Intended for healthcare professionals

Rapid response to:

Clinical Review

Post-traumatic stress disorder

BMJ 2007; 334 doi: (Published 12 April 2007) Cite this as: BMJ 2007;334:789

Rapid Response:

PTSD and retraumatisation in asylum seekers


Perhaps for reasons of space, Bisson’s review (1) does not mention
torture, a depressingly common cause of Post Traumatic Stress Disorder
(PTSD), or the risk of re-traumatisation in such patients. UK doctors are
most likely to encounter these problems among asylum seekers, especially
those who have been detained in removal centres after being “failed” by
the Home Office and Immigration Judges. The number of such cases probably
exceeds 5000 per annum.

It was accepted in the drafting of the Detention Centre Rules (2) and
underlying statutory instruments that detention of torture survivors was
unduly likely to cause severe psychological harm and should only occur
under “exceptional circumstances.”

Indeed doctors working in detention centres are required to report to
the Immigration and Nationality Department(IND)about anyone whose health
is likely to be harmed by detention, which can be of indefinite duration,
exceeding one year without any conviction in some cases.
Sadly, receipt of such reports (when sent) has heretofore resulted in
inaction and significant misrepresentation by IND:

1) In a report on Harmondsworth DC, Her Majesty’s Chief Inspector of
Prisons identified 57 such “torture reports” sent to IND over the first
half of 2006 (3). Not one of these is known to have resulted in any action
by IND to investigate the accuracy of such reports.

2) In a recent statement to the House of Lords (4), Baroness Scotland
alleged that all suitable cases where an immigration detainee is reported
to have suffered torture are referred by IND to the Medical Foundation for
the Care of Victims of Torture for assessment. This is wholly untrue. I
have worked at the Foundation and recently checked with their management.
NO such case has ever been referred to the Foundation.

3) In the past 18 months, colleagues in the Medical Justice Network
and I have seen at least 25 detained asylum seekers with strong physical
evidence of torture (including cigarette burn scars and stigmata of
falaka) as well as fulfilling all necessary criteria for a diagnosis of
PTSD. In some cases, we have been able to provide medico-legal reports
which have assisted their release by judicial decision. This has usually
been resisted by the Home Office.

Doctors, especially general practitioners, whose asylum seeking
patients have evidence they were tortured before coming to the UK, who
have PTSD as a result, and who are at risk of detention, may wish to
supply them with a letter (or full medico-legal report) outlining evidence
to that detention would be unduly harmful. This would go some way to
reducing the very substantial numbers who suffer retraumatisation while
seeking refuge.

Frank Arnold

For the Medical Justice Network

1) Bisson JI. Post-traumatic stress disorder. BMJ 2007; 334: 789-93.

2) Detention Centre Rules 2001 (item 35).

3) HM Chief Inspector of Prisons. Report on an unannounced inspection
of Harmondsworth Immigration Removal Centre 17–21 July 2006.

4) Baroness Scotland of Asthal. [HL982], Hansard. January 8, 2007.

All internet references accessed 15 April 2007.

Competing interests:
FWA helped to found the Medical Justice Network. For assisting detained hunger strikers to obtain adequate medical care, he was reported to the GMC by the management of a detention centre, against the wishes of the patients concerned. He is occasionally paid, under legal aid, for medico-legal reports.

Competing interests: No competing interests

15 April 2007
Frank W Arnold
Independent Doctor
Reading RG6 1QB
14 College Road