Immigration Bill Committee

Further written evidence submitted by the British Medical Association (IB 40)

Immigration Bill- New Clause 1

1. The British Medical Association (BMA) is an apolitical professional association and independent trade union, representing doctors and medical students from all branches of medicine across the UK and supporting them to deliver the highest standards of patient care. We have a membership of over 160,000, which continues to grow each year.

2. The BMA represents and support doctors working in immigration removal centres (IRCs) and have a long-standing interest in promoting fundamental human rights in the context of healthcare. We advocate for individuals and marginalised populations whose health-related rights are infringed, both in the UK and internationally. We have repeatedly expressed concerns about the health and wellbeing of those held in immigration detention, and the quality of the health services they receive, most recently to the Joint Inquiry into the use of Immigration Detention in the United Kingdom, and to the Home Office Review into the welfare of vulnerable people in detention.

3. This briefing highlights the BMA’s support for New Clause 1 regarding the ‘Detention of persons- exempted persons’, which we believe will better protect the health and wellbeing of vulnerable persons, whose needs are often unmet in detention.

New Clause 1- ‘Detention of persons- exempted persons’

4. The BMA supports the inclusion of New Clause 1 in the Immigration Bill.

"Detention of persons – exempted persons

i. In paragraph 16 of Schedule 2 to the Immigration Act 1971 after subsection (4)

ii. insert -

iii. "(5) A person may not be detained under this paragraph if they are a member of one

iv. or more of the following groups of person-

(b) Pregnant women;

(c) Victims of trafficking;

(d) Victims of torture;

(e) Victims of sexual violence;

(f) Any other group as may be prescribed by the Secretary of State.""

5. We acknowledge that the use of detention as a response to immigration involves many complex political and legal issues. The detention of people who are not convicted of a criminal offence must, however, be a measure of last resort, used only in exceptional circumstances. In particular, we have a number of concerns about the health needs of many detained individuals, and how adequately these are addressed in detention.

6. In detaining individuals, and limiting their fundamental liberty rights, the state assumes an obligation to protect and promote their health and wellbeing. This means that detained individuals in immigration removal centres (IRCs) should have available to them the same range of services and quality of care as those in the community. In addition, given their complex and often traumatic histories, they may require additional dedicated health services.

7. We have concerns that the healthcare provided in the immigration detention estate cannot meet these needs and that the state’s obligations to some detained individuals are not being met.

8. Individuals detained for immigration purposes are a diverse population with varied health needs. In addition to having the same basic health needs as the wider population, there are a number of conditions which are more prevalent amongst the detained population, including communicable diseases and chronic conditions, which may have gone either undetected or untreated due to a lack of interaction with, or failings of health services both in the UK and in countries of origin. [1] [2] There may also be a number of medical conditions – both physical and mental – which require specialist medical attention. This is likely to be where individuals have been the victim of traumatic experiences, such as torture, trafficking, and other forms of violence, including sexual violence. [3] Combined with these specific physical health needs are a range of mental health problems, including, depression, anxiety and PTSD, which can be a consequence of past traumatic experiences. [4] [5]

9. There are many reasons why healthcare provision might be inadequate in the detention setting. Detained individuals themselves may struggle to access healthcare due to language difficulties and other cultural issues (including trouble accessing an interpreter); a lack of knowledge about their rights to healthcare and how to access it; and negative perceptions of healthcare, often due to their previous experiences and interactions with healthcare professionals. Where detained individuals do access healthcare, the quality of healthcare provided across the immigration detention estate can also vary drastically from site to site as a result of a lack of consistency in the services available.

10. The BMA urges the Committee to vote upon, and accept New Clause 1.

November 2015

[1] Burnett A and Fassil Y (2002) Meeting the health needs of refugee and asylum seekers in the UK: an information and resource pack for health workers. London: Department of Health.

[2] Health Protection Agency (2006) Migrant health: infectious diseases in non-UK born populations in England, Wales, and Northern Ireland. A baseline report. London: HPA.

[3] Burnett A and Peel M (2001) "The health of survivors of torture and organised violence" BMJ 2001; 322: 606.

[4] Robjant K, Robbins I, Senior V (2009) "Psychological distress amongst immigration detainees: a cross sectional questionnaire study." Br J Clin Psychol 2009 Sep; 48 (Pt 3): 275-86.

[5] Robjant K, Hassan R, Katona C. "Mental health implications of detaining asylum seekers: systematic review." Br J Psychiatry 2009 Apr; 194(4): 306-12.

Prepared 18th November 2015