This piece by Saskia Garner was first published by openDemocracy on 1st December 2014.  Saskia works at Refugee Action as Policy Manager.

The adverse effects of being detained in an immigration removal centre harm possibilities for reintegration in the country of origin.

Being detained can be a traumatic experience for anyone, but for individuals who have been forced to leave their home and arrive in a foreign land with nothing but their life, it can be even worse. Yet, as this recent series on openDemocracy 50.50 has shown, this is the experience of thousands of immigration detainees, many of whom have sought safety in the UK and now face removal to a country where their life is at risk, such as the Democratic Republic of Congo.

The experiences of individuals locked up in the UK’s Immigration Removal Centres (IRCs) have long been recorded by civil society groups, academics and medical professionals as well as in the first-hand accounts of current and former detainees. They starkly document the harm done by the system to the health and well-being of detainees, even if the period of detention is relatively short.

These concerns were again highlighted in written and oral evidence submissions presented to the recent Parliamentary Inquiry into Immigration Detention by organisations, medical and legal professionals and, most poignantly, by former and current detainees.

New research by charity Refugee Action supports accounts of the adverse impact of detention on the physical and mental health of detainees both in the short and long-term. In late 2013, Refugee Action staff interviewed more than 60 male detainees in five IRCs in south east England (Harmondsworth, Colnbrook, Dover, Brook House and Tinsley House). Thirty-seven gave their consent for their interviews to be used to support research and policy-making.

Life in detention

Poor and deteriorating health was a major concern among immigration detainees. More than half of those interviewed said that they had developed a physical or mental health condition whilst in detention. Conditions individuals reported as having developed in detention included depression, insomnia, various physical pains such as back pain or toothache, infections, and stress.

Almost two-thirds said they needed medical assistance but had not received it. People reported that this was mainly due to an inadequate response by a medical professional to a perceived medical problem e.g. having been prescribed paracetamol when a stronger painkiller was required or having had an inadequate health-check to investigate a health complaint. One man said: ‘I have medical problems that have not been properly addressed so it makes me feel subhuman and intolerable.’

Many people interviewed spoke of experiencing depression in detention and reported feelings of loneliness and unhappiness. One said: ‘I have spent 45 days here and it’s like I spent three years. I am so upset and helpless’ while another said ‘I feel like an animal in a cage. I feel isolated and very lonely.’ These comments emphasise the desperation people feel whilst in detention and bring home the reality of people’s experiences whilst cut off from friends and family and having little idea of how long they will remain there.

Others said: ‘I don’t feel good and it’s not easy to gauge the magnitude of our agony and grief’ and ‘People treat us as if we were criminal. I am a victim and came to London to be a free man and ask for protection, but it’s not the case. I came to be protected by human rights.’

Limited communication, misinformation and lack of access to proper legal support worsened the experience of detention. Sixty-two per cent of those interviewed stated that they were not told about their right to apply for bail in their induction and half stated that they were not told how to make an appointment with a legal advisor on their first day in detention. Without this information, it’s difficult to see how anyone could obtain the necessary advice to secure their release or adequately pursue an application to legally remain in the UK.

The negative experiences of detention expressed by so many of those interviewed in our research, and reflected more widely by other organisations working in detention centres, make it no surprise that those affected continue to struggle with the impact of detention even after they return home.

Life after detention

Refugee Action is currently the only organisation that receives funding from the Secretary of State through the Home Office to deliver Assisted Voluntary Return (AVR) programmes. We do so through our Choices service, which is confidential, impartial, independent and free. Through Choices, people receive non-directive advice, information and support to help them decide whether to return to their country or attempt to stay in the UK.

Those who decide to return through the scheme do so in a dignified way. Unlike those who are forcibly removed, there are no handcuffs as people who opt for voluntary return check in to their flights like any other passenger. The cost of the journey is funded. Those who need it can receive help obtaining travel documents. All receive help with planning how they’ll reintegrate after returning. And those in an eligible group receive financial support and support from an NGO in their country. This can help with issues like retraining, obtaining accommodation, receiving healthcare or setting up a business.

In the year April 2013-March 2014, Refugee Action assisted almost 7,000 people to apply for the AVR programme and 4,257 people to return. Over 50% of returnees were detained in IRCs at the point of application. Yet while Refugee Action’s grant agreement to provide AVR services was extended until March 2015, its mandate to provide services to people in detention ended on 1 April 2014. We estimate that the removal of AVR services from detainees will impact on approximately 2,000 people per year.

Refugee Action believes that the withdrawal of Choices from detainees will prove a costly mistake – both in monetary terms to the government and, more importantly, to the mental and physical wellbeing of highly vulnerable people who should be offered the same support as non-detainees in making decisions about their future.

Returns under an AVR programme are not only more humane and informed, but also more likely to result in an individual being able to support themselves and make a sustainable return, than those who are forcibly removed, or who return through the Home Office Voluntary Departures scheme without in-country advice and financial support.
People who have experienced immigration detention often require extra support in reintegrating as they continue to struggle with the effects of being detained.

Impact of detention on reintegration

In order to support people after return, Refugee Action has a network of overseas partners who we contract to deliver services to people after they have returned to their countries through AVR. Agreds-Ghana, our partner in Ghana, reports it can take two to three months longer to build trust with a person returning from detention than someone returning from the community. The returnee will often perceive them to be affiliated to the structures in the UK that arrested and detained them. As a result a person returning from detention requires more patience and an approach that focuses on trying to build trust straight away.

Agreds-Ghana says those who return from the community are usually “mentally sound, stable and find their way”, whereas those who return from detention are often “emotionally charged, angry, bitter and their experience of being detained haunts them”.

Our partner, Caritas Bangladesh reports similar difficulties assisting people who have been detained, often for months, before returning. Caritas Bangladesh say that returnees report feeling “caged”. They can then find it hard to reintegrate and adapt to life in Bangladesh and are often confused after returning – seeming unsure whether they are safe or not.

The decision to return

While the decision to return is a positive one for many and reunification with families and homes is celebrated, it is nevertheless important to note that for others the decision is more complex and exacerbated by negative experiences in the UK.

Iqbal and Ali from Bangladesh decided that return was preferable to staying in detention. Both had been imprisoned in two detention centres, one for six months and one for three and a half months. Iqbal had high blood pressure, a heart condition and diabetes, conditions which were exacerbated by the poor quality and quantity of food in the IRC, the lack of staff care and the delay of proper medical help when requested. He said his health problems worsened to the extent that he decided to return to Bangladesh because he feared that otherwise he would die in detention. Ali had had a heart attack a year before he was detained. He said that he could not get the medical attention he needed whilst in detention and decided to return to Bangladesh before his health deteriorated further rather than continue with his claim.

Both men opted for Assisted Voluntary Return as a result of their health needs not being met whilst in detention in the UK but both said that they felt unsafe in Bangladesh and would have preferred to have continued to pursue their asylum claims in the UK. Choices caseworkers support people to make complex decisions about return such as these by giving people independent and non-directive advice on all aspects of staying or leaving and the decision is ultimately their own.

What is clear from these stories is that the limited legal advice and healthcare provided to many people in IRCs is so significant that some choose to return to difficult and challenging environments as a preference to remaining in detention. Without the opportunity of receiving independent and impartial advice through the Choices programme – in addition to in-country support on return –  it is likely that people won’t be fully informed of all the risks and advantages of returning and are less likely to have an opportunity to raise issues that may mean that their return would be complicated or unsafe. Instead of cutting services to detainees, the Home Office should be investing more resources to ensure that the decision to return is taken by that individual in an environment that ensures that their best interests  are protected

The way forward

We are extremely concerned that the harmful effects of detention impact on people’s decision to return, and their ability to fully integrate upon return. Return is not a decision to be taken or carried out lightly. People need support in making this decision and immigration detention is a difficult place in which to plan ahead.

The government is currently planning an expansion of the detention estate in order for more people to be detained. Rather than expansion, the government needs to respond to the repeated and widespread calls to address the inadequate immigration detention system as it stands, and adhere to the recommendations of the Parliamentary Inquiry into Detention when it publishes its report in 2015.