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Bisson's review does not mention torture, a 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.1 The number of such cases probably exceeds 5000 per year.
It was accepted in the drafting of the detention centre rules2 and underlying statutory instruments that detention of torture survivors was unduly likely to cause severe psychological harm and should occur only under “exceptional circumstances.”
Doctors working in detention centres are required to report to the Immigration and Nationality Department 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 resulted in inaction and significant misrepresentation by the department.
In a report on Harmondsworth Detention Centre, Her Majesty's Chief Inspector of Prisons identified 57 such “torture reports” sent to the immigration department over the first half of 2006.3 Not one of these is known to have resulted in any action by the department to investigate the accuracy of such reports.
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 (beating of the feet)) as well as fulfilling all necessary criteria for a diagnosis of post-traumatic stress disorder. In some cases, we have been able to provide medicolegal reports that have helped 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 United Kingdom, who have PTSD as a result and who are at risk of detention, may wish to supply them with a letter (or full medicolegal report) outlining evidence that detention would be unduly harmful. This would go some way to reducing the very substantial numbers who suffer re-traumatisation while seeking refuge.
For the Medical Justice Network
Competing interests: FWA helped to found the Medical Justice Network (www.medicaljustice.org.uk). For helping 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 medicolegal reports.