United Kingdom – the gap between policy and practice The UK has a policy in place designed to safeguard vulnerable individuals by setting out requirements that health care staff must follow in order that detained persons who have a special illness, health condition or are a VoT are identified.121 The principal purpose of the policy is to ensure that particularly vulnerable detainees are brought to the attention of those with direct responsibility for authorising, maintaining and reviewing detention so that a decision can be taken quickly as to whether the person’s detention remains appropriate.122 Both UK law and policy make clear that people who have been tortured should only be detained in “very exceptional circumstances”.123 However, recent reports indicate that there are serious failings in the implementation of the policy: • In 2011, the Chief Inspector of Prisons found that reports submitted on behalf of detainees who may have been VoTs were often insufficient or formulaic, indicating that the needs of individuals had not been fully considered.124 In particular, where there was medical evidence of previous torture or that a detainee’s health was likely to be injuriously affected by detention, the reports written by health care staff were of very poor quality, often failing to include any diagnostic findings or judgments about the consistency of the allegations.125 • Medical Justice, an NGO advocating for asylum-seekers’ rights, reached a similar conclusion in its 2012 report on the policy.126 It noted: a lack of knowledge and training in the assessment and management of VoTs; failure to provide relevant clinical information or to conduct proper medical examinations; the existence of a culture of disbelief and cynicism amongst officials, which impacted negatively on the quality of the decision-making.127 The health care was of poor quality, with background health information on detainees rarely available, often leading to a failure to prescribe medication and poor doctor/patient relationships.128 Detainees were not adequately screened and thorough mental state examinations were not completed, meaning that those with mental health conditions were not diagnosed early on. The report outlined systemic failures on the part of the immigration authorities and private service providers to follow statutory law and provisions put in place to safeguard vulnerable persons, including VoTs. It reported that although monitoring does exist, “accountability remains sketchy and transparency levels are weak… it is often unclear where responsibility or culpability falls”.129 Germany – poor implementation of the EU Reception Conditions Directive (RCD) A Parallel Report submitted by NGOs in Germany in accordance with the UNCAT130 noted that many regional states still lack a procedure for identification of vulnerable asylum-seekers, despite the obligation on EU Member States to take into account the situation of vulnerable persons in the RCD.131 In particular, medical checks carried out are designed to detect severe illnesses, but not mental health issues, which many VoTs and vulnerable asylum-seekers may suffer from. A failure to detect vulnerable asylum-seekers, including victims of torture and traumatised persons, increases the likelihood that their health condition will deteriorate. The report highlights that although state-employed psychiatrists are not available for consultation in detention centres on a regular basis, an independent psychiatric or psychological evaluation is usually not granted by the authorities. The report further highlights that traumatised refugees claiming asylum at an air- ... 64 / Recognising victims of torture in national asylum procedures