Ignoring medical evidence: how the Home Office's flawed assessments trap people in harmful asylum housing
Dembe has been a client of HBF since 2024. A political refugee who was imprisoned in his home country, he is a survivor of torture and severe cruelty. As a result of his experiences, he lives with significant physical and mental health difficulties and has been diagnosed with post-traumatic stress disorder (PTSD). While torturing Dembe in prison, his attackers smoked heavily. As a result, the smell of cigarette and cannabis smoke now acts as a powerful trigger, causing nightmares and flashbacks that force him to relive his ordeal.
After claiming asylum in the UK, Dembe was accommodated by the Home Office in shared accommodation. In this housing, he is forced to live with people who smoke indoors. He has tried to manage the situation by speaking with housemates and the accommodation provider, but the impact on his mental health has been so severe that he often spends up to 18 hours a day outside and avoids going home.
Recognising the seriousness of the situation, Dembe's GP supported him by contacting the Home Office to request that he be moved to different accommodation. The GP made clear that that there was a clinical need for relocation as exposure to the smoke was directly worsening his mental health. Despite this medical evidence, the Home Office refused the request.
Dismissal of medical evidence
Dembe’s GP had clearly explained the urgency of the situation, but the Home Office disregarded the evidence with no clear explanation. Instead, it relied on an assessment from its own ‘Independent Medical Advisor’ (IMA). But the IMA had neither met nor spoken to Dembe and had failed to recognise the link between Dembe’s traumatic past and the harm caused by his current living conditions.
In our experience, this is not an isolated failure. The Home Office often sends these kinds of requests to the IMA to assess whether there is a clinical need to move. The IMA typically makes its decision from a desk review of the documents sent and rarely, if ever, speaks directly to the individual. The decisions are often inconsistent and vague, failing to detail how the decision was made and frequently failing to account for how living conditions can profoundly affect a person’s health and wellbeing. The clear disregard of independent expert medical evidence is alarming and leaves exceptionally vulnerable people in dangerous and distressing situations.
In Dembe’s case, his home, the place where he is meant to feel safe and secure, forces him to re-live some of the most traumatic experiences of his life. He felt as though the torture was happening to him again. Remaining in such an environment is worsening his conditions. Yet the Home Office caseworker gave greater weight to the IMA’s opinion than to Dembe’s GP, who has known and treated him for over two years.
A systemic failure
Unfortunately, Dembe’s experience is far from unique. Asylum accommodation is provided by the Home Office on a ‘no choice’ basis. Individuals are forced to live where the Home Office places them and may be moved frequently, sometimes with no warning or choice. This can mean being uprooted from a life and community they have worked hard to build while waiting for a decision on their asylum claim. In our experience, the accommodation that is provided is often low quality and causes clients’ physical and/or mental health to deteriorate. Clients have reported mould and damp, bedbugs, leaks and issues with the food in catered hotels being maggot infested or still partially frozen. It has proved extremely difficult to get men moved from ex-army barracks even when being housed there has resulted in self-harm and suicidal ideation.
When someone seeking asylum needs to move because their accommodation is unsuitable, they have to submit a “relocation request” to the Home Office via their contracted charity Migrant Help, supported by evidence such as clinical letters, reports and GP patient summaries. However, these requests are often denied as the criteria is incredibly strict.
Dembe’s case exposes the dangers of the Home Office’s reliance on the IMA. Decisions about accommodation suitability should be grounded in meaningful engagement with individuals and proper consideration of medical evidence.
The Home Office needs to do more to ensure that accommodation offered to people is suitable for their needs. Medical evidence must not be disregarded without clear and justified reasoning. People fleeing extreme violence should be able to feel safe, secure and live with dignity in their own homes. The cost of failing to provide suitable accommodation is profound and long-lasting.