretary of State) at Yarl’s Wood found that of 32 pregnant women it tracked, only 2 (6%) had been removed -‐ the rest had been released. These statistics are similar to Medical Justice’s statistics. The IMB expressed concerns over healthcare for pregnant women and urged the Home Office to abandon its policy of detaining pregnant women. Later, in 2015, Channel 4 News broadcast undercover footage from inside Yarl’s Wood capturing the unacceptable treatment of pregnant women. New Home Office policy that fails to materialize
The RCM and the RCOG met with the Home Office who said a new policy document was being developed but has failed to materialise. This has not materialised.
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“Outsourcing Abuse” / Excessive use of force
Photo : Diane Abbott MP
Independent Advisory Panel on Non-‐Compliance (use of restraints on detainees)
The panel produced its report in March 2014, making 12 recommendations. The Ministerial Statement in response said “the government has accepted all of its [the Panel’s] recommendations”. However, when you look closely you can see that 5 of the Panel’s 12 recommendations are missing. The panel approved the use of the ‘waist restraint belt’, leg restraints and the ‘mobile chair’ which guards can use to immobilise a detainee from the neck down. Though the panel defined certain important caveats to their approval which were not reflected in a subsequent Detention Service Order subsequently issued by the Home Office without public consultation. Medical Justice wrote to the Home Office documenting our above mentioned concerns. Medical Justice has come across an increasing number of detainees on whom the waist restraint belt has been -‐ in one case a client with DVT and on another with no history of absconding or violence. HM Inspector of Prisons reported in 2014 that escorts have still not been provided with scenario based training. And, “Staff had little awareness of important inquiry findings that should have been
cascaded down to them following the death of a detainee during a scheduled flight removal in 2010”. “What is the impact of Medical Justice ?”
“… Medical Justice, through its work with individual detainees as well as through its important research, has shone a light on many malpractices -‐ such as the unlawful detention of children, torture victims and those with serious mental illness -‐ through this worked they have not only made a huge difference to many individuals who have suffered maltreatment but helped bring about really important changes in practice.
… Medical Justice's ability to match up health professionals with detainees in urgent need of an independent consultation has been critical at times. … it is crucial that organisations such as Medical Justice continue to exist to prevent unlawful practices and ensure that we do not depart even further from basic humanity and compassion towards all human beings.
During frightening times when Europe is turning its back on many desperate refugees escaping war, genocide and torture -‐ the role of those who care and can assist in lobbying and supporting the few who make it into the UK will be more important then ever.”
Birnberg Peirce & Partners – Harriet Wistrich, Solicitor (photo below)
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Complaints
Drawing by Rhiannon Hughes
As one of the few supposed avenues of redress for detainees, the complaints process has been a focus of Medical Justice attention for the past 10 years. However, despite several policy improvements, there is little evidence of lessons learnt. Outcomes today are largely similar to what they were 10 years ago and problems of detainees being deported prior to a complaints interview or resolution persist. In March 2014 Medical Justice submitted a briefing on Health complaints in IRCs to the Health Select Committee. “Biased and Unjust: The Immigration Detention Complaints Process” report published August 2014
In 2011 Medical Justice established a project to provide support and assistance to detainees making complaints against the Home Office and its contractors. This report is based on our experience of these complaints. Many complaints were about serious misconduct, particularly injuries sustained during attempts to transfer the detainee or remove them from the UK. There was also a high proportion of complaints about inadequate health care, frequent cancellation of hospital appointments, use of handcuffs and the presence of guards in medical consultations. We found that time-‐scales for replies to complainants were not met, investigations were frequently inadequate and partial, biased towards the Home Office’s contractor, even when there was evidence to the contrary. Almost half the complaints seen by Medical Justice were escalated to the Ombudsmen. Following legal aid cuts an increasing number of detainees are unrepresented. As a result there is an
even greater need for a complaints system that is transparent and effective. Medical Justice recommendations:
• Increase transparency and scrutiny of the handling of complaints
• Provide an independent overview of the process replacing the role of the Complaint Audit Committee
• Implement standards for investigation, access to evidence and police investigation
• Ensure that healthcare complaints meet the standards of the NHS procedures, including access to advocacy
• Ensure that lessons are learnt from complaints, that action plans are produced and regularly followed up
• Strengthen and clarify the role of independent monitoring boards in complaints
• Improve access to the Parliamentary and Health Service Ombudsman to enable direct access
Lord Ramsbotham hosted a round-‐table discuss in the House of Commons 30th October 2014
This was a productive round table session with everyone involved in the complaints process, with the exception of the Home Office who declined to send a representative and a notable absence of IRC healthcare providers. Speakers included representatives from: NHS England, Independent Chief Inspector of Borders and Immigration, Prisons and Probation Ombudsman, Liberty, HM Inspector Prisons, Lord Ramsbotham (ex-‐Chief Inspector of Prisons), Medical Justice, a Medical Justice ex-‐client, and Birnberg Peirce & Partners.
Photo : House of Commons round-‐table discussion on Complaints, October 2014
The meeting was attended by representatives from over 20 organisations. Lord Ramsbotham sent a letter to the Home Secretary which listed all the participants, stressed collective concerns over the complaints system and requested that an urgent review of the handling and investigation of complaints be initiated.
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Subsequent outcomes ; The 2014 annual report from the Independent Monitoring Board at Harmondsworth IRC noted that it had contributed to the Medical Justice “Biased & Unjust” report and “believe its findings resonate with our experience at Harmondsworth."
Photo : House of Commons round-‐table discussion on Complaints, October 2014
Referencing the disbanding of the Complaint Audit Committee, the Independent Chief Inspector of Borders and Immigration announced there will be a themed inspection of the complaints process in 2015/16. The Home Office started a process of reviewing the Detention Service Order (DSO) on complaints. The initial steps involved a pre-‐consultation discussion at a stakeholder meeting in January 2015. The Home Office later circulated a draft DSO. We were disappointed to find that very few of the recommendations we had made during the pre-‐consultation and in the “Biased and Unjust” report. The DSO has been significantly shortened to the point of being meaningless. Medical Justice addressed these shortcomings in our response to the consultation but early indications are that the draft DSO will stand more or less as circulated.
The introduction of the NHS complaints process into IRCs
Complaints about healthcare will come under the NHS complaints procedure. The IRC will investigate the complaint as it does now and if the complainant is not satisfied s/he can appeal to the Parliamentary and Health Service Ombudsman (PHSO). Previously complaint had to be made through an MP. If the NHS procedure is followed, the detainee will be able to complain directly to the PHSO. Complainants can also circumvent the provider system and go directly to the NHS England complaints unit. “What is the impact of Medical Justice ?”
“Medical Justice is the most authoritative source of information on what life is actually like on the ground inside immigration detention centres for anyone with a health condition. This means that they are wonderfully placed to challenge many of the Home Office narratives … As a solicitor it is vital that systemic problems uncovered during the course of litigation are able to be acted on and taken forward after the case is closed. Medical Justice enables this to happen. For example after the case of FGP, in which a detainee was unlawfully handcuffed throughout his medical treatment, we worked together to continue to campaign on this issue and disseminate learning within the medical profession. Without Medical Justice, this simply would never have happened. Medical Justice's effectiveness can be seen in the advocacy they undertake, the information sharing they ensure takes place between solicitors and other organisations, the quality of the medical support and advice they provide and the determination and enormous compassion shown by their staff. Liberty is honoured to work with them and to be given this opportunity to recognise their work.”
Liberty -‐ Emma Norton, Solicitor (photo left)
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Inhuman & degrading treatment
Photo : Channel 4 – Yarl’s Wood segregation
5 cases where continued detention amounted to “inhuman and degrading treatment” but problems persist
There have been 5 cases based on breaches of Article 3 of the Human Rights Act since 2011. They illustrate the system failures which NGOs, medical practitioners and lawyers encounter on a daily basis and offer an independent assessment of the welfare of vulnerable persons in detention. Some common features of all 5 cases include ;
• There were very compelling medical grounds for release but judicial review proceedings were necessary to secure the release of the individuals. … In more than one case, it was clear at the outset of the detention that the person was seriously unwell. BA had a clear and documented history of serious mental illness.
• Problems identified have not been remedied and we could provide similar examples of equally shocking more recent ongoing cases. Government bodies have echoed our concerns ; the Home Affairs Select Committee stated “we are concerned that the cases outlined … may not be isolated incidents but may reflect more systemic failure in relation to the treatment of mentally ill immigration detainees”
• In each case the detainee was so ill that they lacked mental capacity (to give instructions in a legal case) for some or all of the period during their detention.
• It is extremely rare for the UK Courts to make a finding that there has been a breach of Article 3 of the European Convention of Human Rights. We are not aware of any in the prison context, demonstrating the seriousness of the situation,
and the need for urgent action to ensure that it is remedied.
The Home Office has only appealed one Article 3 case (which is not included in the 5 cases mentioned) – this may indicate acceptance that the continued detention did amount to “inhuman and degrading treatment”. July 2014 judgment : Ms MD -‐ detention caused the onset of mental disorder.
Medical Justice client, Ms MD, who had no history of mental illness before she (lawfully) entered the UK, was found by the High Court to have been detained unlawfully in conditions that amounted to ‘inhuman and degrading treatment’. She was detained for 17 months. The judge wrote that after 4 months in detention Ms MD “was restrained, removed from association with other detainees and handcuffs were used to stop her harming herself. [Ms MD] self-‐harmed on at least eleven occasions … including occasions when she cut her forehead with the top of a sardine tin, when she again cut her forehead and the right side of her face this time with pieces of china, when she tried to strangle herself using a mobile telephone cable as a ligature and placed a pillow over her head, when she banged her head against the wall, when she cut her neck using pieces of china and occasions when she cut her stomach, neck and arm.” In response, she was subjected to force on many occasions, often by a number of male Serco officers. She was put in Isolation where she was handcuffed to stop her from self-‐harming. Medical Justice sent a doctor to see Ms MD, followed later by a psychiatrist who diagnosed her as having a major depressive disorder with psychotic features and panic disorder. Medical Justice medico-‐legal reports documenting her deterioration were ignored and the 'Rule 35’ safeguard failed. Ms MD eventually lost mental capacity to instruct lawyers, so the Official Solicitor acted for her in a judicial review of her detention -‐ she was released. Later, an independent psychiatrist concluded that “detention did not exacerbate a pre-‐existing mental disorder but caused the onset of the mental disorder”.
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Deaths
Photos : Christine Case’s funeral
10 year overview -‐ The Home Office does not report deaths in immigration clearly. We may hear of deaths in immigration detention initially from family, friends and fellow detainees, then from the media, and after a considerable gap then from the inquest which may or may not get reported more widely. We were alerted to one death, which may otherwise have gone unremarked, mentioned in a report from the HMIP. We found out about another death purely by chance as it was mentioned in a report we had to FOI to get. Finally, the Prisons and Probation Ombudsman (PPO) may issue a report. Both the coroner at the Inquest and the PPO may also issue general comments, in order to make recommendations to prevent further deaths in similar circumstances. In the last 10 years (to the end of Jan 2015) we have identified 20 deaths in or closely related to immigration detention. Two inquest verdicts were that neglect contributed to the death. All but one of these were male, and where their age was known, were between 18 and 84 yrs old, though most were young. 3 deaths were at Harmondsworth, 2 in Hillingdon Hospital on transfer from Harmondsworth, 2 at Yarl’s Wood, 2 at Campsfield, 2 in Colnbrook, I in the train after release unwell from Colnbrook and another on temporary release from Colnbrook, 1 at Oakington and another in hospital on temporary release from Oakington, 1 each at Morton Hall, the Verne, HMP the Parc and Pennine House as well as on an aircraft during removal. Dungavel, Haslar as well as Colnbrook and Harmondsworth feature in the earlier deaths in 2004.
For one of the more recent deaths we are still waiting the inquest and/or PPO report, but those where the cause of death has been reported (n=19) are given in the table below.
One of the deaths (unlawful killing) – Jimmy Mubenga – was from asphyxiation during restraint at the hands of his escorts. 5 of the deaths, were self-‐inflicted. These personal tragedies in young men reflect the appalling pressures on those held in administrative detention indefinitely. Mostly, the detainee had not been previously identified as being especially vulnerable and no special care had been taken at the time of new stressors, such as the serving of removal directions. Even when the death was from natural causes, there has been much to criticise in the response from those who had responsibility for their care. Those with serious mental or physical illness should of course not be being held under administrative detention in any case, according to Home Office policy. We argue that the life chances of some of those detainees who have died while in the care of the UK detention system may have been much brighter had they been allowed to remain in the community. Immigration detention can be lethal. This financial year (ie Feb 2014 to end Jan 2015) Because of the time lag between deaths and the appearance of published reports, detailed information newly available this year can relate to deaths some time ago. Brian Dalrymple died in July 2011 with a ruptured aneurysm at the age of only 31. The inquest verdict came in June 2014 ; “Jury concludes neglect contributed to death of Brian Dalrymple, who had schizophrenia and dangerously high blood pressure. … an American tourist who was detained upon arrival at Heathrow has criticised an immigration centre's medical records system for being "shambolic". … a catalogue of errors …: "The UK Border Agency contacted the Home Office at Harmondsworth to request a psychiatric
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assessment and repeated the request on a number of occasions. No action was taken. The US Embassy were not notified." Dalrymple was detained for six weeks. A few days before he died he was transferred to Colnbrook but without his medical records. Staff at Colnbrook identified him as being mentally ill but by the time they had arranged a psychiatrist, Dalrymple was dead. His high blood pressure had caused an aortic rupture. The doctor at Harmondsworth had not had any induction training and did not know of his duty to inform the Home Office of detainees with medical reasons for being released, and had not heard of the Mental Capacity Act. Two officers said they were not concerned about people in Harmondsworth "muttering to themselves" because a lot of people did that. Dalrymple was taken to Hillingdon hospital nearby but then discharged himself against medical advice. We heard this year of the death on 17th November 2012 of Jakana Chowdhury only from the HMIP annual report 13-‐14 which says: “a detainee who was dying continued to be handcuffed while he was sedated and undergoing an angioplasty in hospital, although the handcuffs were removed before he died. “ The PPO declined to investigate because he was not in immigration detention at the time. The Home Office investigated the death but refused to give us a copy of their report. The inquest on Tahir Mehmood who died at Pennine House on the 26th July 2013 started on the 7th Jan 2015. After a few days at Pennine House he became unwell. He had pains in his arm and his chest. An interpreter was not used, he was given paracetamol and asked to lie down. He was found collapsed an hour later. The nurse failed to record vital basic observation, entries made in the medical notes were illegible, she did not call a doctor and an ambulance was not called either. When he was found collapsed the nurse did not bring the medical emergency bag or the defibrillator. The post mortem evidence however shows that Tahir had ischaemic heart disease and there was serious narrowing in all his main arteries. The pathologist concluded that even if the matter had been dealt with appropriately and an ambulance had been called his chance of survival would have been below 50%. The verdict was death by natural causes and there were no special recommendations from the coroner. Christine Case died in Yarl’s Wood of a massive pulmonary thrombo-‐embolism on the 30th March 2014. The local paper reported the Director of Yarl's Wood, John Tolland, as saying: "... we have spared no effort in supporting the other residents in
coming to terms with the death of a popular and respected member of our community here." But some detainees said at the time that they had no counselling, some had phones taken off them, were told to shut up and stop crying, and social visits were halted when conversation turned to the account of Christine’s death. A number of detainees gave evidence at the inquest (no jury) on 22/23rd October 2014. Bruno Dos Santos died on the 4th June 2014 at the Verne: as yet no further information on him nor on the cause of his death has been published.
Photo : Channel 4 – Yarl’s Wood guards conversation
26 year old Rubel Ahmed was found hanging in his room at Morton Hall on 5 September 2014. Rubel’s family heard of his death on Saturday 6 September via a fellow detainee. Despite their desperate attempts for confirmation of Rubel’s death they were told by staff at Morton Hall to contact the Home Office’s press office, but that just went to voice-‐mail. They called Medical Justice and were put in touch with a lawyer, thanks to INQUEST. Most media coverage focused on a subsequent disturbance by upset detainees. [On 18the May 2015, the inquest jury returned an open conclusion and a critical narrative ; “inadequate” communication between multi-‐disciplinary teams was one of the factors that contributed to Rubel’s death. The inquest highlighted that detainees at Morton Hall are locked up 8.30 pm to 8.00 am despite HMIP repeatedly raising this as a concern over the years, that guards on duty were unaware Rubel had been served 'removal directions' a few days earlier, didn't know who Rubel was and were not able to identify his body, and hadn't had CPR training for 8 or more years.] The PPO issued a Learning Lessons bulletin in March 2014. “It is disappointing that we have frequently had to highlight the lack of clear and effective systems to ensure that the nature of emergency is correctly communicated, and that healthcare and detention staff working in IRCs are sufficiently
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trained and equipped to deal with medical emergencies”. A new Home Office Detention Service Order (09/2014 -‐ Medical Emergency Response Codes) seems to have been generated as a result of PPO recommendations, Christine Case's inquest and learning from the prisons estate.
Diane Abbott MP hosted a meeting on "The Fire Next Time": Immigrant Rights & Deaths in Custody” in Portcullis House on 8th July 2014, at which Medical Justice was a speaker.
“State Sponsored Cruelty” / Children in detention
Medical Justice published its “State Sponsored Cruelty” dossier in 2012 analysing 141 cases of detained children it had assisted. Subsequently, and after much campaigning by Medical Justice and others, the Home Office changed its policy radically, detaining far fewer children and for much less time. The detention of children has been re-‐branded rather than ended, as the government claims. G4S and Barnardo’s jointly run a new detention facility for families with children (“Cedars”), though a regulatory vacuum means children there have less rights than when they were detained at the notorious Yarl’s Wood IRC. Medical Justice continues to lobby for the end of detention of children.
Though less children are detained, Home Office decision-‐making seems no better than before – for example, of the 19 children leaving detention in the first quarter of 2014, only 6 were removed from the UK and 13 were released, begging the question why they were detained in the first place.
HMIP 2014 inspection of “Cedars” -‐ "The distress experienced by parents and children who are subject to enforced removals is palpable for anyone who spends time in their company …suicide and self-‐harm procedures had been initiated 25 times”
Independent Family Returns Panel advocates the use of force against children – as a part of the Refugee Children’s Consortium in December 2014, Medical Justice met with the Panel who defended their continued advocacy for the use of force.
Barnardo's published a report in April 2014 after 2 years of running “Cedars” detention facility with
G4S. Almost one in six families ended up being separated and that is being used as a means of control. Barnardo’s said they would pull out of the Cedars contract if “red lines” were broken, including excessive use of force and families being detained at Cedars more than once. These red lines have been broken but Barnardo’s did not pull out. “What is the impact of Medical Justice ?”
“It was a huge privilege to be able to support Medical Justice in 2008 – at that crucial time as you got your first employee, the redoubtable Emma Ginn. I met her outside Taylor House where I gave surety and she gave solid support to a detainee who was amazingly released there and then. Your income was not in 6-‐figures then, probably not even in 4. But it was clear at that early stage that the organisation would take off and fly. We are all sorry that we still need Medical Justice, that we can’t rely on our government to do the right thing – but we do, and you all deserve medals for the work that you do.”
Jen McClelland, Appletree Trust (photo below)
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The “Second Torture” / Rule 35 policy work
Photo : Channel 4
Background -‐ Rule 35 of the Detention Centre Rules requires doctors in IRCs to report on the case of any detainee who he/she is concerned may have been a victim of torture. Then the Home Office caseowner reviews continued detention. Detainees with independent evidence of torture and those whose medical needs cannot be met in detention should be released, absent very exceptional circumstances. Discussion with the Home Office since 2009 about Rule 35 failures met with continual obfuscation. In 2012 we published “The Second Torture” dossier documenting criticisms of systemic Rule 35 failures by organisations and inspectorates, and in a multitude of damning court judgments over the last ten years. The dossier analysed the cases of 50 detainees with medical evidence of torture. Only one was released due to Rule 35. Two were forcibly returned to their countries and were tortured again. Both made it back to the UK and were disbelieved and detained again. Our doctors documented their fresh scars of torture alongside the old scars. 5 Medical Justice clients lodged judicial reviews in 2013 to secure their release and/or claim damages for false imprisonment based on breaches of Rule 35. Medico-‐legal reports from our volunteer doctors helped establish that all 5 were victims of torture. The Judge describes the evidence provided by Medical Justice on the systemic failures in this crucial safeguard as ‘disturbing’. In 2011 Medical Justice initiated legal action regarding Rule 35. The Home Office promised an improved package of policy, guidance, and staff training which was implemented in January 2013. The new policy narrowed the definition of ‘torture’ to exclude that not committed by governments, including the likes of Boko Haram and traffickers. In June 2013 Medical Justice initiated legal action again ; in response the Home Office reverted to the
previous, wider definition of ‘torture’, thereby benefiting potentially thousands of torture victims.
The Home Office repeatedly fail to publish results of their audits investigating decisions to not release detainees -‐ The Home Office lost the results of its first audit in 2007. They published results of a second 2009/10 audit but did not include a promised analysis of outcomes, rendering the exercise redundant. A third audit was undertaken but not published. Results of a 2013 quality marking standards exercise have not been published.
Lessons not learned means that Rule 35 failures in 2014 were much the same as in 2006, including;
o Failure by the IRC doctor to complete a Rule 35 report or to do so adequately
o The Home Office caseworker makes unqualified medical judgments or their assessment flouts the policy
o The wrong definition of torture is used
o No training for IRC doctors since 2012 and the training material is out of date
2014 “remedial actions“ have not brought all the improvements needed -‐ In a July 2014 a High Court judge found the operation of the Detained Fast Track unlawful and that “Rule 35(3) reports are not the effective safeguard they are supposed to be” and “do not work as intended”. Subsequently, the Home Office held a series of “remedial actions” meetings with stakeholders. They agreed to do something about detainees who are mentally ill or have learning difficulties not being picked up at screening and safeguarded by Rule 35, but have not implemented anything yet. The Home Office themselves agreed that Rule 35 had the potential to work, but isn’t working. Meanwhile Rule 35 reports at Yarl’s Wood IRC fell from 122 in the third quarter of 2014 to 30 in the fourth quarter, after G4S took over the healthcare contract in the fourth quarter
The Home Affairs Select Committee (HASC) reported in March 2014 that only 9% of Rule 35 reports resulted in a detainee being released. 2014 : Number of Rule 35 reports
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Legal challenge to the Detained Fast Track “At the end of 2013 a sustained legal challenge to the DFT began – which culminated in its suspension at the beginning of July 2015. In December 2013, Detention Action began a three-‐day High Court challenge to the legality of all aspects of the DFT. In July 2014, the court ruled that the fast track’s very tight timetable created such a high risk of unfairness as to be unlawful. Detainees had so little time between meeting legal representatives and presenting their claim that claims could not be properly presented. But the DFT was not suspended, as the Home Office claimed that in the interim, it had made changes to ensure greater fairness. The main change was a four-‐day period for legal representatives to help detainees prepare before the asylum interview. Then, in December 2014, the Court of Appeal ruled unlawful the policy of blanket detention after the initial decision and pending appeal. Since the purpose of initial detention – the speedy determination of claims – had been fulfilled, there was no legal justification for continued detention, unless the detainee had been assessed as someone likely to abscond. This was a big blow to fast-‐track detention. Another blow came in June 2015, when the High Court ruled that the impossibly tight timetable for appeals in the fast track rendered them, too, structurally unfair. At the hearing on 12 June, the Home Office persuaded the judge to stay the ruling, to give it time to implement changes – but two weeks later the Court of Appeal overruled the stay. So far as the appeal stage was concerned, the DFT was in tatters. But it was the challenges to the detention of vulnerable asylum seekers such as torture survivors which were to deliver the coup de grace to the system.” – summary based on text by the Institute of Race Relations.
“What is the impact of Medical Justice ?”
“Looking at where I am now and where I have been, I cannot imagine getting here without the help of medical Justice. It’s like crossing a long and narrow bridge, as narrow as a thread and beneath it is fire. There is no way I could have made it. It is just unimaginable! Medical Justice has influenced so many changes in this brutal system for the past 10 years which have changed 1,000s of lives. The impact that Medical Justice has had on the lives of the most vulnerable in the past 10 years is just incredible! I have a lot of admiration for the staff of Medical Justice and the incredible volunteers who have tirelessly put in their valuable time and efforts to fight our corner. I can never put into words what this means to us. It’s just impossible for me to do so. I know we are not there yet, but without Medical Justice for the past 10 years, we would be attending more funerals. On behalf of all detainees and ex detainees I would like to thank this tremendous team of Medical Justice for their incredible achievements for the past 10 years. I am pleading my heart out to funders and supporters from all walks of life to join hands with Medical Justice in this great cause.”
Ms A – Medical Justice trustee, ex-‐detainee (Photo above)
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Medical Justice Strategic Litigation Group Below is the main strategic litigation Medical Justice has been involved with ;
2009 -‐ Pre-‐action letter challenging Home Office and Serco for hindering access by independent doctors to IRCs
2010 -‐ R (Medical Justice) v SSHD : zero-‐notice removals policy quashed, upheld on appeal in 2011.
2011 -‐ Medical Justice intervenes in R (MD (Angola) v SSHD, challenging detention of HIV+ detainees
2012 -‐ Evidence for judicial review challenging the use of force on detainees in hospital (FGP v Serco & SSHD)
2012 -‐ Successful joint intervention with Mind in R (HA) v SSHD regarding detention of the mentally ill
2013 -‐ Provided evidence in support of judicial review regarding use of force during removal (R (Z) v SSHD
2013 -‐ Evidence in R (Chen and Others) v SSHD – use of force against pregnant women during removal banned
2013 -‐ Evidence regarding unlawful detention of victims of torture (R (EO and Others) v SSHD
2013 -‐ Pre-‐action letter challenging Home Office narrowing definition of torture – definition broadened back out
2014 -‐ Successful joint intervention with Mind in R (DAS) v SSHD regarding detention of the mentally ill
2014 -‐ Evidence for successful challenge of the Detained Fast Track process
2014 -‐ Pre-‐action letter challenging resurrection of zero-‐notice removals – policy withdrawn
2015 -‐ Applied to intervene jointly with BID in Supreme Court in mental health case (OM) Medical Justice is extremely grateful to all the lawyers who represented us pro-‐bono.
“What is the impact of Medical Justice ?”
“I am so pleased to celebrate 10 years of Medical Justice. In that time Medical Justice has developed into the most authoritative organisation on immigration detention and its effects on detainees. ... Without Medical Justice there would be a lack of evidence
about the conditions of immigration detention, and without that evidence challenging government policy would be virtually impossible. That is not to say that Medical Justice wins every fight. But in the last 10 years, Medical Justice has made each fight more of a contest. It has been a privilege to watch this process, and contribute in my own small way to Medical Justice's strategic litigation. This work has only been possible because of unwavering commitment of the Medical Justice staff and the assistance of lawyers working for free. … Medical Justice gives us hope that in 10 years time everyone will accept that immigration detention cannot be justified.”
Justin Leslie -‐ Trustee 2010 – 2015
“What is the impact of Medical Justice ?”
“Medical Justice is unique and it has had a uniquely brilliant impact in the last 10 years. … Their contribution is not just to the individuals they have helped directly, but to all those who have relied on the cases they have
pioneered, the doctors they have trained and the research and campaigning that they have spearheaded. … Medical Justice, through its strategic legal work, has also built up a body of principles in the case law that we lawyers can rely and build on in our cases, pushing for the judges to be more progressive on this issue. … Anyone who has ever worked with an immigration detainee who has been helped by Medical Justice cannot but be inspired by the direct and powerful impact Medical Justice can have and by the lifeline that Medical Justice represents for detainees in the most desperate situations. By its campaigning, research, evidence-‐collection and strategic litigation Medical Justice has the potential to achieve real change to the conditions of immigration detention and the treatment of detainees, and perhaps to the very existence of administrative detention at all... “
Martha Spurrier -‐ barrister, Doughty Street Chambers
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Ex-‐detainee Group
Photo : Ms A and fellow ex-‐detainee help organise the 2014 Festive Awards Party
Medical Justice was founded by an ex-‐detainee in 2005 and there have always been ex-‐detainees on management committee ever since.
Ex-‐detainees training volunteer doctors -‐ Ex-‐detainees give a session at the medic’s basic training days that we hold every few months. Volunteer medics get to hear from an ex-‐detainee first-‐hand about medical mistreatment in immigration detention and the impact Medical Justice had in their life.
“I am not a criminal” short film by ex-‐detainees – this film, edited in 2014, helps raise awareness.
Exposing injustice through the media – getting an issue into the media often requires a “case-‐study” and a number of ex-‐detainees have spoken out in this way. Add MJ has provided training for many detainees on speaking to the media and in making presentation and public speaking.
Speaking at public events – there is always an ex-‐detainee speaker at each public event Medical Justice holds. “Getting involved with the work of Medical Justice means so much to me as an ex detainee”
“It was very moving to see doctors touched after a talk that inspired them to volunteer as medical doctors with Medical Justice. This, for me, meant more torture survivors in detention had a chance of seeing an independent doctor. At one point during my detention I had no voice, even if I decided to scream on top of my voice no one could have heard my cry! Medical Justice has given me a voice. Through the film and media interviews I have been able to voice my concerns at last.”-‐ Aisha Kabejja, Medical Justice management committee member
Medical Justice Members Debate
The July 2014 Members Debate -‐ “Medical Justice : Collaboration or collusion ? Anticipating what's needed to capitalise on opportunities emerging from the transfer of healthcare commissioning from the Home Office to the NHS”. The panel of speakers were ; Dr Hilary Pickles (volunteer), Dr Jonathan Fluxman (trustee), Aisha Kabejja (ex-‐detainee) and Sue Willman (partner, Deighton Pierce Glynn Solicitors).
Photo left : Harmit Athwal (IRR) and Michael Pitchford of the Joseph Rowntree Charitable Trust at the Members Debate The Joseph Rowntree Charitable Trust kindly supported us to engaged the Institute for Voluntary Action Research to facilitate the Debate. “What is the impact of Medical Justice ?”
“The A B Charitable Trust has supported Medical Justice since 2010. We do so because we know its work fills an essential gap by shining a light on very many detainees suffering medical mistreatment in detention centres. These marginalised individuals would otherwise have no hope of help or redress. The model developed by Medical Justice using its network of volunteer doctors provides essential support to these people in a very cost effective way – and no other agency is doing this vital work. Congratulations to all at Medical Justice on many concrete and practical achievements over the last ten years, and all the best for the future – your work is needed more than ever.”
The A B Charitable Trust – Sara Harrity
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Annual accounts Statement of Financial Activities for the year ended 31st January 2015
Unrestricted Restricted Total Total
Funds £ Funds £ 2015 £ 2014 %
Incoming Resources Incoming Resources from Generated Funds Voluntary Income 63,813 0 63,813 44,566
Investment income 221 0 221 41 Incoming resources from charitable activities 149,187 83,373 232,560 105,442
Other incoming resources 0 0 0 0
Total Incoming Resources 213,221 83,373 296,594 150,049
Resources Expended Cost of generating fund
Cost of generating voluntary income 234 0 234 234
Charitable Activities 166,122 83,373 249.495 171,737
Governance Costs 3,329 0 3,329 2,400
Total Resources Expended 169,685 83,373 253,058 174,371
Net incoming/(outgoing) resources before transfers 43,536 0 43,536 (24,322)
Transfer of Funds 0 0 0 0 Total funds at 1st February 2014 61,426 0 61,426 85,748
Total funds at 31st January 2015 104,962 0 104,962 61,426
Balance Sheet as at 31st January 2015
2015 £ 2014 £ Fixed Assets 15,741 20,987 Current Assets Debtors 6,250 1,011 Cash at ban and in hand 103,840 42,943 125,831 64,941 Creditors: Amounts falling due within one year 20,869 3,515 Total Assets 104,962 61,426 Funds
Unrestricted Funds 104,962 61,426
Designated Funds 0 0
Restricted Funds 0 0
Total Funds 104,962 61,426
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Notes to the financial statements for the year ended 31st January 2015
Resources Expended by category of Expenditure Total Total
2015 2014
Costs directly allocated to charitable Activities £ £
Salaries and national insurance 166,069 123,476
Consultancy Fee 6,075 4,250
Medico-‐Legal Report Fees 22,713 10,137
Medical Notes & Records 6,454 3,290
Event Training & Expenditure 3,163 2,622
Interpretation 6,726 1,942
Staff Recruitment & Training 517 0
Travel 724 812
212,441 146,529
Support costs allocated to charitable activities
Rent and Rates 14,272 6,582
Telephone & Fax 1,426 1,383
Postage Stationery & Printing 4,812 5,808
IT expenditure 1,556 792
Insurance 237 260
Volunteer expenses 2,637 2,516
Subscription 164 119
Website 6,254 533
Other Office Expenses 449 216
Depreciation 5,247 6,996
37,054 25,208
Cost of generating voluntary income
Fund raising cost 234 234
Governance Cost
Accountancy Fee 3,329 2,400
Total Resources Expended 253,058 174,371
Treasurer’s Report Medical Justice this year has had to exist in a very challenging financial landscape, with government policies both increasing the need for our services and, through legal aid cuts, reducing our ability to be compensated for these services. This leaves us extremely dependent on grants and private donations. Fortunately, our supporters have continued to be sympathetic to the need for our
services, and a number of new and continuing grants have enabled us to increase our services. We are profoundly grateful to all of these donors. Maintaining the confidence of our current donors as well as building up new funding relationships must remain of the greatest importance to Medical Justice.
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Thank You Medical Justice is completely reliant on a small army of incredibly dedicated volunteer medics, lawyers, detainee visitors and interpreters. Many of our busy volunteers have full-‐time jobs and family responsibilities, but manage to somehow squeeze in work on behalf of detainees. Medical Justice partners
Including: Amnesty International, Yarl’s Wood Befrienders, Bail for Immigration Detainees, Detention Action, Gatwick Detainee Welfare Group, Association of Visitors to Immigration Detainees, Asylum Aid, the Refugee Children’s Consortium, the Institute of Race Relations, Right to Remain, Women for Refugee Women, Asylum Aid, SOAS Detainee Support Group, MIND, the National Aids Trust, Maternity Action, Birthrights, the Helen Bamber Foundation, Freedom From Torture, Doctors of the World, Immigration law Practitioners Association, Liberty, INQUEST, UNHCR, Bhatt Murphy Solicitors, Birnberg Peirce & Partners, Duncan Lewis Solicitors, Bindmans Solicitors, Wilsons Solicitors, Sutovic & Hartigan Solicitors, Deighton Pierce Glynn Solicitors, Hodge Jones & Allen, Fisher Meredith Solicitors, Leigh Day, Islington Law Centre, the Public Law Project, the Migrants’ Law Project and barristers from 1 Pump Court, Tooks Chambers, Landmark Chambers, Matrix, Garden Court Chambers, Doughty Street Chambers, Royal College of Psychiatrists, Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, the Royal College of Paediatrics and Child Health, Royal College of GPs and many more.
Management Committee members
Christine Hogg – Chair Ed Ross – Treasurer Alex Goodman Dr Jonathan Fluxman Aisha Kabejja Dr Teresa Wozniak (elected July 2014) Steve Symonds (elected July 2014) Dr Hugh Grant-‐Peterkin (elected 1st July 2014) Dr Miriam Beeks -‐ Co-‐opted Dr Charmian Goldwyn (resigned March 2014) Jonathan Burnett (resigned May 2014) Dr Ben Robinson (resigned June 2014) Justin Leslie (resigned May 2015)
Photo left : volunteer greets and ex-‐detainee she visited in detention who was released in time for the Medical Justice Festive Party
Staff -‐ Theresa Schleicher, Charlotte Mathysse (joined June 2014), Dr Naomi Hartree, Dr Sarah Chin (joined January 2015), Lisa Incledon, Emma Ginn, and Kris Harris (joined June 2014).
Members
Hilary Pickles Prof C. Katona Dr C. Goldwyn Martha Spurrier Philip Nathan Lochlinn Parker Sue Willman Harriet Wistrich Emma Norton
Didier N'kissi M. Niran Falade Abdeen Arbab Malcolm Alexander Jen McClelland Melanie MacFaydean Dr Eileen Walsh Harmit Athwal S. Youdom Tonmi
Jane Grant Jon Burnett Jed Pennington Jane Ryan Janet Farrell Dr Katy Robjant Dr Liz Clark Dr Helen Salisbury Peter Toon
Rebecca Marcus Rachel Marcus Latifa Chentouf Ravi Low Beer Alison Pickup Celia Carke Phil Miller
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Volunteer medics and interpreters
Abdusalam Zbida Abeera Khan Aga Mytkowska Agnes Orbach Alex Joy Angharad Spencer Anne Hadfield Anushka Mehrotra Asha Pook Ayan Abdi Beata Godlewska Catherine Harkin Charmian Goldwyn Christelle Blunden Cornelius Katona Dalia Arab Diane Wardell Douglas Fink Eileen Walsh Elspeth Carruthers Elspeth Hulse
Fan Li Felicity Hughes Helen McGeown Helen Price Helen Richards Helen Salisbury Hennah Bashir Hilda Deganutto Hugh Grant-‐Peterkin Iona Steen Jan Reiss Jane Mounty Jasmin Lee Jenny Akhurst Jenny Webb Jiang Ping John Gilmurray Jon Orrell Jon Reicher Josh Black Julia Dick
Kami Saedi Katie MacDonald Katrina Stegman Latifa Chentouf Laura Stahnke Laura Kemmis Lily Abedipour Liz Clark Lorna Orriss Lou Millington Maeva Flandorfer Marcus Chenevix-‐Trench Marian Messih Marie-‐France Rowland Marie-‐Jeanne Berger Marina Pinault Mark Brinkley Mary Keniger Mary Walsh
Michael Nelki Miriam Beeks Morag Forbes Nawal Sharief Ngoc Pham Payam Torabi Peter Toon Phoebe Pallotti Princess Chiney Rakesh Sinha Rachel Bingham Rebecca Marcus Rosie Townsend Ruth Sagovsky Sally Jones Samaher Awad Sarah Nurgat Sylvia Chandler Tania Longman Thelma Thomas
Other Volunteers – support from detainee befrienders is greatly appreciated and vital. Particular thanks to ; Dr Hilary Pickles for reviewing detainees’ medical records and help with drafting papers. Anne Singh for the analysis of the evaluation of the family removals process. Beverley Costa of Mothertongue for all the training of our volunteer interpreters. Adele Selma and Louise Orton for assisting ex-‐detainees to make the “I am not a criminal” short film. ‘Professionals’ -‐ Many ‘professionals’ who really went the extra mile to help Medical Justice and the detainees, including lawyers and journalists. Many of them modestly claim they were “just doing their job”.
Marie-‐France raised money for her birthday – Marie-‐France, one of our volunteer interpreters, set up a page on the Medical Justice JustGiving site and raised £634 -‐ justgiving.com/Marie-‐France-‐big-‐birthday
Donors -‐ A dozen supporters donate each month by standing order which is very welcome. A number of doctors working with Medical Justice get some funding for their medico-‐legal reports from solicitors and donate some or all of this to Medical Justice. Funders -‐ We thank our funders in FY2015, without whom we could not continue our work: The Joseph Rowntree Charitable Trust, Trust for London, Comic Relief, the Sigrid Rausing Trust, the A B Charitable Trust, Network for Social Change, the Oak Foundation, the Esmée Fairbairn Foundation, the Bromely Trust, and the Eva Reckitt Trust Fund.
Leoni Hirst walks 1,200 miles for Medical Justice ! -‐ On 10th September 2014 Leoni completed her Land’s End to John O’Groats walk in aid of Medical Justice. Leoni, a barrister at Garden Court Chambers and mother of two
young children, said "Medical Justice has been instrumental in ensuring that detainees receive proper medical care and many of my clients have been released from detention thanks to its help." You can read more at leoniehirst.wordpress.com/about/
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10 years campaigning for medical justice
Photo : Lord Ramsbotham launches Medical Justice in the House of Commons, 2007. 2005 * Volunteer doctor visits detainee on hunger-‐strike in Harmondsworth IRC
* First campaign meeting held in Hyde Park
2006 * Negotiated a protocol with the Home Office for access for independent doctors into IRCs * Medical Justice successfully lobbies for better policy on anti-‐malarials for pregnant women and children
2007 * Medical Justice launched in parliament with “Beyond decency & Comprehension” dossier of case-‐studies * We becomes a company limited by guarantee and get our first office room
2008 * Published “Outsourcing Abuse” dossier of excessive use of force * First grants : £10,000 from JRCT + £10,000 from Appletree Trust -‐ first employee employed
2009 * Medical Justice becomes registered charity with help from Allen & Overy * Medical Justice v UKBA & Serco : proceedings issued -‐ regarding obstruction of medical visits at Yarl’s Wood
2010 * “State Sponsored Cruelty” dossier on children in detention, backed by Royal Colleges * Medical Justice wins judicial review against Home Office’s ‘zero-‐notice’ removals policy
2011 * “Detained & Denied” dossier on cases of inadequate treatment of HIV+ detainee * Issued proceedings against the Home Office challenging Rule 35 failures
2012 * “The Second Torture” dossier on the detention of torture survivors published * Successful joint intervention, together with Mind, in the case of R (HA) v SSHD on mental issues
2013 * “Expecting Change” dossier on pregnant women in detention, backed by Royal Colleges and 300+ NGOs * Successful legal challenge of narrowed ‘torture’ definition, evidence for group of torture victim cases
2014 * “Biased & Unjust” dossier on wholly inadequate complaints procedure * Successful pre-‐action letter challenging resurrected zero-‐notice removals policy
2015 * Lobbying for consultation of NHS England Service Specifications * Detainee referrals top 100 in a month, employs 7 staff, 75 clinicians visit detainees
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“What is the impact of Medical Justice ?”
“Medical Justice’s work is so incredibly important for those held in immigration detention at the whim of the state. … I can think of countless examples of clients who, if they had not been able to contact Medical Justice, would have spent longer in detention, often without access to appropriate healthcare, and without any independent evidence of the impact of detention on their physical and mental health. With the culture of disbelief that exists in the Home Office, and the inadequacies of healthcare provision in the detention estate, such independent evidence is of critical value. Medical Justice has also had the courage to challenge Home Office policy and practice – through its research and policy work but also through litigation, including importantly its successful challenge to the no notice removal provisions which deprived detainees of the basic right of access to the courts. I am proud to have worked with Medical Justice and hope that it will be able to continue to offer a vital lifeline to detainees for as long as detention exists!”
Alison Pickup, barrister, Doughty Street Chambers (photo below)
“What is the impact of Medical Justice ?”
“The first time I received a phone call from Emma Ginn I thought "here we go again, what does the home office want now?" Today I am so thankful for actually sitting across Emma in the visiting hall in Yarl’s Wood detention centre. She was the first and only person that visited me … She took my troubles on, listened when I needed her to, she never complained or said I was too this or too that … Which made me trust her even more. Had it not been for Medical Justice I believe I would be on a plane back to Uganda, meeting doctor Charmain Goldwyn made my case a lot stronger. She made such a great report about my account and my attack which helped win my asylum claim.
Medical justice got me one of the best lawyers they knew was right for my case and I will forever be grateful to them. To me its not just Medical Justice, its this brilliant team of such few workers that do these amazing things with dedication and no complaint. Thank you Medical Justice for all your kind and hard work. Thank you Theresa. Thank you Emma and the rest of the team. Oh and thank you for the Christmas parties and the great food I definitely feel part of a community.”
Ms B – ex-‐detainee
“What is the impact of Medical Justice ?”
“I have been very happy to support Medical Justice ever since it began taking up issues to do with asylum seekers who were in need of healthcare support, including victims of torture. Throughout the 10 years of its existence it has filled a gap in the provision of help for such people, and, on their behalf, has pursued shortcomings, such as inadequate handling of official complaints, with consistent determination.
I was very pleased to hand a dossier that it had assembled on unresolved complaints about the way in which those being extradited were treated, including cases involving physical injury, which resulted in an official inquiry and greater supervision of private contractors.
Its current attempt to have the Home Office’s method of handling complaints made by would be immigrants and asylum seekers is to be applauded, because, if Medical Justice did not pursue the patter, nothing and therefore no improvement would happen.”
Lord Ramsbotham
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Medical Justice 10 Year Impact Matrix Year Issue Action Led / contributed to
2005 + Individual detainees
Casework – now 1,000 referrals annually, medical assessments
Our research based on casework medical evidence, detainees receiving needed healthcare, many released, evidence assists their asylum / immigration case
2005 + Better treatment of hungerstrikers
Provision of medical evidence, lobbying
Promotion of DoH guidelines, Home Office implemented a policy, better treatment achieved for detainees
2006 Independent Doctors access to IRCs
Protocol negotiated with Home Office
Secured access for all independent doctors resulting in independent medical assessments and advice for detainees
2006+ Anti-‐malarials for pregnant women
Provision of medical evidence, policy work
About 50 individual judicial review cases, much improved Home Office policy for pregnant women and children
2008 “Outsourcing Abuse” Media work, policy work, 300 case-‐studies of alleged assault
Home Secretary commissions independent inquiry, legal challenge by Liberty regarding escorts’ training, amended Home Office policy / training
2009 Unblocking doctors access to IRCs
We threatened judicial review
Home Office and Serco withdrew all bar one extra requirements on independent doctors to access IRCs
2010 Zero-‐notice removals Medical Justice Judicial Review won
High Court and Court of Appeal rulings against the Home Office, policy quashed, protecting thousands of migrants
2010 “State Sponsored Cruelty”
Dossier of 141 children we assisted in detention
Used as evidence in Suppiah case in 2011, mobilisation of several Royal Colleges, contributed to campaign and policy change; vastly fewer children detained for much shorter
2011 Access to HIV meds “Detained & Denied” dossier 35 cases
Used in our High Court intervention (MD Angola), prompted National AIDS trust audit, promoted BHIVA guidelines
2012 “The 2nd Torture” Dossier 50 cases detained torture survivors
8 years policy work, 2011 initiated legal action forcing Home Office to meet us and implement new Rule 35 policy, guidance and training package in 2012, media coverage
2013 Definition of torture in Rule 35
We threatened judicial review
Successfully challenged Home Office’s inappropriate narrowing definition of torture – old definition re-‐instated
2012 Mental Health HA cases -‐ Joint intervention with Mind
Royal College Psychiatrists statement, prompted formation of Mental Health in Immigration Detention Working Group
2013 Mental Health Das cases -‐ Joint intervention with Mind
Judgment with better definition of “serious” mental illness and “satisfactory management”
2013 Detention of Pregnant women
“Expecting Change” dossier – evidence in a number of cases
Royal College Midwives and Royal College Obs & Gynae endorsements, Medical Justice meeting the Immigration Minister, media coverage
2013 Banned Use of Force on pregnant women
Identified cases (Chen & Oths), provided evidence
Supplied witness statements, lobbying, resulting in ban on force against pregnant women and children during removal
2014 “Biased & Unjust” complaints dossier
Documenting ineffective investigations
Independent Chief Inspector of Borders and Immigration themed inspection, new Home Office policy
2014 Zero-‐notice removals Threatened Judicial Review (again)
Challenged resurrected zero-‐notice policy ; Home Office implemented amended policy minus zero-‐notice element
2015 NHS England Service Specifications
Attempt to secure consultation
Identified missing safeguards, difference between prisoners and immigration detainees, inappropriate elements (e.g. healthcare involvement in “punitive” actions was deleted).
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Photo by Andy Lee – Miriam Beeks Miriam Beeks, a Hackney GP, first got involved with immigration detainees because she was seeing many patients who were destitute asylum seekers and had no recourse to public funds. She went along to a Hackney Migrant Centre meeting to find out more about their situation and decided she wanted to do something to help. At the time, in 2005, 100 Zimbabweans were on hunger strike in detention and were communicating with supporters on the outside by phone. A few psychiatrists were making visits to immigration detention centres at that point, but nowhere near as many doctors as go into these centres today thanks to the dedicated persistence of Medical Justice. "At first I wasn't brave enough to go into one of those places," said Miriam. "And when I did go in I felt a bit out on a limb. Thankfully Medical Justice has developed a training and ongoing support structure and also an admin system in place to enable medical visits. I was concerned that the person I visited a couple of times was so ill he could barely sit up. An MP got involved with his case and managed to get him released." Miriam has visited or done telephone consultations with dozens of families detained with children over the years. Now that far fewer children are detained and for
a shorter time these consultations have become thankfully much rarer. A lot of the cases involving traumatised children have really stayed with me." "If we as doctors going into detention centres make medical recommendations they are often implemented by the staff. For example they now accept that pregnant women can't be removed to areas where mosquitos are prevalent without adequate Malarial protection.” Miriam said that very vulnerable people are detained. "I saw two people recently who were very vulnerable, in wheelchairs," she said. "Physical health impacts on mental health and vice versa. I think that detainees were quite relieved that doctors came along and pointed out that detention was not a good place for them." While the work can be depressing Miriam finds it rewarding when an expert medical report she has penned helps someone get released from detention and subsequently granted leave to remain. Medical Justice has mounted significant campaigns which have been taken very seriously and had a big impact. Miriam is heartened by the large number of doctors who are interested in helping people in detention. "There is greater awareness now amongst doctors about exactly what goes on in detention centres," she said. "What inspires me is helping people with medical problems that can't be dealt with in a prison environment and being involved in getting them released so that they can be treated properly." "Without Medical Justice so many people would not have received help. Medical Justice is always expanding and able to help more people and having even more of an impact. But it worries me a lot thinking about how many people in detention don't get seen and properly treated by doctors. One of the most rewarding things about our work is helping patients who the Home Office have said do not have credible stories about fleeing persecution and then having experts who can document evidence about scarring and other evidence of torture and persecution that prove the person's story is true. It seems very important that we are there to look again at someone's evidence. That is a vital part of this work."
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Donating to Medical Justice You can donate by debit/credit card, cheque, standing order or electronic transfer. Medical Justice would most prefer it if you could donate via our JustGiving webpage because the GiftAid and banking is all automated, so it doesn't use up any of our resources at all. So, please use our JustGiving facility where possible. You can set up a monthly payment from the JustGiving webpage. Donations by electronic transfer to the account shown below, or by cheque, which should be made out to “Medical Justice” and posted to below the address. Thank you -‐ your support can make a real difference!
JustGiving webpage; https://www.justgiving.com/medicaljustice/
How to get involved with Medical Justice Medics – doctors, psychiatrists, psychologists, midwives and nurses can visit immigration detainees and/or assist remotely. We hold Medical Justice medics training days about 4 times a year.
Interpreters – needed to speak to detainees on the phone or visit with doctors.
Lawyers -‐ Medical Justice always needs to link detainees with lawyers, willing to represent, pro-‐bono where necessary.
Supporters -‐ could visit immigration detainees and make referrals to Medical Justice.
Post: Medical
Justice, 86 Durham Road, London, N7 7DT.
Company Registration No.: 6073571 Registered charity No. 1132072 Bank: CAF Bank
Sort-‐code 40-‐52-‐40, Account Number 00021167 General inquiries: [email protected] Medical inquiries and referrals: [email protected]
Phone: 0207 561 7498 Fax : 08450 529370 Website : http://www.medicaljustice.org.uk/ Co-‐ordinator: Emma Ginn on [email protected] Mobile : 07904 77836
