Joint Committee On Human Rights Written Evidence


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


 
previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2004
Prepared 26 January 2004