Life in Immigration Detention Centers: An Exploration of Health of Immigrant Detainees in Sweden and three other EU Member States
Type of text: Doctoral thesis
Published by: Uppsala university
Author: Soorej Jose Puthooparambil
Short description of text
The study consist of four papers and aims ‘to explore and describe the lives of immigrants in Swedish immigration detention centers, and to identify factors that could mitigate the negative effects of detention on their health’ (p. 71).
Most important results
‘Detainees experienced lack of control over their own lives due to lack of information in a language they can understand, inadequate responses from detention staff and restrictions within detention centers further limiting their liberty. Duration of detention was negatively associated with satisfaction of services provided in detention and the detainees’ Quality of Life (QOL). Detainees had low QOL domain scores with the psychological domain having the lowest score (41.9/100). The most significant factor positively associated with the QOL of detainees was the support received from detention staff. A sense of fear was present among detainees and staff. Detainees’ fear was due to their inadequate interaction with authorities, perceiving it as threatening, and due to their worry of facing repercussions of being involved in incidents caused by others. The potential for physical threat from detainees created a sense of fear among the staff. The detention staff expressed the need for more support to manage their emotional dilemma and role conflict of being a civil servant, simultaneously enabling the deportation process while providing humane care to detainees as fellow human beings. Detention centers in the Benelux countries had more categories of staff providing different services to detainees. Compared to the Benelux countries, healthcare services at the Swedish detention centers were limited. Detainees were offered no medical screening on arrival and no regular access to mental healthcare professionals.’ (abstract)
The Ottawa Charter was used to explore the detention setting and discuss the health-promoting and health-demoting factors present therein, based on the results from Papers I, II, III and IV. According to the Charter, ‘health promotion is defined as the process of enabling people to increase control over, and to improve, their health’ (p. 20). The Ottawa Charter propose five action areas to guide health promotion activities: build healthy public policy, create supportive environments, strengthen community action, develop personal skills and reorient health services.
‘The study used a mixed methods design. The project was divided into two phases. ‘During the first phase, two exploratory qualitative studies (Papers I and II) were conducted on detainee and staff experiences in the detention centers in Sweden. In the second phase, two studies were conducted. The first study was a cross-sectional survey measuring the Quality of Life (QOL) among detainees in Sweden (Paper III). Based on the factors identified from the qualitative studies, detainees’ satisfaction on services provided in the centers and its relationship with their QOL was also assessed. Factors important for the health of detainees in Sweden were identified from the first three studies. The second study in phase two (Paper IV) described how these factors were addressed in the Benelux countries and were compared with the Swedish detention policies’ (p. 25).
1. Recommendations directly impacting detainees:
a. Develop an adequate support system for detainees to cope with their lives in detention:
i. Increase psychosocial support through measures such as employing social workers/counselors at detention centers and through targeted and meaningful activities to avoid passivity.
ii. Enhance the collaboration with Non-governmental organizations at all centers to assist in creating a support system.
b. Take measures to address the sense of fear for detainees:
i. Provide detention staff with customized and regular trainings to improve their communication and interpersonal skills.
ii. Avoid detaining ex-prisoners along with other detainees.
c. Minimize language barriers and ensure easier access to information:
i. Provide legal and practical information relevant to detainees’ situation written in a language reasonably understood by them.
ii. Continue and enhance the use of professional interpreters when needed, even during all medical consultations.
iii. Provide training and support for detention staff to be more receptive and responsive to queries from detainees.
2. Recommendations for improving healthcare services at detention centers
a. Introduce medical screening on arrival for detainees to safeguard the health of detainees and others: i. Mental health screening should be an essential part of screening.
b. Ensure appropriate healthcare services are provided at detention centers, based on needs identified through medical screening:
i. Regular mental healthcare services need to be established at the centers.
c. Adequate training for healthcare staff to provide culturally appropriate and migrant-friendly care.
3. Recommendations directly impacting detention staff
a. Clearer role definitions and division of work to minimize role ambiguity and conflict.
b. Provide customized and timely training for detention staff:
i. Include aspects such as intercultural communication, emotional management and recognition of stress symptoms in the mandatory introductory training.
ii. Same as 1.b.i, 1.c.iii.
c. Provide better support and supervision for detention staff:
i. Provide opportunities for staff to discuss and to receive support for their emotional and professional conflicts.
4. Recommendations to be considered at policy/system level
a. Pursue alternatives to detention much more efficiently:
i. Use detention as a last resort.
b. Enhance efforts to take quickly executable decisions preventing detainees from spending months in detention and thus reducing duration of detention.
c. Grant freedom to detainees to the largest possible extent within detention centers.
d. Develop a long-term strategy to recruit staff appropriate for the roles and to provide them with ongoing training and support:
i. Same as recommendations 3.a,b and c.