Migrants in limbo and the doctors struggling to provide care

Abstract

Caring for migrants in immigration removal centres can present GPs with complex practical and ethical difficulties, Sally Howard reports Several cases haunt Alan Mitchell from his 14 years as a general practitioner at Dungavel House immigration removal centre in Scotland (box). One man was deported to East Asia with a large bowel tumour that a prison GP had failed to find under examination, despite a textbook anal protrusion. The discovery of the tumour did not prevent the man’s deportation. Then there was the detainee with advanced multiple sclerosis whose symptoms had gone untreated for years owing to fear that GPs would report him to the Home Office. There were also avoidable deaths, Mitchell says, from cancers and communicable diseases—the result of late presentation. These losses, he says, “are all part of providing care to this highly vulnerable population.” Mitchell retired from his role at Dungavel House last June but remains the immigration removal centres lead for the Royal College of General Practitioners’ secure environments group. It’s a year and a half since the publication of the Brook House Inquiry report,2 which was commissioned to investigate the mistreatment of detainees at Brook House immigration removal centre near Gatwick Airport in Sussex between 1 April and 31 August 2017. And there are concerns that guidance set out by the report on a range of matters, including the use of force, has not been implemented across centres. Immigration removal centres are one of the most challenging settings for GPs to practise in, presenting ethical quandaries for clinicians navigating between vulnerable patients’ best interests and Home Office pressures that can conflict with clinical independence. The health of people in immigration removal centres is often poor. A 2021 review of the clinical literature found that three quarters of people in immigration detention in the …