Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

Hunger strikers are not properly monitored at detention centre, doctor says

BMJ 2005; 331 doi: (Published 21 July 2005) Cite this as: BMJ 2005;331:178
  1. Jerome Burne
  1. London

    Asylum seekers at a detention centre in the United Kingdom are not being given adequate access to emergency care, a doctor recently called in to attend to two Zimbabwean detainees on hunger strike said last week. He also said that claims by detainees being held at Harmondsworth Detention and Deportation Centre, west London, that they were tortured in Zimbabwe do not seem to have been properly investigated.

    “The first man I saw had been without food for 37 days….He was emaciated, his blood pressure was 90/60 [mm Hg], his pulse 130 (sitting), and he clearly needed emergency treatment,” said Frank Arnold, who is a specialist in wound care and a volunteer worker at the Medical Foundation for the Care of Victims of Torture.

    The man, known as M, was protesting about being sent back to Zimbabwe, where he claimed his life would be in danger.

    Dr Arnold, invited in and speaking at the patients' request, said that the notes he was given were “inadequate.” They contained records neither of M's blood pressure at admission nor that blood tests had been done to monitor his electrolyte levels while on hunger strike.

    “Regular checks should have been made on his potassium levels to give warning of possible cardiac disorders. Staff said blood test results would normally come back in two weeks. In a situation like this you need results in hours.”

    A spokesman for the centre said that M had refused blood tests. M told Dr Arnold he was protesting because the centre had not allowed him to see the results of earlier tests, as was his right.

    Along with the member of parliament Kate Hoey and the former president of the Social Democratic party Shirley Williams, Dr Arnold was a speaker at a press conference at the House of Commons last Friday to urge the government to stop returning asylum seekers to Zimbabwe because of fears of ill treatment. Removals have already been temporarily halted, pending a court case on 4 August.

    Dr Arnold described how M, although too weak to stand or walk unaided, was handcuffed while being taken to hospital in the presence of three guards. He said, “This was despite the fact that I had told the manager of the centre that in my professional opinion handcuffing was wholly inappropriate.” It was only after Ms Hoey had complained in the hospital that they were removed.

    Fears that security measures taken when detainees were transported were overriding proper medical practice were echoed by Sherman Carroll, director of public affairs at the Medical Foundation for the Care of Victims of Torture. “We have a number of detainees brought here in cuffs,” he said. “The question is: at what point does a doctor's intervention cease to carry weight?”

    After the press conference Dr Arnold said that both M and another detainee he saw at the Harmondsworth centre say that they had been tortured in Zimbabwe. He said that M's medical notes show that he had told the staff about this but that no effective action seems to have been taken to investigate his claims.

    The second man, known as H and also on hunger strike, was sent for emergency care at Dr Arnold's insistence. When Dr Arnold examined him some days later in hospital he found signs that were consistent with torture.

    “I saw lesions consistent with having been severely beaten on the soles of his feet, of having cigarettes put out on his arms, and having been whipped with a sjambok [animal hide whip],” said Dr Arnold. H told Dr Arnold that he came to the UK in 2001 and applied for asylum. In 2003, when his mother became ill, he returned to Zimbabwe and was detained at the airport on arrival and then tortured. He was eventually able to flee back to the UK in January 2005.

    “One might think that this was evidence that he should not be sent back,” said Dr Arnold. “Yet the Home Office appears either not to know or not to want to know these things.” According to Mr Carroll, detention centres have a duty to follow up allegations of torture.

    Dr Arnold has no concerns about the equipment in the Harmondsworth medical centre and is at pains not to criticise individual staff. “I feel they are working in a regime that creates conflicts between their professional duty of care and the demands of their employer,” he said. “If I was working there I would feel desperately hamstrung.”

    A Home Office spokesperson said that that it could not comment on individual cases and provided this written reply: “The Harmondsworth Removal Centre provides a level of care equivalent to the NHS. The healthcare manager has considerable expertise in dealing with hunger strikers and the care during and following such acts. All detainees are seen by a medical practitioner at the time of arrival. Details of any person suspected of being a victim of torture will be passed on to the relevant immigration manager.”