Abstract
The UK government has entered an unconscionable agreement, which will forcibly remove people who have come to the UK seeking protection, to Rwanda, with no return to the UK. Despite ongoing legal challenges and widespread criticism, including from the government's own officials 1 and the UNHCR, 2 the government are still planning to go ahead with this plan. 3
Your recent editorial on this policy discussed the moral, ethical and health implications of the plan. 4 The article's prediction that the impact of this policy on refugees and asylum seekers, who are a population with ‘increased rates of some mental health conditions, particularly post-traumatic stress disorder (PTSD) and depression’, is ‘likely to be substantial’ 4 has been confirmed by Medical Justice's recent report titled ‘Who's Paying The Price?: The Human Cost Of The Rwanda Scheme’. 5
The report analyses data from 36 people with Notices of Intent (NOI) for removal to Rwanda who Medical Justice has supported, including 17 people for whom Medical Justice clinicians conducted medico-legal reports (MLRs). The 17 MLRs are based on assessments between 26 May 2022 and 11 July 2022. They all took place whilst the individuals were held at Brook House, Colnbrook or Harmondsworth Immigration Removal Centres (IRCs).
The MLRs show the vulnerability of the cohort with NOIs for removal to Rwanda. All 17 people had a mental health condition, including the following:
- Fifteen people who had a diagnosis of post-traumatic stress disorder (PTSD) or complex PTSD (CPTSD), or were identified to have symptoms of PTSD. - Sixteen people who had a diagnosis of, or symptoms of, depression. - One person who had a provisional opinion that they are likely to have a psychotic disorder and lack capacity to make decisions in relation to his immigration case or to instruct his solicitor in this regard. - One individual who reported a past diagnosis of bipolar disorder and whose account was in keeping with that diagnosis. - Eleven people who were found to have suicidal thoughts whilst they were in immigration detention. This included one person who has self-harmed and another person who attempted suicide twice, whilst in immigration detention.
The MLRs documented individuals’ histories of torture and trafficking. Fourteen of the 17 assessed by Medical Justice clinicians had clinical evidence in keeping with a history of torture. Six people assessed have indicators of trafficking.
There are clear vulnerabilities amongst the individuals who have been targeted for removal to Rwanda. The MLRs further documented the harmful impact that the prospect of removal to Rwanda is having on many, whilst they are still in the UK.
Medical Justice clinicians found that the prospect of removal to Rwanda is causing people to experience fear, confusion, and uncertainty about their safety and a loss of hope. Given the prevalence of mental health conditions within this group of people, these experiences are particularly concerning. Research has identified hopelessness as the biggest risk factor in predicting suicidal behaviour in individuals with depression. 6 More broadly, 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’. 7
For some, the prospect of removal to Rwanda has increased their risk of self-harm and suicide; some individuals were clinically considered to be at high risk of suicide if threatened with removal to Rwanda.
The prospect of removal to Rwanda was found to be reducing individuals’ resilience to the psychological effects of trauma and contributing to existing mental health symptoms. Research has shown that the lack of perceived safety contributes to depression and trauma-related symptoms. 8
The experience of constant fear for their futures means that individuals facing removal to Rwanda have been denied a sense of safety, therefore causing distress and exacerbating individuals’ mental health symptoms. The experience of such fear is a strong re-traumatising factor, which would impact the effectiveness of any treatment accessed whilst they remain in the UK subject to removal to Rwanda, and once they are removed to Rwanda. Specifically, PTSD symptoms are highly sensitive to insecurity or a lack of sense of safety, so the likelihood of success of treatment would be significantly decreased. It is important to note that the prospect of removal is enough to create this impact; people experienced these harms regardless of the situation they might encounter in Rwanda and despite the removals not going ahead.
The prospect of removal to Rwanda is compounding and exacerbating existing mental health issues. If flights resume, detention will be relied on to enable removals, and this suffering is likely to continue. As your editorial highlighted, we will continue to work with doctors and lawyers to ‘navigate the challenges that arise from this new legislation, which has the potential to demean and humiliate people when they are most in need of support and protection’. 4
