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We thank Sally Howard for her insightful feature on immigration detention, highlighting concerns about the impact on health of those detained and the demanding nature of this medical practice. It is important to highlight that immigration detention, unlike prisons, is discretionary and imposed for the administrative interest of the Home Office, rather than part of criminal proceedings.
The Home Office has long agreed that persons particularly vulnerable to harm in detention should not be detained except in exceptional circumstances. The Rule 35 process is an important safeguarding mechanism for identifying such people, built into the Detention Centre Rules(1). It enables people with particular vulnerabilities to be assessed by a detention centre GP, who writes a report to the Home Office, in accordance with the international standards set out in the Mandela Rules(2), so release can be considered in order to prevent further harm.
However, the Rule 35 process has been found to be dysfunctional by expert NGOs and government inquiries, including the recent Brook House Inquiry(3–5). As a result, vulnerable people—including victims of torture and those with serious health needs—continue to be detained, in breach of Home Office policy(1) and UNHCR guidelines(6). The critical purpose of these reports – to protect people in administrative detention from further harm to their health – must not be lost in ineffective processes. For victims of torture and persecution, these reports are also critical to identify their right to protection under international law, including non-refoulement and right to rehabilitation(7).
Alongside the cost to health is the financial cost, due to compensation for wrongful detention, which in the financial year 2023-24 totalled around £12 million, and the enormous expense of detention itself(8). With the government planning to expand the use of immigration detention(9), these costs are only likely to increase.
References:
1. Home Office. Detention services order 09/2016 Detention centre rule 35 and Shortterm Holding Facility rule 32, Version 7.0 [Internet]. 2019 [cited 2025 Mar 4]. Available from: https://assets.publishing.service.gov.uk/media/5c7e8ca940f0b603d3121166/...
2. United Nations. The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules). New York; 2015.
3. Medical Justice. Harmed Not Heard: Failures in safeguarding for the most vulnerable people in immigration detention [Internet]. 2022 [cited 2025 Mar 4]. Available from: https://medicaljustice.org.uk/research/harmed-not-heard/
4. Kate Eves, Chair of the Brook House Inquiry. Brook House Inquiry Report Volume II. A public inquiry into the mistreatment of individuals detained at Brook House immigration removal centre [Internet]. 2023 Sep [cited 2025 Mar 4]. Report No.: HC 1789-II. Available from: https://www.gov.uk/government/publications/brook-house-inquiry
5. Shaw S. Review into the welfare in detention of vulnerable persons: a report to the Home Office. London: The Stationery Office; 2016.
6. UNHCR. Guidelines on the Applicable Criteria and Standards relating to the Detention of Asylum-Seekers and Alternatives to Detention [Internet]. [cited 2025 Apr 7]. Available from: https://www.refworld.org/policy/legalguidance/unhcr/2012/en/87776
7. United Nations. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment [Internet]. 1984 [cited 2025 Apr 7]. Available from: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-a...
8. The Migration Observatory at the University of Oxford. Immigration Detention in the UK [Internet]. 2024 [cited 2025 Apr 4]. Available from: https://migrationobservatory.ox.ac.uk/resources/briefings/immigration-de...
9. Home Office. GOV.UK. 2024 [cited 2025 Mar 4]. 6 December 2024: Immigration Removal Centre (IRC) Expansion Programme (IRCEP) Accounting Officer Assessment. Available from: https://www.gov.uk/government/publications/home-office-major-programmes-...
Competing interests:
MP has personal experience of the UK asylum system and immigration detention and does paid consultancy work in the field. LZW and MP are members of the Royal College of Psychiatrists’ Working Group for Mental Health and Forced Migration. JC is co-chair of the Faculty of Forensic and Legal Medicine’s working group on quality standards for healthcare professionals working with victims of torture in detention, and trustee of charity Medical Justice All authors previously received renumeration for designing and delivering training on Rule 35.
07 April 2025
Lauren Z Waterman
Consultant psychiatrist
Mishka Pillay (expert by experience); Juliet Cohen (trustee for Medical Justice and forensic physician)
North London NHS Foundation Trust
St Pancras Hospital, 4 Saint Pancras Way, London NW1 OPE
We need to remind ourselves of the core purpose of immigration detention
Dear Editor
We thank Sally Howard for her insightful feature on immigration detention, highlighting concerns about the impact on health of those detained and the demanding nature of this medical practice. It is important to highlight that immigration detention, unlike prisons, is discretionary and imposed for the administrative interest of the Home Office, rather than part of criminal proceedings.
The Home Office has long agreed that persons particularly vulnerable to harm in detention should not be detained except in exceptional circumstances. The Rule 35 process is an important safeguarding mechanism for identifying such people, built into the Detention Centre Rules(1). It enables people with particular vulnerabilities to be assessed by a detention centre GP, who writes a report to the Home Office, in accordance with the international standards set out in the Mandela Rules(2), so release can be considered in order to prevent further harm.
However, the Rule 35 process has been found to be dysfunctional by expert NGOs and government inquiries, including the recent Brook House Inquiry(3–5). As a result, vulnerable people—including victims of torture and those with serious health needs—continue to be detained, in breach of Home Office policy(1) and UNHCR guidelines(6). The critical purpose of these reports – to protect people in administrative detention from further harm to their health – must not be lost in ineffective processes. For victims of torture and persecution, these reports are also critical to identify their right to protection under international law, including non-refoulement and right to rehabilitation(7).
Alongside the cost to health is the financial cost, due to compensation for wrongful detention, which in the financial year 2023-24 totalled around £12 million, and the enormous expense of detention itself(8). With the government planning to expand the use of immigration detention(9), these costs are only likely to increase.
References:
1. Home Office. Detention services order 09/2016 Detention centre rule 35 and Shortterm Holding Facility rule 32, Version 7.0 [Internet]. 2019 [cited 2025 Mar 4]. Available from: https://assets.publishing.service.gov.uk/media/5c7e8ca940f0b603d3121166/...
2. United Nations. The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules). New York; 2015.
3. Medical Justice. Harmed Not Heard: Failures in safeguarding for the most vulnerable people in immigration detention [Internet]. 2022 [cited 2025 Mar 4]. Available from: https://medicaljustice.org.uk/research/harmed-not-heard/
4. Kate Eves, Chair of the Brook House Inquiry. Brook House Inquiry Report Volume II. A public inquiry into the mistreatment of individuals detained at Brook House immigration removal centre [Internet]. 2023 Sep [cited 2025 Mar 4]. Report No.: HC 1789-II. Available from: https://www.gov.uk/government/publications/brook-house-inquiry
5. Shaw S. Review into the welfare in detention of vulnerable persons: a report to the Home Office. London: The Stationery Office; 2016.
6. UNHCR. Guidelines on the Applicable Criteria and Standards relating to the Detention of Asylum-Seekers and Alternatives to Detention [Internet]. [cited 2025 Apr 7]. Available from: https://www.refworld.org/policy/legalguidance/unhcr/2012/en/87776
7. United Nations. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment [Internet]. 1984 [cited 2025 Apr 7]. Available from: https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-a...
8. The Migration Observatory at the University of Oxford. Immigration Detention in the UK [Internet]. 2024 [cited 2025 Apr 4]. Available from: https://migrationobservatory.ox.ac.uk/resources/briefings/immigration-de...
9. Home Office. GOV.UK. 2024 [cited 2025 Mar 4]. 6 December 2024: Immigration Removal Centre (IRC) Expansion Programme (IRCEP) Accounting Officer Assessment. Available from: https://www.gov.uk/government/publications/home-office-major-programmes-...
Competing interests: MP has personal experience of the UK asylum system and immigration detention and does paid consultancy work in the field. LZW and MP are members of the Royal College of Psychiatrists’ Working Group for Mental Health and Forced Migration. JC is co-chair of the Faculty of Forensic and Legal Medicine’s working group on quality standards for healthcare professionals working with victims of torture in detention, and trustee of charity Medical Justice All authors previously received renumeration for designing and delivering training on Rule 35.