Immigration detention is harmful to health – alternatives to detention should be used

A new report by WHO/Europe finds that immigration detention can have a severe impact on migrants' health, especially mental health, during and after release from detention. International law clearly states that immigration detention should only be used as a last resort, and never for children, yet immigration detention remains widely practised across the WHO European Region.

Dr Hans Henri P. Kluge, WHO Regional Director for Europe, says: “My vision of ‘leave no one behind’ applies to everyone, including refugees and migrants, because the right to health must be protected for all, regardless of status. Over the last few years, immigration detention has increasingly been used as a tool to manage migration flows in the WHO European Region. To protect the health of refugees and migrants, alternatives to detention should always be prioritized over detention measures, which can be akin to prison. Evidence suggests migrants in detention have the same or worse mental health outcomes as people living in prison.”

Findings show that the environment in immigration detention can cause a decline in the mental health of migrants. The longer migrants are detained, the worse the effects on their mental health. These negative impacts can be long-lasting, continuing even after release. Although the mental health needs of migrants in immigration detention are well documented, psychological care and support are often missing.

Compared with prisons, immigration detention facilities often offer limited safeguards and services. Their conditions also place migrants at risk of communicable diseases, violence and other traumatic events. The deterioration of health in immigration detention can be explained by a multitude of stressors, such as uncertainty about migration proceedings, criminalization of migrants, feelings of isolation, lack of support from staff and communication barriers.

Most immigration detention facilities provide access to essential medical care, but many challenges remain. Often, access to health care is limited, interpreters are lacking, training and support for health-care providers and detention staff are insufficient, mistrust prevails, and medical records are inadequate or incomplete.

Staff at detention facilities can play a vital role in improving access to health services for those detained, often functioning as gatekeepers to available support, health care and much-needed medicines. Evidence shows that support for migrants from staff in immigration detention has a positive impact on migrants' psychological health.

If immigration detention is used, its effects can be mitigated through appropriate training of staff, safeguarding measures, provision of psychological support, and provision of tools to maintain health and prevent the spread of communicable diseases.

Appropriate mental health measures include staff support and psychological support groups for migrants. Programmes that integrate holistic medical teams, including physicians, nurses, cultural mediators, social workers and psychiatrists, were found not only to help to meet the health-care needs of migrants but also to improve the overall environment in immigration detention.

Immigration detention should be used as a last resort. Alternatives to detention should always be prioritized. Usually, alternative programmes enable migrants to reside within the community and access support during migration procedures. Case management-based approaches with a focus on engagement instead of enforcement have been found to improve the outcomes of the migration process as well as the health outcomes of migrants.

The report was developed by the migration and health programme of WHO/Europe in collaboration with the newly established WHO Collaborating Centre on Migration and Health Data and Evidence at Uppsala University in Sweden.

Professor Anders Hagfeldt, Vice-Chancellor of Uppsala University, says: “Refugee and migrant health is an important aspect of an inclusive public health approach and sustainable societies. Uppsala University is proud to have partnered with the WHO Regional Office for Europe to develop this important publication to address the health challenges among one of the most vulnerable groups of migrants. The report serves as a guide for authorities on how to protect the health rights of refugees and migrants in relation to immigration detention, and promote use of alternatives to detention.”