How we treat the desperate  Alice O'Keeffe
  Published 19 July 2007
    
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  Some of the world's most vulnerable and abused women end up in the Yarl's Wood Detention Centre awaiting deportation. 
     

  "Welcome," reads a sign in the waiting room at Yarl's Wood. "Bienvenido"; "Bienvenue"; "Will kommen". Under each word is a smiley face. It is an empty gesture, as in every other respect the sterile white space provides the antithesis of a welcome. Visitors are photographed and searched by uniformed guards and have their fingerprints taken. Just like the inmates (now only women and children, after the prison riots of 2002 which burned half of Britain's most notorious detention centre to the ground), visitors are made to feel like criminals, separated from the outside world by layers of bureaucracy.
  A report launched this month by the charity Medical Justice Network and backed by Lord Ramsbotham, former chief inspector of prisons, highlights extensive abuse of detainees at centres including Yarl's Wood. Entitled Beyond Comprehension and Decency, it is a shocking document, detailing the UK's systematic failure to respect the most basic human rights of some of the most vulnerable people in its care. Doctors working for the charity examined more than 500 detainees and the report focuses on 56 detailed case studies. Medical Justice found that more than 20 of these were survivors of torture or rape - in violation of the UN's, and the Home Office's own, guidelines, which state that torture victims should be held "only in very exceptional circumstances". The report also chron icles widespread "medical abuse" of detainees, who are not entitled to NHS treatment, despite often suffering terrible after-effects from illness or torture sustained in their home countries.
  Medical Justice recorded cases that, according to its small team of expert doctors and lawyers, illustrate "neglect, discrimination and abuse on a scale that is saddening and frightening". In addition to the 20 torture victims, they found that 33 of the 56 detainees spotlighted were depressed, self-harming or suicidal, three had had their HIV treatment disrupted, with potentially fatal results, and three had tuberculosis, which in two cases was not properly treated. Further case studies highlight even more serious abuses: just a few days after suffering a miscarriage, one woman was put into a holding room, even though she had been classified as in danger of self-harm, because she kept asking for her baby and saying she wanted to die. There was no health care available on site.
  Yarl's Wood is Britain's most documented detention centre, but there are nine others around the country, through which about 30,000 people in total pass each year (and roughly 2,000 of these are children, as the UK government, uniquely in Europe, retains the power to detain children indefinitely). Detainees are usually put into detention either upon arrival in Brit ain, or when they are waiting to be "removed" following the failure of an asylum application. A large proportion do not have legal representation. Few, despite Home Office guidelines to the contrary, get a thorough medical examination when they are first detained. The government subcontracts management of seven of the ten centres to private companies, including Global Solutions Ltd (GSL) and Serco, which, in turn, may subcontract health care services. Consequently, according to the Medical Justice doctor and torture expert Dr Frank Arnold, "the quality of med ical care is dire, often resulting in actual harm
 due to failure to di a gnose, refer and treat".
  This had been Sarah's experience. I met her in the large visiting hall, filled with little round tables and cheap foam armchairs. The smell of detergent and unwashed bodies hung in the air. After a few minutes, a set of thick doors opened and Sarah, a small, hunched figure, was brought in flanked by two guards. All around us, sad-faced women greeted their loved ones with tears and hugs.
  An outspoken and intelligent 45-year-old from Uganda, Sarah told me she had experienced beatings, rape and torture at the hands of the Ugandan army. She escaped to Britain, where she waited for eight years for a decision on her asylum case. In the year before her detention, she had been sleeping rough. She has both external and internal injuries as a result of rape and torture, and has difficulty walking. Since arriving at Yarl's Wood she has been vomiting bile. She had not been allowed out to attend an NHS scan booked before she was taken into detention. Her medicines, which she has to take several times a day, are held for "safekeeping" at the medical centre, a long and painful walk from her room. Detainees in Britain are systematically dehumanised, she told me. "Immigration think they are God. They do not believe in people. What is a human being to do?"
  A week after my visit, I got a fuzzy phone call from Sarah on my mobile. She and some other women had decided to go on hunger strike in protest against their conditions. Hunger strikes are common in detention centres, though they rarely make the news. Despite this, the Medical Justice report shows that the Home Office has no policy to guide staff on treating hunger strikers, who can face serious health risks.
  It is far from unusual for tortured and raped women such as Sarah to be held in detention, although incarceration is known to retraumatise victims psychologically. In theory, all asylum-seekers should be given a medical examination within 24 hours of being detained, and if there is evidence of torture they should be held "only in very exceptional circumstances". However, according to the Medical Justice report, in practice, evidence of torture is often not investigated or, when it is reported, it is ignored. In the 20 cases of tortured detainees investigated by the charity, none had been investigated by the Home Office, even when the torture had been reported to officials and doctors.
  The former minister of state with responsi bility for detention centres, and now Attorney General, Baroness Scotland, was asked in parliament whether victims of rape or torture were being held at Yarl's Wood. She replied that if an allegation of torture was made by an asylum-seeker they were "referred to the Medical Foundation for the Care of the Victims of Torture". However, David Rhys Jones, the foundation's refugee policy officer, told me: "Immigration officers have never made referrals of torture victims to the Medical Foundation, and no formal mechanism exists for them to do so. Baroness Scotland subsequently claimed that health care staff at one detention centre had made several such referrals. We are satisfied that in each case the prime referrer was in fact the Immigration Advisory Service at the centre."
  Bullied and humiliated
  Imelda, a 23-year-old from Cameroon, arrived in the visiting hall with her 13-month-old baby, Bessie. Her wide face looked tired and intensely worried; she was wearing old clothes and cheap flip-flops, as she had left almost all her possessions behind on the day she was detained. Bessie, a boisterous toddler, had dark circles under her eyes and dry, cracked skin all the way up her arms. Imelda explained that it was impossible to treat her skin condition, as Yarl's Wood does not provide sufficient baby baths. Neither, she said, was there any decent baby food, and she got no extra milk ration for the child.
  Imelda and Bessie had just been given a "removal" date in two days' time.
  "When I get to Cameroon I will be sent straight to jail, because my family are dead and I have no money to pay the bribe," she told me, looking helplessly at Bessie. We sat in silence for a while. I felt like a voyeur, asking Imelda to tell me her story when I was unable to offer help. All I could do was take her hand.
  Imelda told me of some friends who had recently been taken from Yarl's Wood to the airport for "removal", only to be brought back again having been beaten up.
  Others had stories of psychological abuse. Joanna, a 23-year-old Rwandan who was in Yarl's Wood last year, told me she had been taken to the airport and put on to a plane, even though her removal date had not been set. Just before it departed, she was taken off and driven back to the centre. During those moments on the plane, she said, she saw her life flash before her eyes; she had left Rwanda because she had been abducted and gang-raped by rebel soldiers, and her father, mother and baby daughter had been killed. Even after her experiences in Rwanda, she had no hesitation in describing what she experienced at Yarl's Wood as "torture". "You come to Britain because you are desperate for help," she said. "But once you are here, they bully and humiliate you, and treat you like an animal."
  Cases of abuse at detention centres and on "es corts" to and from airports are well-documented. It is likely that those reported are the tip of the iceberg, given that assault allegations come to light only if a detainee has family, friends or visitors to help them complain. Those who are removed from the country have no way of reporting abuse. In 2004, an undercover journalist at Yarl's Wood reported GSL officers describing giving detainees a "good pasting"; one detainee, Ms A, who was taken to the airport semi-naked and screaming in fear, subsequently won a civil case against GSL and the Home Office. In answer to a parliamentary question, the immigration minister at the time revealed that 71 allegations of "improper treatment" had been made regarding immigration escorts in 2004. He said that all complaints were passed on to the police, "as the appropriate authority to investigate such matters". Medical Justice has not found any instances in which this has actually
 happened - Ms A was not able to bring a case; the police charged her with assault for biting a police officer's hand.
  At five o'clock, visiting was over, and the shuttle bus to Bedford Station was waiting. The other visitors were from all over the world: a Jamaican man in a loud tracksuit, an African teenager, a demure Latin American woman. We sat in silence, but when we arrived at the station we were all extravagantly polite, helping each other to carry bags and buy train tickets. It was as if we felt we had all shared a dirty secret; or maybe we just needed a dose of ordinary kindness.
  After my visit to Yarl's Wood, I saw how catastrophic the effects of detention on a traumatised person can be when I visited Sophie Odogo, a 37-year-old Ugandan who has been left permanently psychologically damaged after her seven-month stay at the centre. I met Sophie at the home of Gill Butler, a member of the Yarl's Wood Befrienders' Group, who visited Sophie throughout her detention. Through Butler's formidable campaigning, Sophie was eventually admitted to psychiatric hospital. She has now been released, and is living with Gill pending a decision on her asylum application.
  Sophie had been imprisoned, raped and tortured in Uganda, from where she fled after her husband was murdered. She had to leave her three children behind. Detained shortly after arriving in the UK, she soon began to show symptoms of psychiatric breakdown. She stopped eating for several weeks because, she told me, "it was a way to death". Gill says that even when she was incapacitated with malnutrition, officers at Yarl's Wood tried to take her to the airport, and that she was given inadequate medical care for her psychological and physical symptoms. Sophie is now bringing a civil case against the Home Office over her treatment.
  It was difficult to get a sense of Sophie's personality, because her short-term memory has been badly affected by her breakdown. She talked in a shaky whisper, referring constantly to suicide. "I will take my life before they pick me up. So they can pick up my dead body, because then I won't be able to feel anything," she said. "I hate my life. If they do come for me, I know the solution." She suffers from hallucinations in which she imagines that Ugandan soldiers and Yarl's Wood guards have come to take her away.
  Partly as a result of Sophie's case, the chief inspector of prisons, Anne Owers, conducted an investigation into medical provision at Yarl's Wood. Published in October 2006, Owers's scathing verdict was that the health care was "inadequate . . . undermined by a lack of needs assessment, weak audit and clinical governance systems and inadequate staff training".
  Her three key recommendations were that, "as soon as possible", health care at detention centres should be transferred from private companies to the NHS, that there should be proper enforcement of the Home Office policy not to detain vulnerable people, and that obstruction to appropriate health care should stop. As the Medical Justice report and my own experiences show, these reforms have not been implemented.
  I am thinking of visiting detainees more regularly, but I don't know if I could bear seeing women go through detention, one after the other, before being bundled on to a plane and left to their fate. Maybe that is why, as a society, we ignore these terrible acts of injustice. But something important happened to me in the visitors' room. I entered thinking I belonged to a civil ised and fair society; I left feeling very differently.
  
  Some names have been changed
  The Medical Justice Network campaigns for medical care and basic rights for detainees at http://www.medicaljustice.org.uk
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