THE MEDICAL FOUNDATION FOR THE CARE OF VICTIMS OF TORTURE
Purpose
The purpose of this instruction is to assist caseworkers in dealing with
requests from applicants who are/will be attending the Medical Foundation.
(See Background for more information about the Medical Foundation.)
Arrangements for deferring dispersal, accommodating in London,
paying travel costs.
Medical Foundation Assessments
Asylum seekers who state that they have suffered torture may wish to obtain
an assessment of their mental and physical health from the Medical
Foundation. The Medical Foundation assessment may indicate the need for
treatment, either at the Medical Foundation or elsewhere, and may also be
submitted as part of their asylum application. Port asylum seekers are given a
leaflet by the Immigration Service advising how to access their services.
The Medical Foundation provides a non-appointment drop-in service, at
midday, Monday to Friday. The first 10 asylum seekers to attend the drop in
service will be seen the same day by the Medical Foundation duty officer. This
is called an initial assessment. A report of this assessment is considered by a
panel of professionals and the result is conveyed promptly to the asylum
seeker in writing (the result being that the asylum seeker is either asked to
return or make an appointment for further treatment etc or the asylum seeker
is advised that the services of the Medical Foundation are not necessary).
Asylum seekers who write requesting an appointment may have to wait
several weeks for an appointment, and may be dispersed in the meantime.
Caseworkers and interviewers must remain alert and receptive to the
difficulties and barriers victims of torture may face. Those that have suffered
at the hands of their own authorities may distrust officials here, despite
travelling to this country to seek refuge. Common sense, awareness and
sensitivity can minimise such problems.
Payment of travel costs for attending the Medical Foundation for an
assessment
Section 96 (1)(c) of the Immigration and Asylum Act 1999 states that support
may be provided to enable the supported person (if he is the asylum seeker)
to meet what appear to the Secretary of State to be expenses (other than
legal expenses or other expenses of a prescribed description) incurred in
connection with his claim for asylum.
This means that NASS must consider meeting a supported asylum seeker’s
travel expenses only where he is the main applicant – not a dependent – and
is attending the Medical Foundation for an assessment in connection with his
asylum application. Generally, this should require only one appointment.
On receipt of an application for travel costs (unless it is from an asylum seeker
who has been dispersed by NASS, in which case see subsequent section),
caseworkers should consider meeting them only where:

the request is made in writing, and in respect of an asylum seeker, not a
dependent; and

the person is/will be supported by NASS; and

the reception assistant has completed the Medical Foundation referral
form;(see Annex A) and

the travel costs have been/will be incurred solely for the purpose of
attending the Medical Foundation for an assessment in connection with his
asylum application.
Where the request is made in advance (ie at least 5 working days) of an
appointment, the applicant should be issued with a self-write ticket.
Exceptionally, where the request is for reimbursement of costs, check that the
costs are reasonable, and supported with evidence/tickets etc. where
possible. Certificate the request by writing “Certified for Payment” and sign
and date the certification. Reimbursement should be made by vouchers.
Travel costs which exceed £10.00 should include £10.00 cash voucher(s).
New port and in-country applicants
NASS policy is to disperse away from London and the South East. Where
accommodation has been requested, and the reception assistant has made a
referral to the Medical Foundation for an assessment of either the main
applicant or a dependant (see Annex A), NASS must give careful
consideration to deferring dispersal – ie maintaining the applicant(s) in
emergency accommodation or providing temporary accommodation in London
- until the Medical Foundation has assessed his/her case. Before
recommending deferral, caseworkers should consider obtaining an opinion
from the NASS medical adviser.
Generally, where the applicant attends the weekday drop-in facility at
12.00pm, the Medical Foundation will assess him/her the same day, and the
decision as to whether or not to accept the applicant for treatment will be
made within 7 days (this is because they consider cases by committee). The
Medical Foundation will note its decision on the referral form, and fax it to the
reception assistant, who will inform the applicant and NASS.
On receipt, NASS must consider the Medical Foundation decision as part of
the assessment process. Each case should be considered carefully and
sympathetically on its own merits. If the Medical Foundation decision is that
the applicant does not require its specialist services, providing there are no
other reasons to suggest that dispersal is inappropriate, then dispersal should
be recommended. The Medical Foundation may advise that a person
requires particular treatment, other than at the Medical Foundation, and that
the treatment is available at a specific location, such as one of the trauma
centres in Leeds, Liverpool or Nottingham. These recommendations should
be carefully considered when selecting the most suitable dispersed location,
and caseworkers would need to show good reason for recommending
dispersal to any other area. Where the Medical Foundation accepts the
applicant for treatment, the caseworker must consider sympathetically
providing suitable accommodation locally. Caseworkers should also consider
obtaining an opinion from the NASS medical adviser.
Subsequent in-country applicants, appeal and disbenefited cases
Where an in-country applicant states that s/he is already receiving treatment
by the Medical Foundation, and requests accommodation but asks not to be
dispersed, NASS must give careful consideration to deferring dispersal to
allow the applicant to continue with his/her course of treatment.
Caseworkers should not contact the Medical Foundation directly to ask for this
information, as this contravenes doctor/patient confidentiality. The
caseworker should write to the applicant, asking him/her to provide a report
from the Medical Foundation within 5 working days, to establish:
i)
whether the applicant is currently receiving treatment by the
Medical Foundation;
ii)
how long the treatment is likely to last; (eg. weeks/months)
iii)
when the (next) six monthly review is due.
If no report is received, the case should be reviewed promptly on the 6 th
working day. The caseworker should write to the asylum seeker, by 1 st class
post, requesting the report without further delay and advising that:

if it is not produced (unless there are exceptional reasons)
then s/he will be offered accommodation, in a dispersal area, on a no
choice basis 3 working days from the date of the letter.

Failure to accept this accommodation may result in his/her
application for support being terminated.
Each case should be considered carefully on its own merits. Where the
Medical Foundation confirms that the applicant is receiving treatment, the
caseworker must consider sympathetically providing suitable accommodation
locally, or as close to the Medical Foundation as possible. Caseworkers
should also consider obtaining an opinion from the NASS medical adviser.
Requests from asylum seekers dispersed by NASS to attend the Medical
Foundation
Where an asylum seeker in dispersed NASS accommodation submits a
request for assistance to consult the Medical Foundation with a view to
receiving treatment, s/he should be advised to make an appointment with
his/her GP. The GP will consider the asylum seeker’s particular needs, and
whether these needs might be met from local NHS and/or other local services.
Where the GP considers that suitable treatment is not available locally, and
specifically that the asylum seeker requires specialist treatment by the
Medical Foundation, s/he will refer the client to the Medical Foundation for an
assessment. Generally the GP will arrange the appointment. If an applicant
has not been given an appointment s/he should be advised to travel to the
Medical Foundation in good time to be one of the first 10 callers that day.
The applicant should be provided promptly with a self-write ticket.
Following the assessment, the Medical Foundation will make a decision
regarding the need for treatment or otherwise within 7 days. Where the
decision is that the applicant requires specialist treatment by the Medical
Foundation, the caseworker, taking into account when treatment is likely to
commence, should consider carefully whether the applicant should be
transferred to accommodation in London.
The Medical Foundation may advise that a person requires particular
treatment, other than at the Medical Foundation, and that the treatment is
available at a specific location, such as one of the trauma centres in Leeds,
Liverpool or Nottingham. In such cases, caseworkers should consider
carefully relocating the applicant(s) to a more suitable dispersed location, and
would need to show good reason for keeping them in their current
accommodation.
Each case should be considered sympathetically on its own merits. Case
workers should consider obtaining an opinion from the NASS medical adviser.
Background
The Medical Foundation for the Care of Victims of Torture, Star House,
Grafton Road, Kentish Town, London, was founded in 1985. It is a registered
charity providing medical treatment, social care and practical assistance,
psychological and physical therapy to survivors of torture. It works with
survivors of torture and organised violence to help rehabilitate them and to
begin the healing process.
The Medical Foundation is funded by voluntary contributions from individuals
and trusts. Its work has received recognition and support from a wide range of
organisations, including the United Nations, the European Union, the British
Medical Association and the British Council of Churches. The Home Office (of
which NASS is part) recognises the Medical Foundation as a bona fide
organisation.
Article 1 of the United Nations Convention Against Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment 1984, provides a definition of
torture for the purpose of the UN Convention (relating to refugees) as:
"any act by which severe pain or suffering, whether physical or mental, is
intentionally inflicted on a person for such purposes as obtaining from him or a
third person information or a confession, punishing him for an act he or a third
party has committed or is suspected of having committed, or intimidating or
coercing him or a third person, or for any reason or discrimination of any kind,
when such pain or suffering is inflicted by or at the instigation of or with the
consent or acquiescence of a public official or other person acting in an official
capacity. It does not include pain or suffering arising only from, inherent in or
incidental lawful sanctions."
More succinctly, s.134(1) of the Criminal Justice Act 1988 provides:
"A public official or person acting in an official capacity, whatever his
nationality, commits the offence of torture if in the United Kingdom or
elsewhere he intentionally inflicts severe pain or suffering on another in the
performance or purported performance of his official duties."
Acts, when committed or sanctioned by officials , which would probably
always constitute torture, include:

forcible abortion;

forcible sterilisation, or

acts involving genital mutilation and allied practices.
The dictionary definition of torture is the infliction of severe bodily pain eg as
punishment or means of persuasion; severe physical or mental pain. Victims
of torture may be reluctant to talk about their experiences and this should not
be taken as an indication that such claims are not true unless claims are
made at a very late stage of the overall asylum process.
Elaine Dainty
Policy & Process Section
August 2000
ANNEX A
ATTENTION : JAN HYNCICA
REFERRAL TO MEDICAL FOUNDATION FOR ASSESSMENT
Please note that in order for the Medical Foundation concession regarding
accommodation in London to operate, the applicant must show that (a) s/he is
a survivor of torture and (b) will need on-going care and treatment and (c)
needs the specialist services of the Medical Foundation. Please note that the
Medical Foundation concession does not operate for access to family,
community or other support which are available by other means.
Please note that the Medical Foundation sees only the first 10 people on duty
every day (Monday to Friday). Please fax this form to the Medical Foundation
and send the applicant with a copy of this form to our duty caseworker as
soon as possible. Registration starts every day at 12 noon.
Our decision will be made at the weekly team meeting (to ensure fairness and
consistency) and will be faxed to the referrer within 7 days of the applicant’s
first Medical Foundation appointment. Please note that the Medical
Foundation will not respond to the referrer with hand written or other letters,
but only by using this form.
DATE OF REFERRAL…………………………..
/
/2000
NAME OF APPLICANT…………………………PORT REF………….…………..
DATE OF BIRTH……………………………… ..NATIONALITY……….………...
NAME OF REFERRER…………………………ORGANISATION………….…...
TELEPHONE…………………………………….FAX………………………………
HISTORY OF TORTURE
(a)
Dates of detention
(b)
Duration of detention
(c)
Nature of torture
(d)
Other experiences of organised violence
CURRENT MENTAL AND PHYSICAL HEALTH (in applicant’s own words)
REFERRER’S OBSERVATIONS AND CONCERNS (which indicate need
for Medical Foundation services)
CONSENT : I HEREBY GIVE MY CONSENT FOR THE MEDICAL
FOUNDATION TO BE INFORMED OF MY CURRENT ADDRESS BY
N.A.S.S. AND ITS AGENTS
………………………………………………………….. DATE:
DATE SEEN AT MF ON DUTY……………………………./………/2000
DECISION
FURTHER ASSESSMENT NEEDED
YES
NO
ACCEPTED FOR ONGOING TREATMENT
YES
NO
DATE OF MF DECISION (FAXED TO REFERRER)…………/
/2000
NAME OF MF INTAKE CASEWORKER………………………………………….