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New Medical Justice report finds Home Office safeguarding mechanisms within immigration removal centres are flawed, ineffective and harmful


Analysis identifies failures at all levels of safeguarding process and across the detention estate

Date of Publication:
26 April 2022

New Medical Justice report finds Home Office safeguarding mechanisms within immigration removal centres are flawed, ineffective and harmful

26 April 2022

Medical Justice yesterday published a new report which considers whether the Home Office's safeguarding mechanisms within Immigration Removal Centres (IRCs) are working effectively.

Report coverYou can download the 40-page report, Harmed Not Heard, here.

For the report, Medical Justice analysed the clinical assessments of 45 of its clients detained in various IRCs across the UK. All of the immigration detainees were considered to be vulnerable and at risk of clinical harm due to detention.

Medical Justice noted: "These clients had numerous indicators of vulnerability: including histories of severe trauma, significant mental health issues, at risk of suicide and with evidence of deterioration in their mental state that had been caused by detention."

As the report explains, however, safeguarding mechanisms led to only one person being released from detention due to being recognised as at risk, which leads Medical Justice to conclude that the Home Office process to identify and release vulnerable detainees is systematically flawed.

"There is a failure to identify people at risk of harm, protect them, and route them out of detention," the report states.

Medical Justice commented: "The immigration detention population has complex needs but this report highlights serious failures in healthcare for highly vulnerable people, often with a history of trauma: failures to screen for post-traumatic stress disorder, inadequate identification of risk of suicide and a lack of identification and reporting of safeguarding concerns."

Medical Justice found that there were failures at all levels of the safeguarding process for its 45 clients and the failures apply across the detention estate. A Medical Justice spokesperson said that the extensive Home Office failures identified meant that safeguarding processes are "so ineffective they are basically fictional."

The report states: "All of the case set of people assessed by Medical Justice clinicians were considered to be at risk of harm due to detention. None had a Rule 35(1) report included or referenced in their medical records to identify that their health was likely to be harmed by detention. A review of the information in the medical records completed before the Medical Justice assessment found that 67% of the case set of people had no communication explicitly addressing the risk to their health by continued detention. This information suggests a serious systemic problem. The safeguarding system relies upon IRC healthcare identifying any harm likely to be caused by detention and reporting this via Rule 35(1) reports. Yet the evidence here is that this did not happen for an overtly vulnerable group of individuals, all identified by Medical Justice clinicians as having mental health issues and the vast majority having already experienced deterioration in their mental health."

The report also provides useful background on safeguarding law and policy, which is found to have a "a chequered history" and to be "troublingly erratic". "[T]here is there is a lack of accessible, straightforward guidance on the specific safeguarding processes in IRCs in a single source for IRC healthcare staff," the report notes.

The introduction of the Adults at Risk policy in 2017 is described as a regressive step that has diluted the protection for the people most likely to be harmed by immigration detention.

In concluding, Medical Justice said: "Fundamentally, the responsibility for the legal and policy framework for adequately safeguarding vulnerable people in detention rests with the Home Office as the government department using immigration detention powers. Whilst this report provides evidence of systemic failures within the IRC healthcare departments, these have occurred within an inadequate and opaque Home Office safeguarding policy framework which fails to prioritise safety and safeguarding in detention decisions. … This is a system in which those held in detention are, ultimately, harmed and not heard."