John Chisholm: Doctors have duty to oppose detention of asylum seekers

The BMA is campaigning for the rights of asylum seekers.
The BMA is campaigning for the rights of asylum seekers.
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SINCE the first ‘detention unit’ opened in 1970 on the outskirts of Heathrow Airport, with space for just 44 people, 
the UK now detains 28,000 people 
each year.

There are 11 immigration removal centres (IRCs) across the UK, such as Morton Hall in Lincolnshire, along with a handful of smaller facilities based in ports and airports. In total, they can hold up to 3,500 people at any one time.

People are not detained in IRCs because they have committed a crime; they are people who have not obtained a visa, or haven’t been able to comply with the terms of their visa. They could be asylum seekers fleeing persecution overseas who have had their claim rejected. The decision to detain is purely administrative, made by Home Office officials and not judges.

The UK is only one of a handful of European countries where no time limits are imposed on detention. This means the Home Office can confine people for weeks, months or, in some cases, years.

The BMA believes the detention of migrants should be a last resort, reserved for people who are a risk to public safety, and that immigration detention must be phased out.

Current detention policies and practices are detrimental to the health of migrants and asylum seekers, and doctors find it more and more challenging to provide the quality of healthcare these patients deserve.

People may ask why the BMA would get involved in this issue but, as a professional association and independent trade union for doctors, we promote fundamental human rights in healthcare. We advocate for individuals and the marginalised whose rights are being violated.

This is why the BMA’s medical ethics committee produced a report, Locked Up, Locked Out, about the health and human rights of people in immigration detention in this country.

The report paints a complex picture of the challenges doctors face providing adequate healthcare in immigration removal centres and the threats to detainees’ health rights.

Rates of mental illness are staggering and evidence points to a link between detention and mental health problems. The Royal College of Psychiatrists says “the very fact of detention… militates against successful treatment of mental illness”. The quality and range of specialist healthcare services provided, and the level of staffing, varies from institution to institution so there’s no consistent standard.

An unannounced inspection of Morton Hall, one of two centres in the north of England, earlier this year found violence, self-harm and drug use had increased and there had been “a significant decline in safety”, illustrating how these environments make it difficult to safeguard patients’ health.

Stephen Shaw, former prisons
and probation ombudsman, conducted an independent review into the welfare
of vulnerable people in detention
and visited Morton Hall two days
before the centre saw its fourth death 
of 2017.

Doctors working in immigration detention feel a deep frustration at the daily hurdles they have to leap to deliver the ethical and legal obligations they owe their patients.

Sadly, it’s an uphill struggle convincing the public of the importance of standing up for detainees’ rights, as the issue of immigration, in general, has been made into a political hot potato.

Even the most committed politician may concede there are few votes to be won in championing the rights of the detained.

Our report outlines the problems and provides guidance to doctors so they can do their best by patients in immigration removal centres, but the problems won’t be rectified without a meaningful shift in policy and practice.

Until immigration detention is replaced with more humane means of monitoring individuals, there must be 
an overhaul of healthcare to meet the needs of some of the most vulnerable in our society.

Dr John Chisholm is chairman of the BMA medical ethics committee.