Chapter 1: Refugees

Chapter 2: The Borderprison

Chapter 3: Daily life

Chapter 4: Medical care

Chapter 5: Protest

Chapter 6: Restriction of freedom

Chapter 7: Expulsions

Chapter 8: Intimidations

Chapter 9: Conclusions

This publication is a summary of the dutch texts that were (Autonomous Centre) published on May 5, 1993.

Chapter 4: Medical care

Medical care in the border prison

The border prison is a judicial institution. At the opening on April 6, 1992 everything was not completely settled, but there were two doctors who were already working in a prison somewhe- re else. Both of them work part-time, and hold surgery in the morning. For the rest of the time they are on call, although one of the doctors is then in Utrecht, about 40 kilometres away. Both the 7 x 24 hours service as well as the practical attainability (to be able to be in the prison within 15 minu- tes) have not been realised.

In the entire design of the medical care an important role is reserved for the nurses. They do the medical intake and the physical examination. The doctors only do the physical exami- nation of heart and lungs. The decision whether further exami- nation is necessary, therefore rests with the nurses.

In the Explanatory Memorandum on the Regulations Border Hostel under 5. can be read: "The degree in which the obligation exists is determined by the lenght of the refugee's residence. This means that it is self-evident that medical help will be given, should this be urgently needed, but longer lasting medical treatment will not be started just like that." The result of this clause is that the medical care given will not be too curative. There is only a minimal treatment of the refugees asking for help, for they are only intended to stay here for a short period of time. In this way a Medical Service has been created which in fact is not even in a single aspect attuned to the health problems of the detainees in the border prison.

Specific problems

As patients the refugees and "illegal" people who have been forcibly detained in the border prison are characterized by the fact that they may face several threats to their health. Not only is their general health and condition poor, they also have great difficulties finding and receiving adequate health care. We are after all considering:

- people who have been fleeing (often for some time);
- people who came from developing countries, or from places where war, famine or oppression rage;
- people who often belong to the lowest economic class and who have therefore had poor food and poor health care for an extended period;
- people who are not well able to express the problems they face in respect of their health, as a result of the trauma they have survived, (which can manifest itself as a 'post- traumatic stress' syndrome, problems adjusting, a culture shock, fear, confusion, shyness, shame) or due to cultural antecendents (wherein language is a barrier as well as the awe for uniforms and other authorities learnt through experience and survival strategy. Moreover, many lack the assertivity which is the norm in the western world when asking for help);
- people who in many cases have diseases which Dutch doctors seldom encounter or which have reached an unusual advanced stage.

On top of this there is the unavoidable tension due to a stay in the border prison. A number of factors play a large role

- the fact that any lengthy medical treatment is not initiated at all;
- the fact that detainees feel that it is totally illogical that they are detained. Seeking asylum is criminalised by this detention. This unjust treatment and the unequal rights of other refugees (who are after all not detained) leads to tension;
- the fact that the period in the prison is not limited to the the six or eight weeks mentioned by the justice department, but easily reaches three months and sometimes six, increases this tension;
- the fact that the refugees are people who have often fled similar injustice and who are re-traumatised by this new situation.

All the above characteristics show the necessity of extra medical care and attention. The initiative will have to come from the medical staff. Such a medical care, however, has not been realised at all in the border prison. In view of the relatively short period of time that the refugees will be patients, the staff show little initiative. In fact a medical policy is pursued which is designed to discourage seeking medical help.

General information

In the months we have visited refugees in the border prison, it became clear to us that many have complaints which are directly related to their detention.

Many refugees have a rash in their face; it is practically certain that this is due to the quality of the food, as the complaints of all the refugees on whom we were able to observe this rash, disappeared after they were released. Almost every- body has the same complaints: people have continuous headaches and are troubled by sleeplessness and concentration difficul- ties. These sort of complaints generally crop up with the refugees who have been staying in the border prison for some time. The result is that they are forced into passitivy. Reading a book or a magazine costs most of them such an effort that they rather leave them alone. The forced passivity only aggravates these complaints; often people are thinking for days about the situation they are in and for which they cannot find an explanation. The confidence of the detainees in the Medical Staff has decreased to an absolute minimum. Many refugees with complaints do not even go to see the nurses, for they feel that they are not taken seriously in the first place. Those who go, afterwards have the impression that they were not taken seriously. Even for the simplest treatments (such as a cold or influenza) there is either no medicine or the will to help the refugees is absent. Of the medications that are given, paracetamol, a simple painkiller, is the most popular one among the doctors and the nurses. Illustrative of the massive dispensation of these pills is the first Dutch word that many refugees know: "kinderasperientje" (children's aspirine). All complaints communicated after locking in at 21.15 h. are dealt with by pushing some tablets of paracetamol under the door. The Medical Staff also advises to drink tea for its medicinal effects. Almost everybody who had had a cold or influenza told us that they were only advised to drink tea. Another advice often given is to do more sport. Should all this be of no avail, then the Medical Staff is quite willing to turn to stronger medication. The sleeping problems of many of the refugees are suppressed by supplying (strong) sleeping tablets. People who become less manageable, can get anti-psy- chotica without much effort. The ease with which this sort of medication is given is in harsh contrast to the problems the refugees have obtaining such a simple thing as a vitamin preparation.