Rwanda plan: Doctors express concerns over patients’ distress
Published 30th September 2022
On September 23, Doctors of the World UK sent a joint letter to Prime Minister Truss, signed and endorsed by fellow medical organisations and bodies, asking her to abandon the detrimental Rwanda plan looking to forcibly expulse people seeking safety in the UK.
The letter said that, to doctors and representatives of leading medical bodies, it is apparent that the scheme is already making a severe impact on people’s health and wellbeing, as outlined by a recent report by the charity Medical Justice.
For more information, contact Doctors of the World UK Communications and Engagement Manager at mdelaroche@doctorsoftheworld.org.uk
Read the letter:
Dear Prime Minister Truss,
We are writing jointly as representatives of leading medical bodies in the UK to express concern about the severe impact that your decision to remove asylum seekers to Rwanda is already having on people’s health and wellbeing.
As stated in a public statement from June 20221, we are horrified by the UK Government’s plans, as laid out in the ‘Migration and Economic Development Partnership’ to forcibly deport people seeking protection in the UK to Rwanda, with no option to return. As you will be aware, the only removal flight to Rwanda scheduled as part of this policy did not depart and no forced expulsion has taken place so far. Yet the scheme is already causing profound harm to people, whilst they are held indefinitely in immigration detention pending their removal to Rwanda at some unspecified point in the future. The chair of the Royal College of GPs Council spoke out in April, on the mental and physical harms of detention and deportation on refugees and asylum seekers as well as on the GP experience of providing care to an already vulnerable and distressed population.2
A recent report by the charity Medical Justice has documented the experiences of 36 people with whom they have worked and who have been targeted for removal to Rwanda. All arrived in the UK since mid-May 2022.
The 36 extremely vulnerable people includes individuals from Albania, Egypt, Eritrea, Iran, Iraq, Sudan, Syria and Vietnam. They include men, women, age disputed children / young people, and some who have family in the UK. Many of these asylum seekers have a history of trafficking, torture and trauma, and have serious mental health conditions, including Post Traumatic Stress Disorder (PTSD) and psychosis. Some have self-harmed and/or expressed suicidal ideation whilst in detention, including one person who including one person who attempted suicide twice whilst in detention. No individual should be forcibly removed to another country for seeking safety and protection in the UK. In addition, the current screening process fails to identify people with specific vulnerabilities, including health conditions.
The report documents how people are detained upon arrival, transferred to an immigration removal centre and issued with a Notice of Intent (NOI) for removal to Rwanda. Many people who were served with an NOI did not understand its content or its gravity. Several people received the NOI in English without a written translation in their first language, and many people have not had adequate legal advice, creating confusion and uncertainty. One client was not even aware that he had been issued an NOI – a Medical Justice caseworker spotted it by chance in the client’s paperwork and had to tell him what it meant.
We are concerned that such a vulnerable group of people are being detained upon arrival and issued NOIs, given the research consensus on the detrimental impact of detention on mental health3, the lack of pre-detention screening and the evidence of ineffectual safeguards in IRCs4.
Medical Justice doctors conducted clinical assessments for 17 people issued with an NOI for removal to Rwanda, and documented signs of severe harm due to being detained in immigration detention and the prospect of removal to Rwanda. The doctors found that the threat of being deported to Rwanda is further exacerbating people’s mental health conditions, causing them to experience fear, confusion, and uncertainty about their safety and a loss of hope. This is particularly concerning given the prevalence of mental health conditions within the detained population. Research has shown that “a high proportion of immigration detainees display clinically significant levels of depression, PTSD and anxiety, as well as intense fear, sleep disturbances, profound hopelessness, self-harm and suicidal ideation”.5 Specifically, 16 out of the 17 had symptoms of, or were diagnosed with, depression. This is concerning as research has identified hopelessness as the biggest risk factor in predicting suicidal ideation in individuals with depression.6
Medical Justice doctors found that for some clients, the prospect of removal to Rwanda has increased their risk of self-harm and suicide. For example, one person has written a suicide note to his family.
This fear of removal to Rwanda results in a worsened sense of safety, which causes distress and exacerbates individuals’ mental health symptoms, including PTSD. It is a significant re-traumatising factor, which would impact the effectiveness of any medical treatment accessed while they remain in the UK, as well as once they are removed to Rwanda.
The UNHCR has raised their concerns with this policy, which is in contravention with the Refugee Convention and fundamental right to seek asylum.7 The UK has a moral responsibility to process asylum claims fairly and provide protection to those whose claims are ultimately accepted regardless of how they arrived in the UK, rather than shirking this responsibility.
Evidence is coming to light clearly demonstrating that this is a cruel and damaging policy, which is already causing profound harm to people’s health and wellbeing. The evidence from Medical Justice’s casework makes it clear that the prospect of removal to Rwanda is already exacerbating existing mental health issues for people seeking safety in the UK.
We urge you to revoke all NOIs, immediately release asylum seekers who have been issued with NOIs from immigration detention, and abandon this policy of forced expulsions to Rwanda, or any other country. It is cruel and unconscionable on ethical and medical grounds and has already caused severe damage to individual’s health and wellbeing.
Home Office officials have warned that this policy will put vulnerable people in danger. We add to this warning by highlighting the harm and danger that has already been caused to vulnerable people.
Yours sincerely,
British Medical Association – Jan Wise, Medical Ethics Committee Chair
Faculty of Public Health – Professor Maggie Rae, President
International Child Health Group, a special interest group of the Royal College of Paediatrics and Child Health
Royal College of Obstetrics and Gynaecologists – Dr Eddie Morris, President,
Doctors of the World – Simon Tyler, Executive Director
Freedom from Torture –Tamara Jaftham, Director of Clinical Services
Helen Bamber Foundation – Dr Katy Robjant, Executive Director Clinical and Counter-Trafficking
Medact – Sophie Neuburg, Executive Director
Medical Justice – Emma Ginn, Director
Individuals:
Dr Laura B Nellums, Associate Professor, School of Medicine, University of Nottingham
Monika Hartmann (NHS nurse)
Professor Jenny Phillimore PhD, FAcSS, Institute for Research into Superdiversity, School of Social Policy, University of Birmingham
