BMJ 1994;308:1509 (4 June)
EDITOR, - In her news article Claudia Court states that 700 people are seeking asylum in Britain(1); this is a considerable underestimate. The Home Office's latest figures show that 45 800 people were waiting for their applications to be processed at the end of 1993 (personal communication). To achieve the coveted status of refugee applicants have to demonstrate a well founded fear of persecution, usually because of religious or political beliefs; only 3% succeeded in 1992. The number of asylum seekers in detention varies but can rise to 950 despite there being only 450 places. Many of the rest are confined in prison - a practice that the chief inspector of prisons, Judge Tumim, recently expressed grave doubts about. His description of the detainees he saw in Pentonville prison - "distressed, despondent, and in some cases desperate" - is vivid. Four asylum seekers have committed suicide since 1987, and others have made serious attempts at suicide.
The countries of origin of most detainees seeking asylum have been reported by Amnesty International as being subject to civil war, political turmoil, or torture and murder of members of opposition parties. The Medical Foundation for the Care of Victims of Torture finds that most alleged victims of torture are genuine. Many, rather than exaggerating, play down their experiences. Falanga (beating the soles of the feet) is so common that many do not think to mention it, and both men and women may be so ashamed of having been sexually abused that they have to be persuaded to admit it. The destructive effect of the torture on the victim's family relationships often provides supportive evidence of what has taken place.
The increase in refugees requesting the foundation's help since the passage of the Asylum Act 1993 has obliged it to develop a training course to enable doctors to establish new support centres outside London. Currently referrals come from all over Britain, so some patients are compelled to travel huge distances, especially when follow up interviews are necessary. The course organiser, Dr Gill Hinshelwood, is adamant that interested doctors should not feel intimidated at the idea of examining victims of torture. They should start with what they can manage and develop a service that responds to local needs in whatever way they can. The staff of the foundation are always available to advise over the telephone if there are any problems.
London NW3 2TB.
1. Court C. Asylum seekers run high risk of detention in Britain. BMJ 1994;308:811. (26 March.)