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BMA report on health-related human rights of detained individuals

British Medical Association: Locked up, locked out: health and human rights in immigration detention, a recently published report “explores the role of doctors in protecting and promoting the health-related human rights of detained individuals”.  You can download a copy to read from the BMA website.  

The aim of the report is to provide guidance for Doctors and practitioners working in immigration removal centres “including the wider duty of doctors to strive to change harmful policies and practices” and “will make recommendations to the government, policy makers, and managers which address those aspects of the systems which can undermine patient’s rights”.

The report identifies:  “A crucial difference between human rights and medical ethics – and thus, a reason for adopting this approach throughout the report – is that human rights regulate the relationship between individual and state, whereas medical ethics focuses on the relationship between individuals: doctor and patient”.

The report states: “The UK has one of the largest immigration detention estates in Europe, holding up to 3,500 individuals at any one time, in 11 immigration removal centres (IRCs) across the country”.  There are no time limits on detention.  

The report reminds us that: “The International Detention Coalition (IDC), an international network of organisations and individuals who work with detained migrants and refugees, has identified over 250 examples of alternatives to detention from 60 countries”.

Considerations and Practical Application

At chapter 2: “Detained individuals present with many and varied health needs. Where some will have similar health needs to the general population in the community, others will have needs that are far more complex”.

The report states that identification of health needs upon reception and induction is crucial.  IRCs should ensure that services are available, as detainees are limited in choice and more staffing is needed.  Continuity of care is important as is the need to meet complex health needs in detention.

The report notes “International evidence (largely from Australia) indicates that prolonged detention has an adverse impact on mental health”. Individuals can suffer re traumatisation”

Importantly the report highlights and reminds us  that: “Doctors working in IRCs are bound by the same professional and ethical obligations as they are in the community. Their primary concern is the care of their patient”.  Although a hard balance, Doctors are to remain clinically independent but are to have regard to the “secure settings” in which they must operate.  

The report notes that there is variance in the rule 35 reports (medical report dealing with situations where health is likely to be injuriously affected by detention) and few reports result in release.  

Doctors need to work with wide ranging language and cultural issues.  The report identifies “stigma” attached to mental health and cultural barriers.  The report concludes: “The process of building trust and getting to the root of the problem not only requires a sensitive and skilled communicator, but is dependent on health professionals having sufficient time”.

The BMA is aware that privacy and confidentiality can be “challenging within an immigration detention setting”.

The report notes that there are many instances of food and fluid refusals of detainees.  Doctors should assess any such patients and in some cases psychiatric assessment may be required.   

The report highlights: “The lack of training and continuing professional development available to doctors working in IRCs can be a contributing factor to low morale and professional isolation”.

Recommendations and Conclusions

In conclusion the report highlights that: “Immigration detention engages a myriad of issues – political, legal and social. It is not for the medical profession to dictate far-reaching policy change or review. What we have done in this report, is to highlight current areas of policy which impact most strongly on the health and wellbeing of detained individuals or affect the ability of doctors to act in the best interests of their patients. Below, we present a number of recommendations grouped under five key headings aimed at addressing those issues”.

In part 3, conclusions and recommendations, the following 5 recommendations are made.

  • Revise detention policies to address the significant health effects indeterminate detention can have on individuals
  • Address aspects of the detention environment which affect the health and wellbeing of those detained
  • Reconfigure current healthcare provision to better achieve equivalence of care
  • Provide training and continued support in health and wellbeing issues for all those working with detained individuals
  • Recognise the importance of doctors acting with complete clinical independence and ensure that the principle is enshrined respected across the immigration detention estate

Detention is under real focus at present, with increased deaths in detention and with well publicised concerns over the treatment of immigration detainees further insight and recommendations should be welcomed.  

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