Healthcare: Yarl’s Wood

Caroline Spelman Excerpts

Wednesday 6th January 2016 Westminster Hall

[Kate Osamor]

My hon. Friend highlights an important point. I know from first-hand experience that if women do not know how long they will be detained, it has an impact on their mental health. I want the Government to take that fact very seriously. I will discuss it later in my speech. I thank my hon. Friend for raising that issue.

In 2014, the report “Detained” by Women for Refugee Women found that 62% of those surveyed described healthcare in detention as “bad” or “very bad”. In its latest report, “I am Human”, 17 out of 38 interviewees raised the issue of healthcare without being prompted. The urgent need to review healthcare was also voiced by HMIP. In its most recent report on its unannounced inspection, which was published in May 2015, it stated that healthcare in detention centres has declined severely. One of the two concerns it identified is healthcare, which needs to be improved. The second is that staffing levels are too low to meet the needs of the population, which links to healthcare. The report shows that staff do not have the time to build meaningful connections with detainees, and no counselling is available. It states:

“Detainees’ perceptions of health care were overwhelmingly negative. Their main concerns included poor access to prescribed medication, a poor overall standard of care, a poor attitude from health care staff, a corrosive culture of disbelief, and a lack of support with emotional and mental health needs.”

The Care Quality Commission issued three requirement notices following the inspection.

In November last year, I went inside Yarl’s Wood to meet women who had been detained. The two women I met were victims of trafficking; one was pregnant. Pregnant women are a particularly vulnerable group in detention. I call on the Government to review urgently their policy of detaining pregnant women in exceptional circumstances. In 2014, just nine of the 99 pregnant women who were detained in Yarl’s Wood were removed from the UK. The removal of pregnant women is rarely medically safe, due to potential pregnancy complications and increased levels of severe malaria on arrival.

The human reality has never been so clear to me as when I went inside the detention centre. I know that the Minister has already visited Yarl’s Wood, but I encourage him to do so again, if possible, on a healthcare visit.

[Mrs Caroline Spelman (Meriden) (Con)]

On the point about the unsuitability of detention for pregnant women and the statistic that the hon. Lady cited, there were 99 pregnant women in detention, but, as we understand it, there are now only two. I am sure she will join me in urging the Minister to ensure that no pregnant women are kept in detention, but the numbers have come down.

[Kate Osamor]

The right hon. Lady makes a valuable point. I agree that pregnant women should not be detained at all.

Meeting women in Yarl’s Wood allowed me to hear the concerns that they do not have the power to voice to the outside world by themselves. I am here today as their voice. This debate is for them. They told me, unprompted, that the worst thing about Yarl’s Wood is the healthcare. The women I met were depressed and exasperated by healthcare, but they were trying their best to stay positive about being released. They told me that the culture of disbelief in detention centres extends to healthcare staff as well, who are reluctant to take their illnesses seriously, and they assume that the staff are pretending to help with their asylum case. That feeling is compounded by the complaints process. Whereas the majority of complaints receive comprehensive replies, usually on time, healthcare complaints in the months prior to the HMIP inspection had either not been responded to or were extremely late.

I want to highlight how damaging such healthcare systems are for detainees who are victims of torture and those who have mental health issues. Unsurprisingly, those groups are often intertwined. They represent a significant proportion of those in detention. According to Medical Justice, 50% of those held in detention are asylum seekers or have sought asylum at some point in the immigration process. More than 80% of those surveyed by Women for Refugee Women for “I am Human” stated that they had experienced gender-related persecution, and 30% had been on suicide watch at some point during their detention. During the previous HMIP inspection, 49% said that they had problems of feeling depressed or suicidal on arrival, compared with 39% at the last inspection. Despite those needs, there is no counselling. Only 68% of staff said to HMIP that they received adequate training in safeguarding adults, and only one said that they were aware of the national referral mechanism for victims of trafficking.

Rule 35 is in place to protect the most vulnerable and ensure that they are not unsuitably detained, but it is failing in Yarl’s Wood. The most recent HMIP report states:

“Yarl’s Wood is failing to meet the needs of the most vulnerable women held. These are issues that need to be addressed at a policy and strategic management level.”

The report reiterates demands that rule 35 processes are appropriately followed. It states that Yarl’s Wood’s rule 35 reports were among the worst HMIP had seen. This included an exceptionally poorly handled rule 35 case in which a woman who had been raped was not considered to have met the criteria for torture even though she had clear symptoms of post-traumatic stress. Thanks to HMIP and independent organisations, the Government are aware of such concerns.

However, at the same time that the Government and Serco have announced reviews of operations at Yarl’s Wood detention centre, access to healthcare is limited. In October 2015, Yarl’s Wood informed Medical Justice that rooms in healthcare would be available only during a short lunch break on weekdays, severely restricting access for independent doctors, most of whom work in the NHS during the week and visit detainees on weekends. Such doctors therefore now have to visit detainees in inappropriate rooms with large windows and without examination facilities. That is wholly unsuitable. External medical assessments are most frequently carried out in order to assess whether someone has medical evidence of torture, which needs to be documented for their asylum case. If the doctor does not have a room where they can offer the woman the dignity of being able to undress and not feel threatened, how can that work?

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[Mrs Caroline Spelman (Meriden) (Con)]

I congratulate the hon. Member for Edmonton (Kate Osamor) on securing this important debate. As a longer standing Member of the House, I pay tribute to all hon. Members who have tried so hard to shine a light on the difficulties. I want to mention in particular Sarah Teather, the former Member for Brent Central, who chaired a detention inquiry, on the panel of which I sat, to take evidence from those who had gone through the detention system in this country.

I think the public will be quite surprised by some of the facts that come out of this debate. Each year, some 2,000 asylum-seeking women are locked up in Yarl’s Wood. The majority of them are survivors of sexual violence and rape. Up to 93% of the women detained at Yarl’s Wood claim to have suffered sexual violence of some form, so these are the most vulnerable women that we can think of in circumstances that are far from ideal. Being locked up in detention exacerbates physical and mental health problems, so it is even more important that the health provision should be to a high standard.

[Alex Chalk (Cheltenham) (Con)]

Does my right hon. Friend agree that we should never forget that those who are detained have neither been accused nor convicted of any offence? It is therefore particularly important that they are afforded the high-quality healthcare to which those who have been convicted of no crime are entitled.

[Mrs Spelman]

My hon. Friend makes a very important point. I just do not think that the bulk of people in our society have any idea that the UK is the only country in Europe with no time limit on immigration detention and that one can be detained for an indeterminate period without charge. Most people in British society would think that impossible, but we are the only country in Europe that currently does it. My hon. Friend is right that people who are detained indefinitely without charge should not be denied the healthcare they need. That is one of the key reasons why securing this debate was so important.

The detention inquiry that took place in the last Parliament made six important recommendations to Government, one of which I want to reiterate:

“Decisions to detain should be very rare and detention should be for the shortest possible time and only to effect removal.”

Those recommendations were made to the coalition Government and I sincerely hope that the present Government’s Minister will be able to say in his response what the Home Office is doing about those recommendations and the ones being made today.

We have heard about the types of health problems that women suffer from, but I will highlight the high percentage of suffering associated with sexual violence and the plight of pregnant women. Women for Refugee Women, an organisation already referred to, collected evidence from detainees in Yarl’s Wood and, frankly, as a mother it makes my hair stand on end. For example, a woman recently detained while pregnant said that she had only one hospital appointment while in Yarl’s Wood, which was for a scan at 20 weeks—as hon. Members know, that is late for a first scan. Even then she was escorted by officers who brought the lady to her appointment 40 minutes late. How anxious and frustrated she must have felt—even when she was brought to the necessary scan, she was not presented in time and was not able to speak to the midwife after the scan because no time was left. As a woman who has been through pregnancy, I would expect such basic healthcare provisions for people.

[Nusrat Ghani]

On the issue of pregnant women, the contrast is between the treatment available to women in my constituency at an award-winning midwifery unit and what women in detention get. Pregnant women in detention cannot even request access to a midwife—surely that has to be discussed further.

[Mrs Spelman]

I could not agree more and that is why we are laying it on with a trowel today.

A further example from Women for Women Refugees distressed me greatly when I heard about it, just as the hon. Member for Edmonton was distressed by describing what women in detention have to go through. One woman had to wait three and a half hours for an ambulance while she was bleeding from a miscarriage. I suffered from multiple miscarriages and they can be a matter of life and death. If our constituents knew that a 999 call for someone suffering a miscarriage had taken three and a half hours to be responded to, they would soon be writing to the Secretary of State for Health.

We are at this debate to emphasise to the Government the urgency required to address the situation. What is it that deters the Home Office from taking a different approach to detention? In other countries, pregnant women or any of the people whom we would detain are detained in the community and kept at large there. Is the Home Office worried about the cost? I doubt it, because our system seems to be both expensive and unnecessary—holding someone in detention costs almost £40,000 a year and some of the detainees are held for a very long period. Community programmes are consistently found to be significantly cheaper. International evidence also demonstrates that such alternatives to detention support high levels of compliance. Perhaps the Home Office is worried about the risk of absconding? The Home Office is evaluating the UK’s new family returns process, which makes minimal use of detention, and the evidence is that there has been no rise in absconding since the introduction of the new community-orientated process.

I urge the Minister, when he responds to the debate, to address such urgent matters of basic rights. We should expect all UK citizens and guests in our country to be able to rely on such rights and on an emergency service and proper healthcare to a standard that we would all expect to be available when needed. As far as possible, we should move away from how so many women are being treated.

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[Sarah Champion (Rotherham) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David. I congratulate hugely my hon. Friend the Member for Edmonton (Kate Osamor), because she has given those women a voice which, as my hon. Friend the Member for Walthamstow (Stella Creasy) said, is being denied them.

At the moment a great deal of attention is rightly being given to those who are crossing borders to seek safety. It is important that we focus our attention on those who reach the UK and seek our protection, and that we ensure they are treated with dignity and humanity. Every year, around 2,000 asylum-seeking women are locked up at Yarl’s Wood detention centre. Most are survivors of rape, sexual violence or torture. Because of their experiences in their countries of origin, those women are clearly vulnerable and many have serious physical and mental health problems. However, in spite of that, when they come to the UK for sanctuary they are locked up in detention, where they are re-traumatised, and the physical and mental health care available to them is wholly inadequate.

The chief inspector of prisons has called Yarl’s Wood a “place of national concern”. He found in his most recent inspection report that, of all the areas in the centre,

“healthcare had declined most severely”.

His report also pointed to the lack of gender-sensitive health practices in Yarl’s Wood. For instance, women who had newly arrived at the centre were expected to speak to male nurses as part of the health screening process and women who were placed on constant supervision, deemed to be so mentally distressed that they might kill themselves, were being watched by male staff in spite of their previous experiences of abuse and victimisation.

When Maimuna Jawo, who was detained in Yarl’s Wood prison, gave evidence to the parliamentary inquiry into the use of immigration detention, she said:

“Anybody who is on suicide watch has sexual harassment in Yarl’s Wood, because those male guards, they sit there watching you at night, sleeping and being naked.”

The Home Office has promised that a new policy will be put in place to ensure that women are watched only by female guards, but while the proportion of female staff at Yarl’s Wood remains under 50% there are serious questions about whether such a policy will ever become practice.

There are also real concerns about the treatment of pregnant women in detention, as hon. Members have said. Research by Medical Justice found that pregnant women miss antenatal appointments and some do not have any scans while detained. The poor care provided to those women is particularly troubling when we consider that, as has been said, for most of them detention serves absolutely no purpose.

[Mrs Spelman]

I want to highlight one important point: staff from Yarl’s Wood were actually prosecuted for offences against detainees. It is important to place that on the record.

[Sarah Champion]

I am grateful that the right hon. Lady placed that on the record. It turns my stomach that we are in this situation. Ninety of the 99 pregnant women detained in Yarl’s Wood in 2014 were released back into the community to continue with their cases, so they were locked up and re-traumatised for no reason at all. One of the pregnant women who the charity Women for Refugee Women is in touch with, a survivor of trafficking, was recently released back into the community after being detained for almost two months, even though Home Office guidance says that pregnant women should be detained only if their removal is imminent.

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[Anne McLaughlin (Glasgow North East) (SNP)]

I congratulate the hon. Member for Edmonton (Kate Osamor) on her heartfelt, moving speech. I want to thank her for crying—I am not the only one who does that in this place. She said that she wanted to be the voice for women detained in Yarl’s Wood and she has been that incredibly well today. Her demonstration of how deeply she feels will matter to them when they watch the debate.

If the UK Government need more evidence of the desperate human consequences of unlimited incarceration of vulnerable people, the shameful reports of inadequate healthcare as well as the dire treatment of female detainees in Yarl’s Wood should be telling enough for them to abandon their inhumane policies. I appeal to the Minister, who I know has a humane side to him—sometimes a very humane side—to do something now. We are waiting on the outcome of reports, but we already have significant reports, so we should not wait for more of them before we do anything.

Yarl’s Wood is a prison for people who have committed no crime, as the hon. Member for Cheltenham (Alex Chalk) pointed out, where diabolical health and safety standards threaten the lives of innocent people, many of whom have already been victims of torture and trauma. Evidence of the degrading, inhumane consequences of indefinite detention shows the vital need for time-limited detention as a matter of urgency. The Scottish National party has long supported that. The UK Government are fundamentally failing to protect some of the most vulnerable women seeking refuge.

Yarl’s Wood fails to meet the most basic standards of health and safety for detainees and is a “place of national concern”. Those are not my words, but those of the chief inspector of prisons, Nick Hardwick. I sincerely hope that the Government will listen to that and do something as a matter of urgency.

I want to return to something that the hon. Member for Edmonton talked about. Last year, 90 of the 99 pregnant women detained were later released and not deported. I think it was the hon. Member for Rotherham (Sarah Champion) and the hon. Member for—[Interruption.] She and the hon. Member for Walthamstow (Stella Creasy)—I do that in every debate—asked, if 90 of those women were later allowed to go to homes in the UK, what were they doing there in the first place? The hon. Member for Bishop’s Stortford—

[Mrs Spelman]

Good try—Meriden. [Laughter.]

[Anne McLaughlin]

The constituency names do not come up on the Annunciator in Westminster Hall. In an equally moving speech, the right hon. Member for Meriden (Mrs Spelman) noted that in 2015 there were—I think she said—only two pregnant women in Yarl’s Wood. I would be interested to hear from the Minister whether that is because the Government are now politically opposed to the detention of pregnant women and whether we can expect that number to go down rather than up.

I also pay tribute to the right hon. Lady for speaking movingly about how deeply she feels about the situation, and in particular for mentioning her experience of miscarriage. That is not an easy thing to do, but she recognised her duty to do that to highlight the problems faced by other women.

I share the shame that the hon. Member for Walthamstow mentioned she feels. She did something important: she spoke in this place the words of women currently in detention. The hon. Member for Rotherham—I know where she represents—has been a true champion of those seeking asylum. She rightly questioned why 90 pregnant women were at Yarl’s Wood in the first place if they were released.

The SNP has long called for an end to the unlimited detention—imprisonment, in fact—of migrants. It recently advocated that a 28-day maximum time limit be written into the Immigration Bill, based on evidence that being locked up for any longer would be catastrophic for the detainees’ health. An unlimited period of detention not only causes damage to health, but is a fundamentally unnecessary and expensive exercise.

My hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who is our immigration spokesperson, asked a parliamentary question in September about the cost per capita of detaining someone in one of these centres. The reply from the Home Office was that last year the average cost to hold an individual in detention was £91 per day. I would argue, as others have, that that money could be better spent elsewhere. The Home Office has also said that the UK detains immigrants only as a last resort, but in 2013 it detained just over 30,000. Germany detained just over 4,000, Belgium just over 6,000 and Sweden almost 3,000. During that time, Germany received four times as many asylum applications as the UK, and I do not think anyone would accuse Germany of being a soft touch. We are the only EU country to have no time limit on detention.

Many of the women detained at Yarl’s Wood have backgrounds that include trafficking and torture, as well as physical and mental abuse. A young woman who fled persecution in Uganda on account of her sexuality talked about the lack of support for those with mental health problems and how the lack of appropriate healthcare in the detention centre led to suicidal thoughts. I understand that some counselling services were withdrawn last year; will the Minister give us an update on that? Surely that was a mistake and those services will be reinstated, because if anywhere needs it, it is that place. We must address the failures not only in Yarl’s Wood but in the immigration system as a whole. We cannot put up with a prison-like system, not only because of the financial consequences, but because of the devastating human cost, which is simply not just.

I pay tribute to a choir that came to this place from Manchester at Christmas. In fact, they might have sung in this Chamber. They are called WAST—Women Asylum Seekers Together—and it was incredibly moving to witness them just before Christmas. All the women had been in detention and were now out, but the damage that had been done to them, by not only the detention but whatever had happened in their past, was visible.

I conclude by repeating something I have said on more than one occasion in this place. I know that we no longer detain children, but I am going to use the words of a 10-year-old boy who I knew extremely well. He was in Yarl’s Wood with his mother and could stand it no longer, and said to her, “Mummy, please can we just die? Please, dying would be better than this. Let us die.” That child was 10 years old. It does not matter what age someone is; if we are doing something to people that makes them feel like they want to die, we have to do something about it. We cannot keep waiting for report after report after report. Listen to the reports that have come out already and take action as soon as possible.