New report documents how vulnerable people continue to suffer harm and inadequate care in UK's detention centres
Medical Justice has published its first annual review on the state of healthcare and harm in immigration detention in the UK, based on a detailed analysis of clinical and other evidence from 73 of its clients.
You can download the 56-page report here.
The organisation, which advocates for an end to immigration detention, says its first annual report marks the beginning of important work to document and scrutinise the effectiveness of safeguarding measures within detention centres. By providing detailed statistical and clinical findings, the report offers a snapshot of the state of harm and healthcare in immigration detention in 2024. This baseline will enable ongoing year-on-year scrutiny, helping to track whether the system improves or deteriorates over time.
The report highlights a pattern of mistreatment and poor conditions at immigration removal centres (IRCs) in 2024, and the continuing systemic failure of clinical safeguards to protect vulnerable people. Medical Justice notes that in a July 2024 report on Harmondsworth IRC, His Majesty's Inspectorate of Prisons for England and Wales (HMI Prisons) said they had encountered the worst conditions ever seen in immigration detention.
Among the 73 clients reviewed for Medical Justice's annual report, 82% were survivors of torture, 63% reported a trafficking history, and 91% exhibited symptoms of post-traumatic stress disorder (PTSD). Nearly a quarter had self-harmed, and over three-quarters had experienced suicidal thoughts. Despite these severe vulnerabilities, individuals were detained for up to two years. Given that 90% of clients were later released, Medical Justice questions whether their detention was ever justified.
The report examines who was detained, where, and for how long, and draws on clinical assessments to highlight health vulnerabilities and the harm caused by immigration detention. The review assesses failures in safeguarding processes, the adequacy of healthcare provision, and whether detainees' medical needs were met. It also covers the use of segregation and force, deaths in detention, protests and resistance, detention in prison under immigration powers, and the disruption of continuity of care.
In particular, the report highlights what it calls a "dysfunctional" safeguarding system. Medical Justice raises serious concerns about the effectiveness of Rule 35 safeguards, which are meant to help IRC doctors alert the Home Office to individuals at risk of harm in detention.
The report states: "Medical Justice continuously finds the Rule 35 safeguard to be extremely flawed in terms of the lack of completion of Rule 35 (1) and (2) reports (on those at risk of being injuriously harmed by detention or at risk of suicide), the quality of information in the Rule 35 report and waiting times for a Rule 35 appointment. Where Rule 35 reports are completed, we continue to see IRC GPs giving inaccurate information about the individual's needs being met in detention via interventions such as referrals or care under the mental health team, providing assurances that individuals are 'stable' or even, 'fit for detention', in cases where our clinicians have identified serious and deteriorating mental health issues, or not providing or giving limited information relating to the client's vulnerabilities to the Home Office for them to fully consider whether the person's detention should be maintained."
In addition, delays in Rule 35 appointments and reports remain a serious concern, with potentially life-or-death consequences. While some detainees among Medical Justice's clients were seen quickly, others faced long waits - in one case, over three months passed between a medical need being identified and the assessment taking place. These delays meant the Home Office may have remained unaware of individuals' risks, failing to review their detention accordingly. In one case that Medical Justice described as "shocking", a person who had attempted suicide in detention had to wait more than two weeks for a Rule 35(2) report to be completed.
Medical Justice continues to raise serious concerns about the quality of healthcare in immigration detention. The report highlights repeated failures to diagnose mental health conditions, including 47 cases where detainees were diagnosed by Medical Justice clinicians with previously unrecorded conditions. PTSD was missed or overlooked in 31 clients, despite its known risk of worsening in detention. The report also highlights a lack of psychological therapy in immigration detention, with many detainees offered only medication as a default response to complex mental health needs. Despite clinicians sending 71 letters with clinical findings and recommendations, in many cases there was no evidence of action taken by IRC healthcare staff.
Overall, Medical Justice concludes that the detention system is broken beyond repair. Safeguards intended to protect vulnerable individuals routinely fail in practice, leaving people to languish in detention for months or even years. In many cases, detainees only access help through chance encounters or word of mouth, connecting them with support organisations like Medical Justice that can advocate for their health rights and challenge unjust detention.
Medical Justice warns that without proper support, interpretation, and legal representation, vulnerable people are unlikely to be identified or released. The organisation further warns that recent political developments and rhetoric from the Labour government are likely to lead to a rise in detention numbers in 2025, increasing the risk that more vulnerable people will be harmed and rapidly removed without adequate legal support - a trend already evident in their 2025 casework.