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Health care for children in UK detention centres
Editorial
Health care for children in UK detention centres About 2000 children up to the age of 18 years are held in UK detention centres every year. Many are children of families who have been refused asylum or have overstayed their visas; some are asylum seekers or are detained on arrival because they have no identification papers. Often families are taken from their homes with no time to pack even essential medicines and clothes. Once at a detention centre, which for families is usually Yarl’s Wood Immigration Removal Centre, children are essentially imprisoned with little to do, and provided with inadequate education and health care. In her report of Yarl’s Wood from her visit in February, 2008, HM Chief Inspector of Prisons, Anne Owers, stated that “the plight of detained children remained of great concern”, particularly those incarcerated for long periods of time, and “Healthcare needed further improvement, particularly to address mental health and child health needs”. The report recommended that “Children should be detained only in exceptional circumstances and then only for the shortest time necessary”. General practitioners who are contracted to provide primary care to detainees often have to see patients without their medical records, particularly for new arrivals, and may have little time to assess patients. Follow-up care is difficult to provide, owing to unpredictable detention periods combined with variable waiting-list times when referrals to hospital are requested. Children with chronic illnesses on admission to detention centres get little continuity of care. Routine childhood immunisations are often missed, and children can be returned to countries where measles and meningitis are common causes of death in children under 5 years, yet the opportunity for protecting these children while in the UK has been lost. When children become ill in detention centres, concerns have been raised by clinicians and advocacy groups that clinical care is not always adequate. Nick Lessof of the Royal College of Paediatrics and Child Health Advocacy Committee told The Lancet that he saw two children with sickle-cell disease, who had both had a high fever, in Yarl’s Wood in May this year. The children’s prophylactic penicillin had been stopped and they were unable to take fluids, yet had not been admitted to hospital. Earlier this year, Frank Arnold of Medical Justice examined another child with sickle-cell crisis who had not been given adequate analgesia and was www.thelancet.com Vol 372 November 22, 2008
expected to walk, despite being in pain, from his room to the health-care facility to obtain treatment. Children born to HIV-positive mothers may not be tested for HIV infection. Furthermore, the appropriate clinical care of such infants is often interrupted if detained under the age of 6 months. Families can be removed to malaria-endemic countries without adequate malaria prophylaxis. If there is time between the decision to return the family and flight departure, the onus to obtain even a bednet for protection is left to parents, who cannot leave the centre to buy one even if they did have the money available. According to England’s Children’s Commissioner, Al Aynsley-Green, only two of 14 children from sub-Saharan Africa in Yarl’s Wood in May this year had received malaria prophylaxis, but in neither case was it given for long enough. Arnold told The Lancet that two children had contracted Plasmodium falciparum malaria as a consequence of being returned to their country of origin in 2005 without adequate prophylaxis. Unfortunately, there is no reason to believe that this could not happen now. These appalling failures in the health care of children in detention centres are the ultimate responsibility of the UK Home Office, and are in marked contrast to the UK Government’s global health strategy, Health is Global, which emphasises the Government’s responsibility “to improve the health of people across the world, and in particular people in the UK”. It is noteworthy that the Government is committed to halting and reversing the spread of HIV/AIDS, to reducing the incidence of malaria, and other major infectious diseases, and to doing all it can to increase child survival—except it seems in its own detention centres. The UK Government will introduce a new Immigration and Citizenship Bill to Parliament in early 2009, which is available for consultation in draft form. Little change is expected in the provision for detention centres, but the Secretary of State will take on a new statutory duty to safeguard and promote the welfare of children who are in the UK. This Bill is an opportunity for more radical change. Routine administrative detention of children should cease. If the courts accept that detention is necessary, those few children should receive the same standards of primary and specialist health care as other children in the UK. ■ The Lancet
The printed journal includes an image merely for illustration
For HM Inspectorate of Prisons’ report on Yarl’s Wood see http://inspectorates.homeoffice. gov.uk/hmiprisons/inspect_ reports/irc-inspections. html/544687/Yarls_Wood_ 2008.pdf?view=Binary For campaigns to stop detention of children see http:// www.newstatesman.com/ subjects/no-place-for-children which includes article by Aynsley-Green For more on campaigns to stop detention of children see http:// www.medicaljustice.org.uk For Health is Global see http:// www.dh.gov.uk/en/Healthcare/ International/DH_072715 For the draft immigration bill see http://www.bia.homeoffice. gov.uk/policyandlaw/ immigrationlaw/
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Health care for children in UK detention centres About 2000 children up to the age of 18 years are held in UK detention centres every year. Many are children of families who have been refused asylum or have overstayed their visas; some are asylum seekers or are detained on arrival because they have no identification papers. Often families are taken from their homes with no time to pack even essential medicines and clothes. Once at a detention centre, which for families is usually Yarl’s Wood Immigration Removal Centre, children are essentially imprisoned with little to do, and provided with inadequate education and health care. In her report of Yarl’s Wood from her visit in February, 2008, HM Chief Inspector of Prisons, Anne Owers, stated that “the plight of detained children remained of great concern”, particularly those incarcerated for long periods of time, and “Healthcare needed further improvement, particularly to address mental health and child health needs”. The report recommended that “Children should be detained only in exceptional circumstances and then only for the shortest time necessary”. General practitioners who are contracted to provide primary care to detainees often have to see patients without their medical records, particularly for new arrivals, and may have little time to assess patients. Follow-up care is difficult to provide, owing to unpredictable detention periods combined with variable waiting-list times when referrals to hospital are requested. Children with chronic illnesses on admission to detention centres get little continuity of care. Routine childhood immunisations are often missed, and children can be returned to countries where measles and meningitis are common causes of death in children under 5 years, yet the opportunity for protecting these children while in the UK has been lost. When children become ill in detention centres, concerns have been raised by clinicians and advocacy groups that clinical care is not always adequate. Nick Lessof of the Royal College of Paediatrics and Child Health Advocacy Committee told The Lancet that he saw two children with sickle-cell disease, who had both had a high fever, in Yarl’s Wood in May this year. The children’s prophylactic penicillin had been stopped and they were unable to take fluids, yet had not been admitted to hospital. Earlier this year, Frank Arnold of Medical Justice examined another child with sickle-cell crisis who had not been given adequate analgesia and was www.thelancet.com Vol 372 November 22, 2008
expected to walk, despite being in pain, from his room to the health-care facility to obtain treatment. Children born to HIV-positive mothers may not be tested for HIV infection. Furthermore, the appropriate clinical care of such infants is often interrupted if detained under the age of 6 months. Families can be removed to malaria-endemic countries without adequate malaria prophylaxis. If there is time between the decision to return the family and flight departure, the onus to obtain even a bednet for protection is left to parents, who cannot leave the centre to buy one even if they did have the money available. According to England’s Children’s Commissioner, Al Aynsley-Green, only two of 14 children from sub-Saharan Africa in Yarl’s Wood in May this year had received malaria prophylaxis, but in neither case was it given for long enough. Arnold told The Lancet that two children had contracted Plasmodium falciparum malaria as a consequence of being returned to their country of origin in 2005 without adequate prophylaxis. Unfortunately, there is no reason to believe that this could not happen now. These appalling failures in the health care of children in detention centres are the ultimate responsibility of the UK Home Office, and are in marked contrast to the UK Government’s global health strategy, Health is Global, which emphasises the Government’s responsibility “to improve the health of people across the world, and in particular people in the UK”. It is noteworthy that the Government is committed to halting and reversing the spread of HIV/AIDS, to reducing the incidence of malaria, and other major infectious diseases, and to doing all it can to increase child survival—except it seems in its own detention centres. The UK Government will introduce a new Immigration and Citizenship Bill to Parliament in early 2009, which is available for consultation in draft form. Little change is expected in the provision for detention centres, but the Secretary of State will take on a new statutory duty to safeguard and promote the welfare of children who are in the UK. This Bill is an opportunity for more radical change. Routine administrative detention of children should cease. If the courts accept that detention is necessary, those few children should receive the same standards of primary and specialist health care as other children in the UK. ■ The Lancet
The printed journal includes an image merely for illustration
For HM Inspectorate of Prisons’ report on Yarl’s Wood see http://inspectorates.homeoffice. gov.uk/hmiprisons/inspect_ reports/irc-inspections. html/544687/Yarls_Wood_ 2008.pdf?view=Binary For campaigns to stop detention of children see http:// www.newstatesman.com/ subjects/no-place-for-children which includes article by Aynsley-Green For more on campaigns to stop detention of children see http:// www.medicaljustice.org.uk For Health is Global see http:// www.dh.gov.uk/en/Healthcare/ International/DH_072715 For the draft immigration bill see http://www.bia.homeoffice. gov.uk/policyandlaw/ immigrationlaw/
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