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Editorials

Torture and doctors’ dual obligation

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h589 (Published 03 February 2015) Cite this as: BMJ 2015;350:h589

Re: Torture and doctors’ dual obligation

In recent years, colleagues and I have examined several hundred asylum seekers who gave histories of torture, and had congruent scars and/or psychological damage, but who were subjected to discretionary administrative detention in Immigration Removal Centres (IRCs). Many were seriously, avoidably, and unlawfully harmed. Our experience accords with numerous reports by the Prisons Inspectorate (1). Many of us would agree with Sheather et al (2): “New approaches are therefore required to support health professionals confronted with violation of detainees.”
Recent practice has caused such severe re-traumatisation of numerous vulnerable individuals that they have required hospitalisation for psychosis. In seven others, courts have held that detention constituted inhuman and degrading treatment (3). The Home Office probably spends some £10M annually compensating unlawful immigration detention (4) and attendant legal costs.
These recurrent failures have complex causes.
- Doctors employed in detention centres have little time or training to document those vulnerable individuals who should not be detained according to Home Office policy and the law through the “Rule 35” process (5). Many of these doctors feel caught between their duties to their patients and those to their ultimate employers, the Home Office, eg conflicting loyalties. Yet they issued some 1500 or more Rule 35 reports last year.
- Home Office caseworkers who take decisions to detain, usually formulaically reject these reports as “not independent evidence” of torture.
- These factors intersect. When a report is rejected by a caseworker, the latter must send a “reasons for refusal” letter to the detainee and the doctor. According to detention service orders (4), the doctor should read and where appropriate respond to the refusal letter, setting out their reasoning. This rarely happens.
All doctors have another duty: to work within their competence or to refer a colleague to address patients’ clinical needs. This fundamental injunction is one of the GMC’s Duties of a Doctor (6). It is being universally ignored. Accordingly, in addition to the damage to patients, the doctors themselves are at risk.
As colleagues, we owe them practical assistance and support in complying with their undoubtedly difficulties. Medact (via our Preventing Torture working group) is establishing a forum for doctors working in IRCs to contact and interact with colleagues who have expertise in the documentation of clinical stigmata of torture. We hope the BMA, GMC, NHS England and professional indemnity bodies will support this initiative.
Confidential enquiries to ethics@medact.org

1) HMIP Inspection Reports for IRCs https://detentionforum.wordpress.com/resources-and-links/resources-and-i...
2) Sheather J et al. Torture and doctors' dual obligations. BMJ 2015;350:h589
3) Grant-Peterkin H et al. Inadequate mental healthcare in immigration removal centresBMJ 2014;349:g6627
4) Detention Service Order 17/2012. Application of Detention Centre Rule 35. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
5) Good Medical Practice, para 15c. General Medical Council. 2013. http://www.gmc-uk.org/guidance/good_medical_practice/apply_knowledge.asp

Competing interests: Frank Arnold has examined more than 200 survivors of torture during or after their detention in the UK. He is sometimes paid for doing so and producing expert evidence to the courts.

08 February 2015
Frank Arnold
Doctor
Medact
Grayson Centre, 28 Charles Square London N1 6HT