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A case example that serves to illustrate the shortcomings detailed above is the story of Anna, a victim of torture, rape and trafficking, who spent 12 weeks held at an IRC while pregnant. Her story has been documented in an investigation into the ineffective and damaging medical care of detained pregnant women [19]. Anna claimed asylum on arrival to the UK. She was then transported to an IRC. Her initial health screening happened the next morning at 05:20, at which stage she was 4-5 weeks pregnant. Anna spoke almost no English at the time, yet during the assessment her English language ability was recorded as “fair”. Given the absence of adequate interpreting services serious communication problems continued. On one occasion Anna was found vomiting and crying so her roommate, who spoke a different language, was asked to interpret for the healthcare staff. Furthermore, there was a failure to identify Anna as a vulnerable detainee. A month after Anna’s arrival to the IRC, an independent Medical Justice doctor visited her. The resulting medico-legal report recounts Anna’s long history of physical, emotional and sexual abuse. It was reported how her pregnancy duration was consistent with her account of rape and how she presented scars from cigarette burns and from a burning knife, and patchy hyperpigmentation caused by pouring hot water on her. Despite this evidence she was not released. Finally 12 weeks after her arrival, Anna was liberated from the IRC, though her immigration case remained pending. Anna’s case speaks to the potential risks that can occur when initial health screening assessments are poorly conducted.

With regards to the provision of healthcare while in detention, it has been documented [11, 12, 20] that IRCs are generally only able to deliver basic medical care to detainees. Access to necessary treatments is not always available and there have also been reports of delayed access to medication [6, 19]. This can be particularly serious for those with serious complex health issues. For example, an investigation into the clinical care of detainees living with HIV concluded that interruptions and disruptions in antiretroviral therapy occur repeatedly in detention [20]. The consistency, quality and suitability of the health care services are hindered by several factors including the pervasive culture of disbelief. In this way, the first obstacle in accessing healthcare is a dismissive attitude encountered by detainees when reporting symptoms [15, 18]. According to Dr. Naomi Hartree, clinical advisor of Medical Justice, staff in IRCs routinely ascribe behavior indicative of mental disorders to intentionally disruptive or manipulative behavior by detainees [6]. Physical symptoms, unless observable, are sometimes equally met with skepticism and unresponsiveness. Gatwick Detainees Welfare Group has reported the case of a man who was convinced that he had broken his leg during an accident while in detention. The healthcare staff at the IRC told him that this was not the case. Six weeks later he was finally taken for an X-ray at a local hospital and the diagnosis of broken leg was confirmed [21]. It should also be pointed out that the lack of trust goes both ways. Anecdotal reports [4, 15], from both detainees and volunteer visitors, suggest that people in detention do not always see a distinction between custodial and healthcare staff, which can lead to poor doctor-patient relationships. 

One of the difficulties that contributes to the low standard of ongoing health care for detainees is inefficiencies relating to IRC’s medical records system. This is particularly disruptive for people with on-going conditions, as transfers of detainees from one IRC to another are fairly regular [6]. The catastrophic potential consequences of poor medical record keeping are exemplified by the death of Brian Dalrymple [22, 23], a US citizen who suffered from schizophrenia and hypertension. Brian came to the UK on holiday, but was refused entry because his behavior appeared unusual and uncooperative. As a result he spent six weeks in detention. While in detention, it was documented that Brian did not appear to be completely rational in his thinking, yet a psychiatric assessment was never carried out. As he was found to have dangerously high blood pressure, a hospital referral was made. It is understood that Brian discharged himself against medical advice. Three days before his death, Brian was transferred from one IRC to another. However, he arrived there without his medical records. Staff at the second IRC were not made aware of his current state of health. The inquest into Brian’s death concluded death by natural causes (ruptured aorta) compounded by neglect. The jury's narrative verdict stated: "Throughout Mr. Dalrymple's detention at Harmondsworth, medical record-keeping was shambolic" [24].

Regarding the treatment of detainees with mental health conditions experts have raised the question as to whether it is really possible to treat serious mental illness satisfactorily in a detention setting [15, 18, 25]. 

According to the Royal College of Psychiatrists [26], given the harsh living conditions and the lack of specialized mental health treatment resources, IRCs are not appropriate therapeutic environments to promote recovery from mental illness. C was trafficked to Europe as a teenager. After years of being beaten, raped and tortured he found his way to the UK but ended up held in an IRC. Over the three years that C has spent in detention, the UK Border Agency has made eight cursory attempts to deport him. These attempts have been unsuccessful because nobody is sure about his nationality. C was born in the Bakassi peninsula, which used to belong to Nigeria, but is now governed by Cameroon. Immigration officials from both countries refuse to admit him back, and thus C remains locked in limbo. C has been diagnosed with Post-Traumatic Stress Disorder and has tried to commit suicide on more than one occasion. Medication has been prescribed to relieve secondary symptoms of depression and anxiety, yet given the absence of specialized psychiatric services within the IRC, the trauma-focused cognitive-behavioral therapy recommended by two independent psychiatrists has not been delivered. C’s medical needs are not being met in detention. His case exposes some of the shortcomings with regard to the provision of healthcare for detainees with severe mental health needs.