Doctors in Italy are campaigning to stop their colleagues certifying people as fit to be detained in immigration centres, citing major concerns over the impact these centres have on health.
The campaign is a collaboration between the Italian Society of Migration Medicine (SIMM), an activist network called Mai più lager—No ai CPR [No more concentration camps—No to permanent centres for repatriation], and the Association for Legal Studies on Immigration.
It argues that the negative impact that the centres have on health mean no person can be labelled fit for detention. It is supporting doctors to reject applications to certify migrants as “suitable for administrative detention,” as required by Italy’s detention process. The assessment is commonly carried out in the presence of a police officer and doctors are usually unable to order diagnostic tests or conduct thorough examinations.
The campaign is advising doctors on ways they can reject requests for detention along with providing sample rejection forms and evidence outlining the health risks these centres pose.
In 2022, the World Health Organization in Europe called for an end to immigration detention, warning that the systems used across the continent can have a “severe impact” on the health of migrants who are often vulnerable.1 “Interpreters are lacking, training and support for healthcare providers and detention staff are insufficient, mistrust prevails, and medical records are inadequate or incomplete,” WHO said.
Unjustified suffering
Nicola Cocco, infectious disease specialist and coordinator for the SIMM working group on detained migrant health, told The BMJ, “I’ve been inside most of the detention centres in Italy. Nobody could be fit for these places. Even if you enter without any social or health problems, you will develop them.”
Earlier this month, a 21 year old man from Guinea was found dead in a detention centre in Rome after taking his own life.2
“The system is not working. It is not protecting the health of these people. They are just there waiting for deportation, and that happens in less than half of the cases because it’s very expensive to deport someone. This suffering seems to be so that the government can say it’s fighting undocumented migrants,” said Cocco, who works in prison health.
He stressed that the people being presented to doctors are not being detained as part of criminal proceedings but for administrative reasons, for example because of a lack of paperwork.
Cocco described the process of having doctors certify people as suitable for detention as “not a medical act” but a “political diagnosis” in which clinicians are asked to decide what the life of that person will be like for the coming months.
“This is the reason we are asking doctors to take a position,” he said. “If the doctor does not certify a person as fit for detention, they cannot be detained. Instead, the police have to find an alternative—for example, asking the person to visit the police station every day, or by taking their passport or giving them a notice to leave the country.”
Ethical unease
One Italian doctor, anonymised as ‘F’, told The BMJ she had felt a “great deal of ethical unease” when asked to judge people as being fit for detention. “Detention conditions are far worse than those in prisons, and many rights, including the right to health, are systematically violated within these facilities,” she said.
F described the visits doctors have with those on their way to detention as “hasty and perfunctory,” often carried out in the presence of the police and “under strong pressure from police headquarters” to complete the assessment as quickly as possible.
With support from the campaign she has decided no longer to certify people as being suitable for detention. “The campaign offers a series of informational and ethical points to hold on to in order to declare a person as not suitable to enter a place harmful to their health and dignity,” she said. “It allows us not to contribute to potential damage we can cause to these patients and gives us back our freedom of judgment.”
Similar concerns in the UK
In a linked opinion piece3 in The BMJ, the Italian campaigners have published a call to action from all healthcare professionals, not just those in Italy. While the UK system does not have the same medical process as Italy, the authors said that all “healthcare practitioners should be firm in saying that no one should ever be considered fit to be locked up in pathogenic environments where health is disregarded and fundamental rights are at risk.”
Commenting on the campaign, Emma Ginn, director of UK charity Medical Justice, told The BMJ she welcomed “any initiative by doctors to protect their patients from being subjected to perilous conditions in immigration detention sites and to preclude themselves from becoming complicit in that process and in causing harm.”
Ginn highlighted the findings of last year’s Brook House immigration removal centre inquiry, which found “credible evidence” of human rights breaches. It also uncovered instances where the centre’s healthcare provider had not properly carried out the clinical safeguards that should have protected detainees from unlawful and harmful detention.
In light of evidence suggesting poor provision of healthcare and human rights abuses, the BMA has called for immigration detention centres to be abolished.4