The British Medical Association is calling for immigration removal centres (IRCs) to be phased out and replaced with a more humane system of community monitoring because of concerns about the serious impact on the health of detainees.

The report, published on Monday, calls for sweeping changes to the way IRCs are run because of a range of concerns about issues including restraint, segregation, PTSD and the management of complex health conditions. BMA chiefs say a “fundamental rethink” is required by the Home Office.

While human rights campaigners have expressed concerns about immigration detention conditions for many years, it is the first time that the doctors’ union has made such a strong call.

The BMA says it has published this report because of its growing concern about health and human rights in detention settings.

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The UK operates one of the largest systems of immigration detention in Europe, holding around 3,500 individuals in 11 IRCs at any one time.

The new report, Locked Up, Locked Out: health and human rights in immigration detention, finds that immigration detainees are “vilified and ignored in equal measure” behind bars.

The BMA is demanding action from government and policymakers on aspects of detention policy and practice that are detrimental to health. While immigration detention continues, it aims to support doctors and other members of the healthcare team in providing the best possible care for those detained.

“In our view, the detention of people who have not been convicted of a criminal offence should be a measure of last resort,” the report states. “Detention should be reserved for individuals who pose a threat to public order or safety. Ultimately, we believe that the use of detention should be phased out and replaced with alternate, more humane means of monitoring individuals facing removal from the UK.”

The researchers add that while detention continues, it should be time-limited, with asylum seekers and other migrants detained for the shortest possible time.

The report is highly critical of the Home Office and also of NHS England, which has been responsible for commissioning healthcare in IRCs in England since 2013.

“Problems with the accuracy and timeliness of health assessments, availability of services, staff shortages, and ensuring continuity of care have all been identified as adversely impacting on the standard of care provided in detention. For some detainees with complex health needs, there is a question of whether their needs can be met in the detention setting,” the report states.

Of particular concern to the BMA is the way doctors may find their ethical obligations to patients in conflict with the demands of the centre staff and Home Office officials who may try to draw them into issues around restraint and segregation.

The rule 35 process is supposed to highlight specific vulnerabilities, such as torture and PTSD relating to detainees, but the report says the rule 35 process is not always properly understood by detention centre staff. The BMA is calling for a pre-detention screening process to be introduced before individuals are detained to highlight those who are too vulnerable to be locked up.

The practice of moving detained individuals into and between IRCs at night or early in the morning should end, says the BMA, unless there are exceptional reasons for doing so. Forced restraint and segregation should be used only as a last resort.

In particular, segregation units should not routinely be used as a way of managing individuals at risk of suicide, self-harm, or those experiencing a serious mental health crisis.



The authors of the report emphasise that doctors must be able to act with complete clinical independence and ensure that principle is enshrined and respected across the immigration detention estate. Doctors should never be involved in disciplinary or non-therapeutic activities within IRCs.



“International standards of medical ethics make clear that any medical involvement in these measures will be in direct contradiction with the doctor’s primary duty to patients.” the report states. “Doctors should therefore resist formal or informal involvement with centre administration or security tasks, such as the use of force or restraint.”

Concerns have been raised about the confidentiality of health records in IRCs, with detainees being asked to consent to their medical records being shared with the Home Office.

Commenting on the report, Dr John Chisholm, BMA medical ethics committee chair, said: “Migrants and asylum seekers shouldn’t have their health-related human rights infringed and must be able to access healthcare adequate for their needs. The BMA hopes to work with policymakers and other organisations to restructure and develop policies that meet the health needs of people in detention and ensure doctors can meet their ethical and professional obligations. A fundamental rethink of current policies is required.”

Emma Ginn, coordinator of the charity Medical Justice, which works to improve the health of immigration detainees, said: “Medical Justice welcomes the call from the BMA to phase out immigration detention. We agree wholeheartedly and call for immediate action. The BMA’s report echoes concerns we have been raising for over a decade of many disturbing healthcare failures. The Home Office and NHS England would be wise to take heed of such an authoritative voice as the BMA.”

A government spokesperson said: “Detention and removal are essential parts of effective immigration controls, especially in support of the removal of those with no lawful basis to stay in the UK.



“It is vital these are carried out with dignity and respect and we take the welfare of our detainees very seriously. We operate on the basis of a presumption against detention, and the adults at risk policy aims to improve our approach to identifying individuals who may be particularly vulnerable to harm in detention.



“The provision of 24-hour, seven-days-a-week healthcare in all immigration removal centres ensures that individuals held there have ready access to medical professionals and levels of primary care in line with individuals in the community.”

