Medical Justice last week published a new report examining the impact of the UK’s “one in, one out” agreement with France on people detained for removal from the UK, concluding that the policy has caused serious harm to survivors of torture, trafficking and other trauma.
The 28-page report, Politics over people? How the UK’s ‘one in one out’ knowingly harms and forcibly removes torture and trafficking survivors to France, can be downloaded here.
Under the July 2025 agreement, the UK detains people who arrive by small boat and seeks to remove them to France, in return for accepting an equal number of people from France to seek asylum in the UK.
While the Government’s stated aim of the scheme is deterrence, Medical Justice says that the way the policy is implemented results in the arbitrary detention of highly vulnerable people whose asylum claims are not considered before removal decisions are made. It states: “With vaguely defined selection criteria, people with serious mental health conditions and experiences of trauma who have arrived by boat to seek safety in the UK are being detained under the scheme. Their claims for protection are not being considered, nor are their risks of harm in detention. Survivors of torture and trafficking are being harmed by detention, by the anticipation of forced removal to France and during forced removals themselves. Clinical safeguards in detention are failing to protect these vulnerable people, with alarmingly high levels of suicidality among this group of clients. Many people have not been able to access adequate and timely legal advice.”
The report analyses the cases of 33 Medical Justice clients detained under the UK–France Treaty since August 2025 and draws on clinical, legal and documentary evidence. The men, women and age-disputed young people were detained in immigration removal centres for periods ranging from one month to more than three and a half months. Their nationalities include Eritrean, Iranian, Palestinian, Sudanese, Afghan, Syrian and Ethiopian. All had arrived in the UK by small boat and claimed asylum on arrival.
Of the 33 clients, 20 were assessed in detention by independent Medical Justice clinicians, who produced medico-legal reports. All 20 had clinical evidence of a history of torture, ill-treatment and/or trafficking, and all were experiencing at least one serious mental health condition or symptoms requiring further assessment. Diagnoses and symptoms documented by clinicians included post-traumatic stress disorder, depression and anxiety disorders. Medical Justice states that many of those assessed described severe violence and highly traumatic events prior to arrival in the UK, including experiences in France such as threats from traffickers and witnessing the violent death of another person.
The report finds that clinical safeguards intended to protect vulnerable people in immigration detention were largely ineffective for this group. Under the Detention Centre Rules, individuals should be offered a GP appointment within 24 hours of arrival and clinicians should complete safeguarding reports where detention is likely to cause harm. Medical Justice reports that only two of the 20 people assessed had a GP appointment within 24 hours, and in neither case was the mental health assessment sufficiently detailed to meet safeguarding requirements. Only three individuals had a safeguarding report identifying that detention was likely to cause harm, including in cases where health had already deteriorated.
Levels of suicidality documented in the report are described as “alarmingly high”. Twelve of the 20 assessed individuals reported suicidal thoughts, one attempted to take their own life in detention and two self-harmed. Five were identified by detention centre staff as being at risk of suicide or self-harm, with one placed on constant supervision, yet only one safeguarding report was completed to alert the Home Office to suicidal risk. Medical Justice states that in 14 cases where it had access to Home Office responses to safeguarding reports, only one person was released as a result.
The report also documents the use of force and segregation during removal attempts. One client, referred to as Hamid, who had clinical evidence of a history of torture, described being restrained during an attempted removal to France in a way that obstructed his breathing. A Medical Justice clinician later documented physical injuries and psychological harm. Hamid has since been removed to France.
Medical Justice further reports that many clients were unable to access adequate and timely legal advice, particularly given the accelerated nature of the removal process. Some individuals were released in the UK after being granted bail by a tribunal judge, while others were released and subsequently re-detained for removal. At the time of publication, 16 of the 33 clients had been released in the UK, and 14 had been forcibly removed to France.
The report raises particular concern about the detention of age-disputed young people, noting that Medical Justice is receiving proportionately more referrals from this group under the UK–France scheme than in other detention cohorts. The report states: “The failures of safeguards in detention are not new. However, for this cohort, there is a near-total disregard for identified vulnerabilities in decisions to maintain detention – and what appears to be active decision-making to detain and remove vulnerable people. While almost half of clients detained under this scheme have been released after being granted bail by a Tribunal judge, only one was released by the Home Office in response to safeguarding reports completed by GPs within the IRCs. Although historically the Home Office only releases a low number of people in response to Rule 35 reports, the number for this cohort is particularly low. Keeping vulnerable people from this cohort in detention despite clear evidence that they are at risk and with few ‘immigration factors’ to justify the decision is difficult to reconcile with the Home Office’s Adults At Risk policy and effectively renders the safeguarding system a futile exercise. “
In its conclusions, Medical Justice states that the UK government has chosen to detain and forcibly remove survivors of torture, trafficking and other trauma in full knowledge of the harm detention is known to cause. While many of the report’s findings reflect longstanding concerns about immigration detention, the organisation argues that what is new is the detention and removal of people immediately after a traumatic journey to seek protection, without consideration of their asylum claims. The report concludes that detention safeguards have been rendered largely ineffective for this cohort and calls for an end to the scheme, the release of those detained under it, and for affected individuals to be allowed to have their asylum claims processed in the UK.