Intended for healthcare professionals

Opinion

Public health and human rights must be prioritised over inhumane immigration policies

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2709 (Published 09 November 2022) Cite this as: BMJ 2022;379:o2709
  1. Amy Stevens, public health registrar,
  2. Yusuf Ciftci, policy and advocacy manager
  1. Doctors of the World UK
  1. Twitter @AmyJStevens1@yusufciftci42

The UK government has left us in no doubt that it is willing to violate human rights and harm people’s health in pursuit of its immigration agenda, say Amy Stevens and Yusuf Ciftci

Recent weeks have thrown a spotlight on the UK’s escalating inhumane treatment of people forced to flee their homes because of war and persecution. In the past two weeks alone, a Dover immigration centre had petrol bombs thrown at it1; the HM chief inspector of prisons released a damning report on the state of short term holding facilities;2 and outbreaks of diphtheria and scabies, along with a case of meticillin resistant Staphylococcusaureus, were reported in an immigration processing centre in Manston, Kent.3

The UK received eight asylum applicants per 10 000 population in 2020/21—far fewer per capita than many other European countries—and even though there has been an increase in asylum applications, this is not, as is claimed, unprecedented.4 As the number of people seeking asylum is subject to external factors, fluctuations are to be expected. To date this year, around 40 000 people have arrived in the UK by crossing the English Channel—a figure that experts say should be manageable.5

The challenges we are seeing are the result of a long term backlog in asylum claim decisions. By the end of 2021, the Home Office had 101 000 outstanding cases.4 As government policy does not allow people seeking asylum to work while their claim is being processed, those that cannot support themselves are housed in accommodation funded by the Home Office. Yet slow decision making on claims has resulted in a shortage of community based Home Office accommodation, and tens of thousands of people are currently inappropriately housed in contingency accommodation, including hotels and former military barracks.6 As even this accommodation has become in short supply, due to mismanagement by the Home Office and its contractors, it has inevitably led to overcrowding and unacceptable lengths of stay at the 24 hour processing centre at Manston. In short, what we are seeing is not a refugee crisis, it is a political crisis, with vulnerable people paying the price of ministerial decisions.

Despite claims to the contrary by home secretary Suella Braverman, the United Nations Refugee Agency has stated that a “clear majority” of people arriving by boat on the English coast are refugees in need of humanitarian protection.7 Indeed, one report estimated that 70% would be granted refugee status if the UK government did not refuse to consider their claim because of their mode of arrival.8

People seeking humanitarian protection have often experienced multiple traumas associated with the circumstances that have forced them to flee their country of origin and make the difficult and often dangerous migration journeys. Many have experienced physical and sexual violence, persecution, torture, human rights abuses, extreme poverty, and exploitation by human traffickers. To arrive in the UK to seek safety and to be exposed to the conditions described in the report on short term holding facilities by the HM chief inspector of prisons only exacerbates the trauma.2

Appalling conditions

The report describes exhausted detainees being regularly held for more than 24 hours in non-residential accommodation; unaccompanied children being detained for too long; detainees unable to use toilets in private in some areas; a failure to consistently record detainees’ vulnerability to inform subsequent assessments; and weak governance of staff security clearances and training to work with children and vulnerable adults. Food provision was described as unhealthy and not meeting all dietary requirements. Detainees are at a high risk of physical and mental health problems, yet governance of healthcare processes at the holding facilities was described as weak.

The overcrowding at the Manston processing centre, which reportedly reached 2.5 times its 1600 capacity of detainees, has left it vulnerable to the additional risks of infectious disease outbreaks and fire.9 The situation at Manston draws worrying parallels with the widely criticised conditions at the Napier Barracks contingency accommodation. The site had a large covid-19 outbreak in 2021 and residents held protests and hunger strikes in response to the appalling environment they were being held in.10

Doctors of the World UK’s lived experience advisory group has described how short term processing facilities, including Manston, often do not have adequate facilities for people to rest, leaving both adults and children trying to sleep between chairs with blankets. They gave accounts of constant questioning from staff about their reasons for entering the country. Their phones were confiscated, leaving them unable to inform their families of their whereabouts or safety.

Events in Manston are the latest addition to a growing body of evidence documenting the Home Office’s consistent failure to accommodate people seeking asylum in a safe environment that meets basic human needs.1011121314 This failure extends across processing and detention centres and initial, contingency, and dispersal accommodation.

Harming people’s health

The association between housing and health is undisputed. Poor living conditions are associated with infection, unintentional injury, poor mental health, vulnerable household relationships, and poor early childhood development. The adverse impact of detention on the mental health of people seeking asylum is well documented, and emerging evidence shows that being housed in contingency accommodation also causes a deterioration in mental wellbeing, with depression and thoughts of suicide a recognised risk.12

Placement in mixed housing and hotels is distressing for women and girls who have experienced sexual and gender based violence on their migration journey. One research study reported that sexual harassment in Home Office accommodation is hard to report and not taken seriously.13 Safeguarding failures have left children who are housed in contingency accommodation at risk of human trafficking and sexual assault.1516 The right to health irrespective of an individual’s legal or administrative status is enshrined in numerous international treaties ratified by the UK. Yet research has shown that initial and contingency accommodation is unsafe for people seeking asylum—not only as a consequence of the direct risk of harm from its conditions, but also due to the lack of access to adequate and appropriate healthcare services.12

The UK should be capable of developing a fair, humane, and effective refugee system, in keeping with our obligations under international humanitarian and human rights law, and which offers safe routes to the UK for people seeking asylum. Instead, the UK government has left us in no doubt that it is willing to violate human rights and harm people’s health in pursuit of its immigration agenda.

The medical community should not stay silent in the wake of these violations. Doctors of the World UK appeals to fellow health professionals to join us in calling on the UK government to take urgent action to ensure that people seeking asylum are accommodated within communities and in a humane way. People should not be placed in conditions that risk harming their physical and mental health, and they should have meaningful access to full National Health Service care. The use of detention centres and large scale facilities, including military sites, to accommodate people seeking asylum should be put to an end. Finally, the backlog in asylum claims should be tackled as a priority to ease tension on the asylum accommodation system, enabling people to move forward with their lives and begin the process of recovery from the trauma they have experienced.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References