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The UK's exportation of asylum obligations to Rwanda: A challenge to mental health, ethics and the law

Prof Cornelius Katona
(Piyal Sen, Grace Crowley, Paul Arnell, Mishka Pillay, Lauren Z Waterman, and Andrew Forrester)
Medicine, Science and the Law 2022, Vol. 62(3) 165–167

The United Kingdom government has made a concerted decision to ramp up its ‘hostile environment’ policy towards asylum seekers and refugees. The original policy took the form of ‘a package of measures designed to make life so difficult for individuals without permission to remain in the UK that they will not seek to enter the UK to begin with or if already present will leave voluntarily’. The Nationality and Borders Act provides a new legislative framework for issues relating to nationality, asylum and immigration which makes asylum claims less likely to succeed and limits the rights available to many of those whose claims are successful. Critics of the policy have raised serious moral and ethical concerns relevant to both health and legal professionals. In addition, it appears that it will fail to deter those planning to make risky journeys to the UK for protection, as the government has argued in justification.

This editorial looks at one the most controversial elements of the government's plans - transferring people  to Rwanda to have their asylum claims determined - and the implications of this for the mental health of refugees and asylum-seekers and the health professionals working with this patient group.

Refugees and asylum seekers have increased rates of some mental health conditions, particularly post-traumatic stress disorder (PTSD) and depression. The adverse impact of the new policy on such a population is likely to be substantial. In the face of extreme uncertainty and lack of hope, it risks provoking self-harm and suicide among some of those affected. It is therefore necessary to ensure that healthcare services in Rwanda have sufficient capacity to identify and manage people with mental health difficulties. However, the current provision of mental health resources in Rwanda is extremely limited, with only 12 psychiatrists working in the country (0.10 per 100,000 people), no child psychiatrists, and only two psychiatric hospitals.

The editorial also looks at the role of medico-legal reports in decision making around removals to Rwanda and concludes:

"Never has it been more important for doctors and lawyers to work together to jointly navigate the challenges that arise from this new legislation, which has the potential to demean and humiliate people when they are most in need of support and protection."