Visiting patients in immigration detention

I first visited an immigration removal centre (IRC) on 8 July 2005, the day after the London bombings. At that time it was my understanding that a large number of Zimbabweans were being held in several IRCs, with the intent of returning them to their country of origin. Many of those I visited alleged that they had been tortured by the Mugabe regime and feared more of the same or worse, if they were removed to the country they had fled.

I was advised that about 100 of them had gone on hunger strike (1) to prevent their forced return to Zimbabwe. Some had been without food for over 35 days, though all were drinking water.

A GP friend had called one night about 11 pm, a few days earlier, to say that she was outside Harmondsworth IRC (near Heathrow), trying to get in to see a man about whom she was professionally concerned because he had been refusing all food for a number of weeks. Could I call IRC healthcare in the IRC and get them to let her in to see this hunger striker?

I knew nothing of prisons or IRCs at the time. But even in my ignorance it was plain that this request was unlikely to succeed. Nor did it. Though when I tried, I did get through – to my amazement – and spoke with the head of healthcare, a senior nurse. The conversation was illuminating, almost prescient, in the light of subsequent events (2).

Not daunted, my friend approached an MP, who was campaigning very actively for human rights in Zimbabwe. The MP used parliamentary privilege to visit two of the men on hunger strike. But before the MP went in to see them, my friend got her to call me, and we agreed a consent form whereby those detainees could formally request that I visit, examine and advise them on medical issues. An immigration lawyer used this consent to ensure that I was permitted to enter the centre and examine them the following afternoon.

Both of the men that I visited were lucid, although very weak. They were also moderately dehydrated, could not walk unaided, and became dizzy on standing. One, who was short and small-boned to start, was so emaciated that it was frighteningly easy when I had to lift him onto the examining couch.

It was clear that relations between them and IRC healthcare staff had broken down. The medical notes revealed that they had not been seen by a doctor for over a week and that they had refused to allow blood to be taken from them (3) because (they said) the clinicians had refused to guarantee to discuss the results of the tests with them.

While my examinations of these men were going on, the lawyers were negotiating with the Home Office in court to secure their voluntary transfer to hospital. The lawyers called me and requested that I dictate my professional clinical opinion as to the feasibility of safe medical care in detention. In view of the condition of the patients and the current medical attention documented in the medical notes, it was not difficult to give a clinical opinion that the men’s lives were at heightened risk if they were not immediately transferred to hospital.

Partly on the strength of this, the Home Office agreed that one of the two Zimbabweans should be transferred to hospital forthwith (4). The other man was also hospitalised after he vomited blood the following day. Both men eventually agreed to start eating again and were released into the community. They were both subsequently granted leave to remain, as were others of the hunger strikers (5).

Few visits to IRCs are as problematic as this one. But they can be difficult. Accordingly, we have worked out simple procedures as set out in the next section, for ensuring they can proceed as smoothly and effectively as possible.

Dr Frank Arnold


  2. The healthcare manager replied to the request that my friend be admitted in the middle of the night to examine the patient, about whom the doctor was concerned: “Sorry, we can’t do that; if we did we would have busloads of doctors demanding to visit the centre.” This excellent advice led my friend, that hunger striker and me, a few months later, to initiate the Medical Justice Network. See:
  3. Byrne J. Hunger strikers are not properly monitored at detention centre, doctor says. British Medical Journal 2005;331:178.
  4. Although unable to walk, much less escape, this man was transferred to and kept in hospital in handcuffs, despite medical advice that this was potentially dangerous for one so ill. The cuffs were only removed after the MP remonstrated with the Home Secretary.
  5. Mcgregor JA. Contestations and consequences of deportability: hunger strikes and the political agency of non-citizens. Citizenship Studies. 2011; 5: 597.

This paper also cites a surprising front page article about the Zimbabwean hunger strikers in the Daily Mail headlined: “For Pity Sake Let Them Stay”. This did not prevent Charles Clark, the Home Secretary at the time, from falsely informing the House of Commons that the hunger strikers were being seen by a doctor in detention every day. This is claim is disproven by their medical notes.


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