16. Memorandum from the Medical Foundation
for the Care of Victims of Torture
1. The Medical Foundation for the Care of
Victims of Torture has helped more than 35,000 people with medical
treatment, psychological support and practical assistance at its
north London treatment centre since it was established in 1985.
It is the only organisation in Britain dedicated solely to helping
survivors of torture and organised violence and their families.
The Medical Foundation has a recognised expertise in the documentation
of torture. We currently prepare more than 1,000 medico-legal
reports per year.
2. The Medical Foundation is an independent
charity (company limited by guarantee, registered in England no
2398586, charity reg no 1000340).
3. The Medical Foundation is staffed by
approximately 210 volunteers and employees, including medical,
clinical and professional support staff. Essential to our services
is our team of 95 regular and occasional interpreters, who facilitate
communication between staff and clients in some 60 languages.
4. The Medical Foundation will limit its
submission to torture survivors who may, because of their past
experiences, be more at risk of suicide or self harm. The Committee
is referred to our publication Protection Not Prison: Torture
Survivors detained in the UK[189].
Six main recommendations were made in that study:
— greater use should be made of Port
Medical Inspectors to carry out initial medical examination of
asylum seekers;
— factors telling against detention
should be recorded when the decision to detain is made;
— comprehensive physical and mental
health screening should be offered to all on arrival in detention;
— staff in detention facilities should
receive training to recognise and deal with health care issues,
including those of torture survivors;
— legal representatives should ensure
that any medical evidence of torture is sent both to the section
of the Home Office that deals with the decision to detain, and
to the section that considers the asylum application;
— Home Office officials reviewing a
decision to detain should check whether there is any information
on the asylum file relating to a history of torture.
5. These recommendations have not or have
not adequately been followed up, in the view of the Medical Foundation.
Page 17 of the said report deals with our concerns regarding the
mental health of the subjects of the report and refers to one
particular case where a torture risk had been unobserved:
The files of seven of the 15 men with psychological
problems mentioned that medication was being prescribed, usually
sleeping tablets or antidepressants. The fact that something was
prescribed does not necessarily mean that the treatment was adequate.
There were a few cases where the data suggested that the case
was not handled appropriately. One of these (16125) concerned
a man who was detained, first in Tinsley House and then in HMP
Rochester after his appeal was dismissed. His history of torture
is given on page 6. He was receiving medication in Tinsley House
and was examined by a GP there on account of his erratic behaviour.
The GP reported that it was not in the patient's interest to be
sent to a mental hospital, since his detention was only for the
purposes of removal to his country of origin. His solicitor believed
he was mentally ill and arranged for a consultant psychiatrist
to visit. By this time the man had been detained for two months.
The consultant reported that he was suffering from paranoid schizophrenia
and that inpatient psychiatric care was urgently needed. He was
said to be a serious suicide risk and not fit to travel. He was
transferred to a secure psychiatric unit. It is clear in this
case that Tinsley House failed to deal with the case appropriately.
The GP's view that psychiatric treatment should not be pursued
for a detainee who was to be removed was patently wrong.
6. The Medical Foundation does not believe
that the situation has improved since these case studies were
put forward in 2001. The Medical Foundation remains concerned
that no mechanism exists (notwithstanding the Detention Centre
Rules) to identify torture survivors in detention so as to ensure
that adequate consideration be urgently given to the question
of their continued detention. Indeed the Immigration Service Detention
Services were put on notice of similar issues in HMIP's reports
on Removal Centres and specifically Strategic Recommendation 10:
Protocols should be agreed for the release of
medical information, with consent, to the immigration authorities
and detainees' representatives, if such information is relevant
to fitness to detain or the detainees asylum claim, and the action
that should follow.
7. However, while accepting the concerns
raised, Detention Services were unable to offer a concrete and
immediate solution in the Action Point proposed:
Rule 35 of the Detention Centre Rules 2001 already
provides for the reporting of health matters likely to be affected
adversely by detention and on any case where the centre doctor
is concerned that the detained person may be a victim of torture.
Systems are in place in removal centres and the Immigration Service
to ensure that such information is transmitted and taken into
account in the context of continued detention or the consideration
of the persons asylum claim. There are however, complex issues
of disclosure and the Immigration Service is looking at ways in
which the flow of information might be improved consistent with
the requirements of patient confidentiality.
8. This response concerns the Medical Foundation.
Our own report dated 2001 (the year in which the Detention Centre
Rules came into force) highlights the very issue that Detention
Services is only now turning its attention. It was pointed out
to Detention Services at its User Group meeting of 10 June 2003
that:
. . . the (Detention Services) Operating Standard
on Health was insufficiently robust on ensuring that action was
taken in Removal Centres in respect of victims of torture . .
. the proposed action plan should refer to the EU Directive on
Minimum Standards for the Reception of Asylum Seekers[190]
(January 2003) which required the Secretary of State to lay down
minimum standards and that the Immigration Service would be remiss
if it did not take the Directive into account.
9. The Medical Foundation has also offered
to discuss the issue of confidentiality and has in the past suggested
to detention Services that these issues are fully addressed in
the BMA Handbook on Human Rights[191].
Doctors under a dual obligation are examined at length therein.
The Medical Foundation considers that, if the will truly existed,
the "complex issues of disclosure" could have been addressed
some time ago.
10. Unless and until the Immigration Service
Detention Services apply themselves to the real risks inherent
in maintaining the detention of torture survivors (identified
and unidentified) then cases similar to those in our study of
2001 will continue to emerge and the risk of suicide and self
harm among torture survivors in detention centres remains a real
risk.
16 September 2003
189 Dell, S & Salinsky, M, Medical Foundation for
the Care of Victims of Torture, 2001. Back
190
203/9/EC of 27 January 2003. Back
191
The Medical Profession and Human Rights: Handbook for a changing
agenda. BMA 2001. Back
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