Intended for healthcare professionals


The UK’s Illegal Migration Bill will have grave consequences for health and human welfare

BMJ 2023; 380 doi: (Published 17 March 2023) Cite this as: BMJ 2023;380:p642
  1. Sophie McCann, migration advocacy adviser
  1. MSF UK

The UK government’s plans will inflict great harm on people fleeing violence and persecution, writes Sophie McCann

The UK’s Illegal Migration Bill, announced by the home secretary on 7 March 2023, will have devastating humanitarian and medical consequences for people seeking sanctuary in the UK. On a daily basis, we at MSF witness the grave impact worldwide of violent policies that focus on deterrence and containment to control asylum. We know that these practices cost lives.

This bill is supposedly aimed at preventing “illegal” immigration by punishing and effectively banning people who come to the UK irregularly—mainly by crossing the English Channel in small boats—from claiming asylum. This is particularly insidious policy making because, for most people seeking safety, virtually no safe and legal routes are accessible, as the government has systematically closed or severely restricted them. Consequently, many people are left with no choice but to attempt dangerous crossings to reach the UK—even with the threat of punishment if they arrive. The legislation is deliberately designed to inflict harm on, and dehumanise people seeking safety.

MSF teams around the world work with people who have been displaced by violence, persecution, and other hardships. Many are survivors of torture, trafficking, and sexual violence, or members of marginalised communities. Under the new bill’s stipulations, all of these people would be barred from receiving protection in the UK if they arrived without prior permission. This is in spite of the Home Office’s own data, which show that the clear majority of people crossing the English Channel go on to be granted refugee status.1

The bill allows authorities to detain—immediately and indefinitely—people who arrive in the UK irregularly, before they are removed to Rwanda, another “safe” country, or their country of origin. This is a colossal expansion of the official and de facto detention of people. Realistically, removing people seeking asylum from the UK will not be a workable policy and will simply strip people—including children, pregnant women, families, and survivors of torture and trafficking—of their dignity and rights. They will be contained, indefinitely, away from local communities, with no opportunity to claim asylum, insufficient access to healthcare, and no idea when, or even if their situation will change.

This uncertainty, lack of dignified treatment, and the conditions of detention have serious health consequences. In Greece, where MSF works with people seeking safety who are contained in isolated and highly securitised centres on Lesvos and Samos islands, our teams have seen many people with serious mental and physical health problems. Most people have fled conflict or persecution and have been exposed to appalling levels of violence during their migration journeys. Between September 2021 and September 2022, 40% of MSF’s patients with mental health problems on Samos had symptoms related to psychological trauma.2 Although the situation has now improved, our teams previously witnessed high levels of mental health suffering among the people there, exacerbated by deplorable accommodation conditions and a lack of information on their legal status or length of confinement. In 2022, our staff routinely treated patients with post-traumatic stress disorder, depression, and other mental health problems.2 The UK government has publicly stated that it views the Greek approach as a model for its own policy.

Harm on a bigger scale

We know that the health of people seeking asylum in the UK has already been harmed as a result of their detention in the UK. Delays in the asylum system have led to tens of thousands of people being accommodated for months or years in inadequate, unhealthy living conditions as they wait for their claims to be processed.3

In late 2022, bottlenecks in the system led to severe overcrowding at the Manston asylum processing centre in Kent, where people were forced to sleep on the floor of tents in unsafe and unsanitary conditions, resulting in outbreaks of scabies and diphtheria.4 By blocking entry to the asylum system entirely, the Illegal Migration Bill will recreate similar circumstances to those seen at Manston, but on a much bigger scale.

The Home Office has continued to issue adults and children whose age is disputed with notices of their removal to Rwanda, despite the policy facing ongoing litigation and with no imminent start date. This practice is clearly designed to instil fear and anguish among those targeted, their families, and the wider community. If the policy goes ahead, it will cause further human misery. In 2017-18, MSF worked on Nauru island, where the Australian government sent people seeking asylum for “offshore processing,” and our teams saw some of the worst mental health suffering in MSF’s 50 years of existence. We found that 60% of our patients experienced suicidal ideation, and 30% attempted suicide, including children as young as 9.5

These cruel and deplorable policies breach the UN Refugee Convention and will not stop people fleeing war, persecution, and other horrific realities from trying to seek safety in the UK. All this bill will do is inflict greater suffering, force people to take even more dangerous routes, and ultimately cost lives. The only realistic way to stop people making treacherous crossings across the English Channel is to urgently set up safe and legal routes to the UK, accessible to people of all nationalities, and commit to a fair, workable asylum system.


  • Competing interests: none declared.

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