Doctors met recently to discuss the right to health of detained asylum seekers and their invidious role as gatekeepers to health care.
The conference held on 25 June 2005 on the right to health of detained asylum seekers and migrants, organised by Doctors for Human Rights, focused primarily on a report produced by Médecins Sans Frontières (MSF) and Bail for Immigration Detainees (BID). The report ‘Fit to be detained? challenging the detention of asylum seekers and migrants with health needs’, published in May, had analysed medical assessments of sixteen detainees – men, women and children – in different detention centres and highlighted areas of concern with regards to their health rights.
Ensuring health standards
Concerns of the conference centred on the lack of follow-up treatment for those detainees who required further health treatment, and the disruption to treatment as detainees were moved to different centres. Most worryingly, privately-run removal centres such as Harmondsworth and Colnbrook are not obliged to implement health care to NHS standards and, therefore, contract out services to GPs and other health professionals. Health professionals at the conference were aware that such actions ran the risk of downgrading the quality of care and discussed the suggestion that NHS Trusts take over responsibility of centres within their catchment area. (At present, to ensure quality of care, contract monitors are employed as independent assessors of those centres. However, it is alleged that such contract monitors sometimes resemble ’employees’ rather than impartial examiners, thereby calling into question the independence of the monitoring process.)
Illness and bail
Although asylum seekers are at risk of suffering or having suffered from ill health, Sarah Cutler, author of the BID report, highlighted that health was not considered as a significant factor in bail decisions on detainees. Ill health was not given importance within bail hearings even though it could be a vital reason for granting bail, particularly in cases of mental illness in those who had fled their countries because of fear of persecution or who had been tortured. It was also found that those asylum seekers who had increased health complications and therefore more of a financial ‘burden’ on the health service were more at risk of deportation.
The third focus point for the conference was the internment without trial of over ten foreign ‘terror suspects’ in Belmarsh high security prison. After varying lengths of detention, psychiatric and psychological assessments of the detainees found that they suffered from post-traumatic stress disorder, depression and a host of other psychological ailments. Internment without trial had led to at least three of the internees being transferred to Broadmoor – a secure psychiatric hospital.
The most disconcerting aspect of the conference was the underlying issue of health professionals becoming the ‘gatekeepers’ of health care to vulnerable individuals. For doctors could become implicated in violating not just their own Hippocratic oath but the right to medical care enshrined in the UN Declaration of Human Rights.