Psychological Debriefing by nikeborome

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                     ORAL SUBMISSION on behalf of

                THE MEDICAL FOUNDATION FOR THE

                    CARE OF VICTIMS OF TORTURE



        Delivered to the Independent Asylum Commission

       Hearing on Vulnerable Groups, Cardiff, 22 May 2007
                         By David Rhys Jones
                         Refugee Policy Officer




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Submission to Independent Asylum                               The Medical Foundation
Commission. Hearing on Vulnerable                     for the Care of Victims of Torture
Groups May 2007




Introduction

The Medical Foundation was founded 22 years ago and the need for its
services are as great today as they were in the 1980‟s. Indeed, in the world
post 9/11 it may be said that its services have never been in greater need.
You have been given general information about the background and work of
the Medical Foundation and I will not repeat it here save to note that we have
four treatment centres in the UK and last year received some 2,100 referrals
on behalf of torture survivors.

Torture is Endemic

Torture is still endemic in many countries throughout the world as the
Commissioners‟ briefing paper highlights. Last year the Medical Foundation
saw clients from over 86 countries including almost every country where other
human rights organisations document gross violations of human rights as a
matter of routine. For a complete list of source countries the Commission is
referred to the 2006-2007 Annual Review.

Evidence of Torture before the UK‟s Refugee Determination Process

Evidence of past torture is important in the determination of asylum claims in
substantiating whether international protection should be granted according to
international refugee and human rights law. The UNHCR Handbook of
Procedures and Criteria for Determining Refugee Status makes it clear that
the collection of evidence is to be a shared task between the asylum applicant
and the decision-maker.

The Medical Foundation is concerned that such evidence is not made
available to or actively sought by decision makers and immigration courts
despite the guidance of the UNHCR Handbook.

The Qualification Directivei makes clear the importance of evidence of torture
in two important areas when determining if a person is in need of international
protection as a refugee:

Article 4(3): „The assessment of an application for international protection is to
be carried out on an individual basis and includes taking into account: [...] (b)
the relevant statements and documentation presented by the applicant


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Submission to Independent Asylum                               The Medical Foundation
Commission. Hearing on Vulnerable                     for the Care of Victims of Torture
Groups May 2007

including information on whether the applicant has been or may be subject to
persecution or serious harm; [...].’

Article 4(4): ‘The fact that an applicant has already been subjected to
persecution or serious harm or to direct threats of such persecution or such
harm, is a serious indication of the applicant’s well-founded fear of
persecution or real risk of suffering serious harm unless there are good
reasons to consider that such persecution or serious harm will not be
repeated.’

The earlier EU Council Directive on Reception Conditionsii also recognises
the importance of evidence of torture in determining a grant of international
protection and instructs Member States to identify persons with special needs
with regard to reception conditions.

Article 17(1): ‘Member States shall take into account the specific situation of
vulnerable persons such as [...] persons who have been subjected to torture,
rape or other serious forms of psychological, physical or sexual violence [...].’

Although the UK has transposed both these Directives the Border and
Immigration Agency (BIA) has some way to go before it can be said to have
fully implemented them. For example:

    Interviewing officers have received little or no direct training in the
     interviewing of vulnerable persons. iii The Work Books which form the
     basis for their self study over their 55 day foundation course refer to
     torture as such very rarely and then in little (and somewhat contradictory)
     detail.

    Articles 4(3) and (4) are consistently watered down by references to
     “general credibility.” So, for example, a torture survivor who delays making
     an asylum claim will have that delay weighed against the question of their
     being a torture survivor.

    In considering the reception of asylum seekers little or no consideration is
     given to the special needs of torture victims when determining their
     support and accommodation needs.

Torture and risks on return beyond further torture

Torture is also an important element in considering the return to their country
of origin of those who have been tortured but who may not qualify for
Convention Refugee status, for example Articles 8(1) and (2) of the
Qualification Directive deals with “Internal protection” i.e. whether there is
another part of the country to which she can return:

‘…Member States may determine that an applicant is not in need of
international protection if in a part of the country of origin there is no … real
risk of suffering serious harm and the applicant can reasonably be expected to

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Submission to Independent Asylum                               The Medical Foundation
Commission. Hearing on Vulnerable                     for the Care of Victims of Torture
Groups May 2007

stay in that part of the country. [But] In examining whether a part of the
country of origin is [safe] Member States shall … have regard to the …
personal circumstances of the applicant.’

In this context „personal circumstances‟ must surely include the fact that the
individual has been tortured and greater weight must be attached to this fact
in any determination of whether a torture survivor can reasonably be expected
to return to the very state from which they fled torture.

This goes to the point made by the previous witness, Cristal Amissiv [that the
Home Office‟s own guidelines on Gender Issues are routinely ignored or
contradicted.]

Identifying Torture Survivors, meeting their special needs and facilitating
disclosure

As the briefing papers note, the Medical Foundation and UNHCR share the
view that mechanisms to identify survivors of torture and organised violence
are required at the earliest possible stage of any asylum procedure and,
following identification, that treatment of such persons should be allocated to
specialist medical staff and organisations.

In the view of the Medical Foundation this would be best achieved by ensuring
a medical assessment of all asylum seekers on arrival. This would ensure
that those with immediate health care needs would be dealt with promptly and
those requiring specialist attention as survivors of torture would be referred to
organisations like the Medical Foundation. In addition, as the Reception
Directive requires, torture survivors and similarly vulnerable people would be
identified and their „special needs‟ catered for.

Furthermore, health assessments are a vital mechanism for facilitating
disclosure. As your briefing papers indicate, through shame, distress,
embarrassment, mistrust of officialdom, humiliation or unwillingness to
disclose sensitive information of, for example, sexual violence to an
immigration officer of the opposite sex, barriers to disclosure are very
frequently created.

In the experience of the Medical Foundation, almost all torture survivors are
reluctant to disclose all the details of their torture, particularly so soon after
arrival as the New Asylum Model expects (often within a matter of four or five
days). This is not surprising following a very unsettled and disorientating
period when an asylum seeker may be more concerned with the impact upon
them of the journey to the UK, and where they are to be located following their
initial induction. There is a great deal of information to take in. Even those
who are sufficiently resilient to divulge some details will be reluctant to reveal
all to strangers.

A health assessment by a well trained clinician who can gently probe the
individual by asking questions, not about their asylum claim, but about their


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Submission to Independent Asylum                                The Medical Foundation
Commission. Hearing on Vulnerable                      for the Care of Victims of Torture
Groups May 2007

health and well-being (something which is uppermost in the minds of most
asylum seekers) can often find out more than a case owner, even with the
best of intentions. The Medical Foundation has been able to demonstrate this
time and time again in the detailed testimonies taken by its doctors and other
clinicians which are often far more detailed than even the applicant‟s lawyer
was able to obtain. For example, a rape victim may be extremely reluctant to
talk about her experiences, even in the context of her asylum claim, but she
may have concerns about, for example her reproductive health. Through
gentle questioning about such matters, she may gain the confidence of a
doctor or a nurse, which will then equip her to tell more.

Surely there must be some duty on the government to ascertain if a person is
a torture survivor and upon so finding, to take all appropriate measures to
ensure their care and treatment irrespective of whether they are ultimately in
need of international protection? Article 20 of the Reception Directive requires
that: Member States shall ensure that, if necessary, persons who have been
subjected to torture, rape or other serious acts of violence receive the
necessary treatment of damages caused by the aforementioned acts.

A vital first step which may avoid the detention of torture survivors

As Dr Heaven Crawleyv said when discussing children‟s cases, “there is a
gap between policy and practice” and this goes for torture survivors as much
as for children. [Doubly so for children who are torture survivors?].

Torture survivors are not suitable candidates for detention and a health
assessment is more likely to produce the early identification of torture
survivors to prevent that detention. The BIA‟s current policy is to regularly
detain those cases it thinks are „straightforward‟ in a „detained fast track‟
process and the BIA agrees that this „detained fast track‟ process is not
suitable for torture survivors because their claims are often far from
straightforward and who are, in any event, inherently unsuitable for detention.
But BIA‟s own screening interview procedures do nothing to identify torture
survivors. No questions about torture are asked at the screening interview.
Indeed, in the experience of the Medical Foundation torture survivors who
have disclosed their torture have nevertheless been deemed suitable for the
„detained fast track‟ because they are “not taking any medication.”

Although committed to „front loading‟ the BIA‟s NAM processes have failed to
recognise the importance of health assessments in the process. Not least in
the detained fast track. Instead, the BIA relies on an ad hoc process of
referrals to the Medical Foundation by legal representatives with limited or no
training and variable skills to try to overcome its own failure to put in place the
means to identify torture survivors before they are detained.

As the Commissions briefing points out, the Medical Foundation is opposed to
any asylum procedures taking place until a thorough medical assessment has
been carried out and the asylum seeker has been allocated a GP. Even then
there must be flexibility in regard to the treatment of torture survivors within


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Submission to Independent Asylum                               The Medical Foundation
Commission. Hearing on Vulnerable                     for the Care of Victims of Torture
Groups May 2007

the asylum process. The Medical Foundation is not opposed to the „fast track‟
procedure per se although it will be unsuitable for a considerable number of
torture survivors.

Torture Survivors as Manifestly Well-Founded Cases

However, there will be those cases that are very straightforward precisely
because the issue of torture is so clear and full disclosure has been made. In
such cases, consideration should be given to treating the claim as „manifestly
well-founded‟. Sadly the BIA procrastinates in considering this proposal
(which is also supported by the Refugee Council and UNHCR).

Dispersal of Torture Survivors

Commissioners have a detailed briefing before them on this question,
however the Medical Foundation would add that it is aware that a
considerable number of torture survivors are regularly dispersed away from
London precisely because they are not identified as such. Once again this is
a question of „front loading‟ the identification of torture survivors and the
earliest consideration of the health care needs and status as torture survivors
of all asylum seekers (before their claims for asylum are considered).

Conclusion

The key to ensuring that international protection is provided to torture
survivors under the current refugee status determination procedure in the UK
rests on two basic premises:

1. early identification of those who are survivors of torture
2. that torture survivors are treated with the utmost sensitivity by ensuring they
get the care, treatment, and support they need to enable them to pursue their
claim to asylum.

However, even if all those procedures advocated above were implemented
tomorrow, the Medical Foundation believes that there would always be a
significant number of torture survivors who are not identified as such and who
do not disclose their torture until late in the process (or indeed at all).
Therefore the only way to be sure that all those who may be torture survivors
are treated sensitively is to assume that all asylum applicants may be torture
survivors and to treat them accordingly.

As the Commission is aware, these are complex matters and time today has
only allowed for an overview of certain key concerns of the Medical
Foundation.

[We will in due course make a written submission to the Commission in
furtherance of its vital and timely work. Finally, on behalf of my colleagues of
the Medical Foundation we would be pleased to welcome Commissioners to
visit our centre in London to discuss in more detail the challenges faced by


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Submission to Independent Asylum                                        The Medical Foundation
Commission. Hearing on Vulnerable                              for the Care of Victims of Torture
Groups May 2007

our clients in their journey through the refugee determination procedure in the
UK.]

On behalf of the Medical Foundation for the Care of Victims of Torture
David Rhys Jones
Refugee Policy Officer

Revised and delivered at Cardiff 22 May 2007


Endnotes
i
 COUNCIL DIRECTIVE 2004/83/EC of 29 April 2004 on minimum standards for the
qualification and status of third country nationals or stateless persons as refugees or as
persons who otherwise need international protection and the content of the protection
granted. Article 38: Transposition: Member States shall bring into force the laws, regulations
and administrative provisions necessary to comply with this Directive before 10 October 2006.
ii
  COUNCIL DIRECTIVE 2003/9/EC of 27 January 2003 laying down minimum standards for
the reception of asylum seekers Article 26(1): Transposition: Member States shall bring into
force the laws, regulations and administrative provisions necessary to comply with this
Directive by 6 February 2005.
iii
  Article 13(3) of the EU Qualification Directive: ‘Member States shall take appropriate steps
to ensure that personal interviews are conducted under conditions which allow applicants to
present the grounds for their applications in a comprehensive manner. To that end, Member
States shall: (a) ensure that the person who conducts the interview is sufficiently competent to
take account of the personal or general circumstances surrounding the application, including
the applicant’s cultural origin or vulnerability,insofar as it is possible to do so [...].’
iv
      Co-ordinator of the Black Women‟s Rape Action Project (BWRAP), London
v
 Senior Lecturer, University of Wales, Swansea. Author of Gender, Persecution and the
Politics of Protection: Refugee Women and Asylum in the UK, University of Oxford Child first,
migrant second: Ensuring that every child matters [Heaven Crawley/IPLA, February 2006]
and a forthcoming publication on Age Disputed Minors [Crawley/ILPA May 2007]




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