The UK is failing to protect vulnerable people in immigration detention: Medical Justice Annual Review 

Guest post by Ariel Plotkin. Ariel is the Researcher for Medical Justice, the only UK charity to send independent doctors into UK immigration detention. Using Medical Justice's irrefutable medical evidence, Ariel documents the harm and treatment of people held indefinitely in immigration detention in the UK and the inadequacies and failings of healthcare in detention. Prior to Medical Justice, Ariel worked at Freedom from Torture and Amnesty International. 

Medical Justice’s annual review highlights how failures in clinical safeguards continued to put vulnerable people at unacceptable levels of risk and failed to prevent harm in immigration detention during 2024. Against the backdrop of government plans to increase detention capacity and speed up removals, this systemic failure of existing safeguards to protect vulnerable people in detention is even more concerning as we expect to see more pressure added to an already broken, dangerous and harmful system.  

The review - which Medical Justice plans to publish on an annual basis going forward - draws on a detailed statistical analysis of clinical and other evidence from 73 of our clients detained at immigration removal centres (IRCs) who were assessed by Medical Justice clinicians and whose Medico-Legal Reports were completed in 2024. It documents the prevalence of factors that are likely to make our clients particularly vulnerable to suffering harm in detention, including having a history of torture, trafficking and other trauma, as well as mental and physical health conditions. The review considers health deterioration while detained, levels of suicidality, and the functioning of healthcare provision and safeguarding mechanisms in detention. It also highlights the inappropriate use of segregation and of force on vulnerable detained people.  

A deep dive into the functioning of available safeguarding mechanisms reveals worrying failures in implementation – including of the initial healthcare screening undertaken by IRC healthcare staff, medical examinations mandated by Rule 34 of the Detention Centre Rules, reporting of vulnerabilities under Rule 35, and Assessment Care in Detention and Teamwork (ACDT) – a process intended to manage the risk of self-harm and suicide. The review also highlights the inappropriate use of segregation and of force on vulnerable detained people.  

The findings are stark:  

• 82% of the clients included in this review were survivors of torture and 63% reported a history of trafficking. However, healthcare screenings on arrival largely failed to identify these critical vulnerabilities – missing 77% of the survivors of torture and 89% with a reported history of trafficking. 
• 99% had a diagnosis of at least one mental health condition, including post-traumatic stress disorder, according to the Medical Justice clinician. Many of these were new diagnoses that had been missed or not explored by healthcare in detention. 
• The mental state of 97% of clients deteriorated while in detention and 74% had an increased risk of suicide since they were detained. 23% of clients self-harmed in detention and three people attempted suicide. 
• Only 6% of clients that Medical Justice clinicians assessed had been harmed by detention had a Rule 35 (1) safeguarding report, as they should have had. This is the report IRC GPs are required to complete to alert the Home Office that they suspect a detained person is likely to be injuriously affected by detention and which triggers a detention review.  
• Clients with mental health conditions were put in segregation for extended periods. More than half of these clients (53%) were not visited daily by the IRC GP, as required by the Detention Centre Rules. 
• Force was used on 16 clients, with force applied to two clients’ head and neck.  
• 90% of clients were eventually released, calling into question the justification for their detention in the first place.  

Medical Justice recommends that immigration detention must end and the government should also consider credible community-based alternatives.  

In the interim, the risk of further mistreatment and abuse can be reduced by promptly implementing all 33 recommendations of the Brook House Inquiry, and ensuring that the review of the Adults at Risk in Immigration Detention policy currently underway strengthens the available protections rather than further weakening them.  

You can read Medical Justice’s full report here. 

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