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Stop denying migrants their fundamental right to healthcare

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1971 (Published 12 April 2016) Cite this as: BMJ 2016;353:i1971

Re: Stop denying migrants their fundamental right to healthcare

The difficulties encountered by migrants in obtaining basic healthcare provisions are of great concern. The awareness and work undertaken by Médecins du Monde should be commended. An area of particular concern is of those known to authorities who are wishing to claim asylum in the UK placed within the detention system. Two UK based charities, Detention Action (1) and René Cassin (2), have highlighted the lack of rights of those in the detention system. At a recent event organised in conjunction with these two organisations, personal accounts of those previously detained in such UK Immigration Removal Centres (IRCs) were shared. Issues surrounding the appropriate and timely access to medical services were raised by previous detainees. Their stark accounts were echoed in two recent reports in which further criticism has been levied at the IRCs, the first being an 'All Party Parliamentary Group (APPG) Inquiry into the Use of Immigration Detention in the United Kingdom' (3) and the more recent 'Shaw Review into the Welfare in Detention of Vulnerable Persons' (4). Both reports highlight the absence of a uniform assessment tool for the initial health screening process in IRCs. Currently health screening is rushed, it can take place in the middle of the night after a lengthy journey and interpreters are not always used. There is little assessment of past trauma, mental health or systematic identification of communicable diseases despite this being high risk amongst detainees (3,4).

The speakers at the event described how response to medical concern is often delayed with access to medication being restricted. According to them the level of healthcare offered was limited to a nursing assessment providing 'paracetamol' as the mainstay of treatment for most complaints until symptoms become unbearable requiring urgent escalation. Waiting lists to see general practitioners are lengthy. An environment of mutual disbelief and mistrust exists between IRC staff and detainees in relation to matters of health. Non-observable physical symptoms such as "...pain (are) perceived as an excuse to get out of detention," the speaker shared. "We could be gone tomorrow, so they don't care about our medical problems". These comments were also findings of both the APPG inquiry and Shaw report (3,4).

Currently detention in the UK has no time limit and this causes major psychological distress or as put by the speaker "the entire experience was mental torture, the uncertainty, the lack of contact with the outside world and not knowing how long you could be there for". He further went on to describe the emotional account of seeing another detainee lie in a pool of blood following a suicide attempt. Both reports state many of the issues relating to individuals with mental health conditions are exacerbated. The Shaw Report further alludes to findings from different countries consistently showing that immigration detention has a negative impact upon detainee's mental health – mainly depression, anxiety and post-traumatic stress disorder (4). The narratives we heard suggest an alarming lack of counselling and access to psychiatric healthcare, with the main solution being "slipped sleeping tablets". Indeed in this regard it would appear that there has been a regression in services offered. Before August 2010, the policy was that individuals with mental illnesses would 'normally be suitable for detention in only very exceptional circumstances'. After this date, the policy was amended and stated that "those suffering from serious mental illnesses that cannot be satisfactorily managed in detention are only considered suitable for detention in very exceptional circumstances" 3 thus leaving this open to interpretation and detainees being placed inappropriately.

The issues do not stop there, when accessing services outside of the IRCs there is difficulty with restrained transfers to hospitals as they compromise confidentiality and hamper the ability of clinicians to undertake their consultations. Indeed, the British Medical Association acknowledges that doctors often feel pressurised to disclose patient information to IRC staff. Furthermore detainees have been forced to consent for their medical files to be shared with the Home Office (3,4).
History will not look upon us favourably, unless we, the healthcare profession act now to ensure the basic physical and mental healthcare needs of these individuals are met, particularly those who are known to the authorities. These conditions do not comply with the basic medical standards expected of westernised medicine. We live in unprecedented times with the biggest mass migration of people ever encountered. Whilst this places a huge strain on our NHS, we can and should do better. Healthcare should not be an area of compromise when it comes to basic human rights. NHS England is now in charge of the commissioning of healthcare in IRCs, however they have significant challenges and conflicts of interests to overcome to ensure refugees and migrants have the same rights and access to basic healthcare that we enjoy.

1 Detention Action UK. http://detentionaction.org.uk/
2 René Cassin. http://www.renecassin.org/
3 The Report of the Inquiry into the Use of Immigration Detention in the United Kingdom. A Joint Inquiry by the All Party Parliamentary Group on Refugees & the All Party Parliamentary Group on Migration. Available online https://detentioninquiry.files.wordpress.com/2015/03/immigration-detenti...
4 Shaw S. Review into the Welfare in Detention of Vulnerable Persons: A Report to the Home Office. 2016. Available online
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...

Competing interests: No competing interests

17 April 2016
Mohsin I Choudry
National Medical Director's Clincal Fellow and Core Surgical Trainee
Dr Denis Mayer, Foundation Year One Doctor
London, UK (Details on Request)