Open letter to the Ministry of Security and Justice

Hongerstakers_demonstratieOPEN LETTER TO:

The Minister and Secretary of State of the Ministry of Security and Justice, and Mr Teeven especially.

Dear Mr Teeven,

It is with surprise and wonderment that I read your letter to the chair of the House of Representatives of 21 May 2013, concerning the reports in the programme ‘Nieuwsuur’ of 18 may 2013 with regard to the treatment of hunger strikers.
After having read your letter a few times I can come to no other conclusion than that you are either not informing the House properly, or that you have received incorrect information from your own departments that are involved in this case.

I will try to give you, and others reading this letter, a correct and true account of what happened since Ascension Day (9 May 2013).
I will try to follow the same order in your argument as in the letter mentioned above, and I will refute those items that clearly deviate from the facts as I have determined them through observed facts and reality.
First the preamble to the interview for the programme Nieuwsuur.
On Wednesday 8 May during my regular work the first requests to act as trusted doctor for various hunger strikers reached me. Some of those I was already familiar with as patient. This is because I work as an independent medical doctor for undocumented persons throughout the entire country for approximately 6 days per month.
Because of the number of requests – 16 – of hunger strikers from both DCR (Detention Centre Rotterdam) and DCS (Detention Centre Schiphol), I established a medical team comprised of doctors willing and able to assist the hunger strikers as independent trusted doctors. This team consists of five medical doctors and several medical specialists in the background.
Since Thursday 9 May 2013 we as a medical team have been trying to get access to patients that had requested our presence.
On Thursday 9 May we were refused, with the reason that it was a national holiday and therefore no decision could be taken.
On Friday 10 May we of course continued our attempts to attend to the hunger strikers as independent trusted doctors with regard to the hunger strike that was going on in Rotterdam (DCR) and Schiphol (DCS) Unfortunately without result, but with disconcerting messages from the hunger strikers themselves. In order to complete the statement sent at that time, it should be made clear that the independent trusted doctor presented by DCR, Mrs Ronner, is co-director of Detentiezorg Nederland (Detention Care Netherlands) and judicial medical doctor. This illustrates the limitations of the term ‘independent’. She will not speak to either myself, nor the other doctors of the team. I have had short contact with a director of DCR, but she, Mrs Couwenhoven if I recall correctly, refused adamantly to speak to me.
On Saturday 11 May I was refused access in DCR to a hunger striker that had specifically asked for me as trusted doctor.
On Sunday 12 May I was also refused access in the Judicial Medical Centre (JMC) in Scheveningen when this patient had been transferred there due to his physical condition.
More and more requests from hunger strikers wishing to retain an independent trusted doctor started reaching us either directly or through family and/or friends.
On Monday 13 May I could only enter DCS as a visitor, as we were refused access to attend the hunger strikers as doctors. The stories of the patients that we were able to visit worried us greatly, already they were telling us of intimidation, sleep deprivation and isolation. Some patients had succumbed to this pressure and had ended their hunger strike.
On Monday, after an intervention by the solicitor of the patient concerned, I was able to gain access to JMC. The patient’s solicitor consulted with the State Solicitor to enable me to gain access to my patient. From then on the contact with JMC was smooth, with mutual respect and with the patient’s interests at the centre.
On Monday evening we entered into Summary Proceedings in Den Haag with the objective of gaining access to our patients that had requested us. The list of names was present, as were the recorded telephone conversations with the requests.
During recess of this hearing a modus operandi was found and the summary proceeding was adjourned. This modus operandi consisted of the following; we would be given access to those patients that made a request with either the board or the medical services for a specific trusted doctor that they were required to mention by name.
Tuesday morning 14 May we wanted to inform our patients of this new procedure that we agreed with the state attorney, namely that they had to inform the board or the medical services of the required trusted doctor by name.
When we put in requests to be called back, we were told that this would be taken care of, but within half an hour I received a telephone call from the medical services – in hindsight the only time that I have been in contact with them – that the board had decreed that our requests for call backs would not be honoured. When I asked how these patients were going to be informed of the new and currently valid procedure, I was told that the patients would simply have to stick to the agreed procedure and that we were not going to be given the opportunity to inform them of this new procedure.
Call back requests were no longer honoured in DCR and we were no longer able to gain verbal contact with our patients. In the mean time cooperation with JMC was smooth and we were given access to several hunger strikers there.
On Tuesday evening one of the hunger strikers in JMC is released immediately by order of the court, as there were developments in his case. His story is probably known to you from the media, for instance the NRC.
On Thursday 16 May the solicitor that had assisted us in the summary proceedings informed us that hunger strikers that wanted to retain us as their independent trusted doctors would have to now also inform their solicitor of this.
The solicitor would than contact the chosen trusted doctor.
A note: there are many people in detention of aliens that have never applied for asylum. So they do not have their own asylum solicitor. This group is also usually not aware of the Dutch rules concerning duty solicitors or pro bone solicitors. It is therefore now impossible for this group to ask our medical team for help.
On Thursday 16 May there is also first contact in JMC between myself and Mr Bah who has allowed me to use his full name here, as well as other information that I will refer to further on.
Contact with the hunger strikers in the DCR has come to a stand still. We get some requests and despite instructions relayed to the hunger strikers by family and friends about how to obtain an independent trusted doctor, we hear nothing from DCR and they will no longer speak to us.
DCS notified us that there were no more hunger strikers. It was impossible for us to verify this as certain people had been placed in isolation. Various family members and friends of the hunger strikers told us that requests were submitted to the board, but that these had been denied.
Some were afraid to contact a solicitor both due to lack of knowledge and fear for costs.
Being unable to have contact with the hunger strikers is a cause for great concern, since more stories are reaching us about inhumane treatment like: isolation, 24 hour camera surveillance, sleep deprivation and intimidation in the form of threatening that actions may be detrimental to the asylum procedure.
There are several people in the detention centre in Rotterdam who are still in the process or who have a status in another country and who are locked up in detention of aliens through administrative “errors”.
We are also greatly concerned that as far as we know there is no, or very little medical after care in DCR and DCS, since they cannot give us a protocol, nor will they inform us about the after care process, nor will they talk with us.
From several hunger strikers that have stopped we have heard they are getting no, or very little after care. Even worse, people in or just after a hunger strike are being told removal dates by your department DT&V with their tickets order for removal within the week.
I would like to refer you to the letter by dr. Van Willegen of the Johannes Wierstichting that I have included here.
This letter has also led to this being the official position of Johannes Wierstichting – well known to you – on the subject of medical assistance after a hunger strike.
We van prove the above with examples with full names, but because of fear for reprisals we do not have permission to publish these publically in an open letter to you, secretary of state Teeven.
However, should it come to an investigation – which we hope and which we want to request of you personally – then the people involved are prepared to cooperate depending on guarantees and protection.
The fear of your ministry and especially of the department return and removal (DT&V) and the military constabulary and uniforms in general is great, unfortunately.
As the responsible secretary of state I can imagine that you think it is regrettable and perhaps even painful that this fear of your employees is this great. Especially since in the name of your ministry of Safety and Justice, the term Safety is first. Safety, also for this group of vulnerable people.
As a concrete example of a hunger striker and the resultant obstruction of the necessary medical care I would like to refer you to the statement I made as trusted doctor of Mr S., who has been on hunger strike for 2 weeks and has only ended his thirst strike a week ago. Yesterday he was told that despite his physical condition after two weeks of hunger strike and a week of thirst strike, he will still be removed by your department DT&V. He is still on hunger strike and is persisting. His weight and condition are steadily declining.

Another example from 21 May:
Ali lives with his wife and children in France and has his affairs in order there. But when visiting a member of his family in The Netherlands 3 months ago he was arrested and placed in alien detention. Of course he informed the IND immediately that he lives in France, but the IND did not find this believable.
Ali’s wife requested that the French authorities send over proof of his residence there. This they have done. But even after the French authorities sent the papers, the IND kept claiming that they had “not received anything”.
Fortunately the court has freed Ali U. But all in all he was detained on entirely unjustified grounds for three months and separated from his wife and children.
I can expand on this for hours and I have many, many examples, but also too much fear.
I will now concentrate on Mr Bah and give his story as much as possible in chronological order.

Then I will compare points 1-6 and the recent developments mentioned in your later with that what I have personally perceived and established.
I will give as much detail as possible and some parts may be shocking. Mr Bah has specifically requested that I tell the entire story of my findings as doctor and his story behind it that I have recorded from his telling.
Mr Bah has appointed me his trusted doctor on 16 May 2013.
My first contact with Mr Bah was on Thursday 16 May 2013. Mr Bah was in the Judicial Medical Centre (JMC) in Scheveningen at that time.
Mr Bah was recovering from a hunger strike. He told me that he had been on intermittent hunger strike since 21 March. I examined him at that time and saw an emaciated, moderately vital man with no special findings at the physical examination. His skin was dry but entire, no haematomas.
He told me that he would be transferred to the alien detention centre Rotterdam (VDR) where he according to arrangements made with the department of return and removal (DT&V) and VDR would be placed on a normal wing, with contact with other detainees and the general rules regarding the number of hours outside of the cell and the number of hours of recreation per day.
The conversation with the DT&V in which these arrangements were made was also on Thursday 16 May 2013. The date of the arrangement with the DVR is not known to me, but I do know that his solicitor mr. Lith was aware of these arrangements with regard to placement in a normal wing with the general rules.
According to the arrangements Mr Bah was transferred to Rotterdam on Friday 17 May. At the beginning of the evening of 17 May 2013 Mr Bah rang me with the disconcerting notification that after he arrived at DCR he was placed directly into an isolation cell after being assaulted by a so called internal support unit (IBT). Mr Bah told me he had started a hunger and thirst strike in protest against this treatment and assault and against the fact that he was in alien detention.

Saturday 18 May 2013 I was able to visit Mr Bah in DCR
This consult was very badly facilitated. I was not provided with a medical examination room, but only with a office with glass in the door so that the guards could look inside. Since Mr Bah was only wearing a so called anti-suicide smock, without underwear and bare footed, this means he was naked while his skin was being examined for haematoma. This was humiliating to Mr Bah, as the guards could see everything. Furthermore I was not provided with scales for this hunger and thirst striker. I was also not given access to his medical file. The medical service was not willing to communicate with me in order to discuss the treatment plan of this hunger and thirst striker who had been assaulted.
On physical examination I observed an emaciated man, with a slightly raised blood pressure, heart and lungs normal and ear drums intact. On his lower back and flanks Mr Bah had clearly visible haematoma that were not present on Thursday.
I asked Mr Bah how these haematoma had occurred and he told me the following;
Mr Bah was transferred from JMC to DCR and was placed in a waiting area upon arrival.
A guard told him that he would be placed on wing H, a special control wing. This was apparently a new wing, especially furnished for people on hunger strike or who have been on hunger strike.
The cells on this wing are single occupancy, with camera surveillance and restricted airing and recreation.
Mr Bah was given a form that stated that he was voluntarily going to this wing, with the request to sign it.
Mr Bah refused to sign because this was against the earlier arrangements that he would be placed on an normal wing with normal recreation and airing. Section head ‘R’ made it know to him that he was the person that told the current affairs programme Nieuwsuur about possible fraud with giving out laissez-passers from Guinea and that they would take him down a peg. Mention was also made of the fact that they would quell the hunger strike.
Mr Bah refused to sign the document that he would go to this wing voluntarily.
The door to the waiting area was closed, the light was turned off and a little while later the IBT stormed in. There were about 10 men/women that were helmeted and carried batons. This IBT jumped Mr Bah and kicked him when he was already on the ground and cuffed. Mr Bah did not resist, although he did try to fend them off a bit. I would like to note here that Mr Bah’s physical condition after two months of intermittent hunger strikes is quite bad.
He was then taken to the isolation/special control unit. On the way there he was pinched by members of the IBT. Upon his arrival he was put on his knees, undressed and put naked on the floor, face down. When the cuffs were removed he had to put his hands in front of his abdomen and he was kicked against his upper arms. Members of the IT were sitting on his feet, back and head. The members of the IBT left his cell one by one.
About 10 minutes later a guard entered with again the form to sign that he was voluntarily in isolation.
Mr Bah refused to sign as he did not choose the isolation cell voluntarily and it was arranged and clearly communicated that Mr Bah would be placed on a normal wing, this is the reason that he initially interrupted his hunger strike.
Mr Bah stated that he would immediately go on hunger and thirst strike again because of this treatment, because of the refusal of the DCR to stick to the arrangement and because of his placement in alien detention even though he cannot be removed to Guinea.
Mr Bah immediately voiced his wish to speak to his solicitor and his trusted doctor, which was not initially honoured.
His cell is small, with only a mattress, a blanket and a toilet. Flushing the toilet and turning the light on and off is done by the guards. There is a very small window at the top of his cell.

On Saturday I saw him, barefooted in an anti-suicide smock with several large haematoma.
I was unfortunately not able to take pictures of these. Guards were able to look in the examination room and since I was not only his trusted doctor, but also on call for my regular work, I could not run the risk that my telephone (including patient data) would be confiscated. Despite mine and Mr Bah’s request I was not allowed to see and examine Mr Bah’s isolation cell.
I made arrangement with Mr Bah that I would visit him again the net day and I clearly communicated this to DCR.
The next day, Sunday 19 May, I made a courtesy call to DCR to let them know what time I would visit my patient Mr Bah. This in order to cultivate a good relationship with DCR.
I was told over the telephone that I was not welcome in DCR. I expressed my astonishment at that and also my concern about this hunger and thirst striker that had clearly been assaulted and the necessity of him being able to see his trusted doctor.
Only after intervention of mr. Lith, solicitor to Mr Bah, was I able to visit my patient. On arrival I had to sign a form that I would not make any audio-visual recordings. I signed this under protest.
Again this visit was badly facilitated.
Despite my insistence there was no medical examination room, no scales and no opportunity to consult the medical service. The medical file that I was given contained three sheets of paper.
The medical file I saw in Scheveningen was centimetres thick. This is logical since Mr Bah has been on intermittent hunger strike since 21 March, so many medical examination have taken place and this information was documented.
Mr Bah indicated that he would be persisting in both his hunger and thirst strike, despite my insistence that he at least halt his thirst strike. Fortunately Mr Bah had passed water that morning. Further examination, apart from the already described haematoma and slightly raised blood pressure, was normal.
We parted with the arrangement that there would be a consult over the telephone the next morning (Monday 20 May) so that I could determine if a visit to Mr Bah in the DCR would be necessary.

Monday 20 May I attempted from 10:30 onwards to get in touch with Mr Bah over the telephone. Every time after communication with management I was assured that Mr Bah would call me back soon. At 13:36 I was fed up and I decided to contact mr. Lith.
He also did not succeed in contacting Mr Bah.
At about 15:00 mr. Lith is informed that Mr Bah will be transferred to the penitentiary in Vught (PIV) because of a violent incident that allegedly happened that morning.
This was alarming news. I rang DCR with the urgent request for the director of DCR to ring me back. I also decided to travel to Vught in order to establish the physical condition of my patient, as he was now on day 4 of his hunger and thirst strike and had been assaulted.
At 16:50 I receive a short and very distressing call from Mr Bah. He alleges he was beaten again and was in a very bad condition. He requests my urgent attention. He also indicates that he requested to call his solicitor and myself all day, but that he was not allowed to.
At about 17:00 I arrive in Vught and presented myself. I was taken to a reception hall. At 18:01 I was told that it is after 18:00 and therefore it is now night shift and no more visitors – not even the trusted doctor – are allowed.
I ask for a consultation with the medical service and am told that they have already gone home. I give a short overview of Mr Bah’s condition and tell them that I am seriously concerned with his physical and psychological condition after 4 days of hunger and thirst strike and one assault and a possible second one.
I was informed there would be no more medical examination since this had already been done in Rotterdam. I expressed my grave concern and arranged to be able to visit Mr Bah at 8:00 the next morning.

Tuesday 21 May I present myself at PI at 8:00. At about 8:45 I am able to see Mr Bah. I was not allowed – by order of the management – to take my telephone or camera. I expressly mentioned that as his trusted doctor I needed those in order to document the injuries Mr Bah had, caused by the second assault that he had spoken about on the telephone.
On examination I find an emaciated man that can hardly stand. His mucous membranes are dry. Mr Bah indicates that he is persisting in his hunger and thirst strike. On his forehead above his nose a large bump with a cut can be seen. On his forehead, temples and cheeks haematoma are visible. He also has a cut on his right cheek.
According to Mr Bah his injuries were caused as follows:
The previous Monday morning around 9:00 he was offered some food again for the first time. A guard came in with bread and coffee.
Mr Bah indicated that he already felt the guard would want to provoke him when he entered. When Mr Bah got up off his bed he was unsteady on his feet. The guard told him: “You’re acting wrong, you’re inciting other people to hunger strikes”. Mr Bah: “I’m not inciting anyone to hunger strikes”. Guard: “You dirty nigger” Mr Bah: “Djoeka” (Surinam for bush nigger).
The guard was already out of the cell and became angry. He threw the food, bread and coffee, into the hall and wanted to hit Mr Bah.
He was stopped by two colleagues that said “Don’t do it, don’t do it”. The guard said “make one move and I’ll hit you.” Mr Bah: “So hit me”. The guard: “Make one move, make one move”.
The guard grabbed a pen and Mr Bah was afraid that the guard was going to stick this in his eye. He bent his head forward and down. The guard stabs at Mr Bah with his pen, which caused the cut on his forehead and cheek.
The pen falls on the floor, it has blood on it. The guard then hits Mr Bah in the forehead with his fist, he is wearing a ring. He hits Mr Bah about 7 times before his colleagues grab him and pull him back.
Mr Bah tries to fend him off, but is very weak and unsteady on his feet. Mr Bah states he will report this violence.
A doctor comes to see him at about 11:00 and Mr Bah states that he wishes to see his trusted doctor. At that point in time he is still bleeding. He also states that he wishes to speak to his solicitor.
At about 14:00 the director comes by with the IBT. He says that misconduct will not be tolerated and that he will receive 7 days punishment. Mr Bah says that he can also be punished for 30 or 50 days.
The director wants the remains of the pen. Mr Bah hands it to him, saying that it is evidence. He also indicates that he wants the footage of the surveillance camera given to mr. Lith.
The director says that during the assault the camera was off. Mr Bah replies that the camera’s red light was on while the assault was going on. Mr Bah says that the previous agreements have not been adhered to, that he has been assaulted twice since his transfer from JMC and that he persists in his hunger and thirst strike.
Tuesday afternoon 21 May I was informed by PIC that Mr Bah would be transferred to JMC because of his general bad physical and psychological condition. At the end of the afternoon Mr Bah rang me to tell me that he was transferred to JMC and that he persisted in his hunger and thirst strike. I pressed him to at least take small amounts of liquids. We arranged for me to visit him in JMC today, Wednesday 22 May.
Now the statements in your letter;
to start with,

ad1: You say that because of Mr Bah’s history it was decided that he was to be placed in a so called control unit on arrival in DCR.
Earlier statements from your spokespersons said that it was a voluntary choice of Mr Bah to be placed in isolation. This is a strange statement, because why would the director DCR send an IBT in for a physically weak man who was voluntarily going into isolation?
You write that the same facilities are present in the control unit as on normal wings. I would like to request access to this control unit, since we have heard significantly different descriptions from various sources (including Mr Bah).
Amongst other things: no contact with other detainees, very restricted airing (1,5 max) and very restricted recreation.
Furthermore this seems to be turning into a word game about control unit, segregation cell, all to avoid using the word isolation cell, but it seems that all these terms mean exactly the same thing where it concerns the type of cell.
We would like to request that you show us the voluntarily signed statement – that your spokesperson says you have – of Mr Bah for voluntarily placement in isolation.
Referring to the statement of Mr Bah above, he indicates he has never signed this statement.
As a medical professional I cannot believe that – in light of the physical condition of Mr Bah that I determined the day before – Mr Bah was any kind of threat for your guards or other personnel and certainly no reason to send an IBT in to this weakened man.
We insist that in no way were de-escalating actions taken conform the LTC method as used in the JMC. An obvious choice was made for confrontation and it was made very clear that there were bills to settle.
ad2: I can only repeat that Mr Bah is by no means a threat to the strong men and women that work as guards in DCR for the company ‘G4S’.
You talk about proportionate and de-escalating, but it seems your IBT attaches another meaning and execution to that, the bruises on his body are testimony to that..
The story of the anti-suicide smock is used as an excuse to apply violence. You write “with light resistance from Mr Bah”.
Light resistance from a weakened man who is brought to an isolation cell against his will and with a large team, seems quite normal.
U say that on the basis of all available data and having reviewed everything, Mr Bah was placed in isolation in the correct manner.
I’m afraid that I will then have to conclude that you do not have the right data and are not coherent with your story.
You say that Mr Bah was not examined after the IBT action to see if he was injured and that Mr Bah refused examination by the medical staff. Why did the medical staff not take photographs or video of Mr Bah? Your institution in Rotterdam has high tech fantastic camera’s that register everything in and around the building in high definition.
All we can conclude is that the procedures were not applied correctly. There was no major threat from Mr Bah due to his physical condition and therefore disproportionate violence was used.
And another question: how is it possible that Mr Bah saw helmets and batons, but you say that those were not present?
Another question relative to this: are IBT members employed by G4S, or on loan from G4S, or are they employees of the Ministry of Justice, i.e. civil servants?
I am asking because I still assume that the monopoly on violence is only mandated to the government. I am assuming that it is not possible for the mandate on violence to be transferred to a commercial institution.
ad3; I can be brief here; we have examples of patients of ours that are neither suicidal, nor pregnant, nor disabled, or any other health situation that would indicate sleep deprivation is necessary.
I cannot imagine the use of sleep deprivation for these categories, because people who are in bad health need their sleep and rest and are transferred to the JMC, which is meant for these cases.
DCR and DCS have said themselves that they are not geared to caring for people in a bad health situation.
Sleep deprivation in pregnant women is torture and as you know sleep deprivation is on the list of torture.
Your letter says that in most cases people are not woken up, but in the cases known to us people were woken every hour, full artificial lights and sometimes the airco on extra cold with only a think blanket and camera surveillance. This way people can be broken completely and a hunger striker could be convinced to stop his hunger strike, but it can also lead to the exact opposite.
ad4; you state that my assertions are not supported by facts. As you know this is happening and has happened with several people on hunger strike, or who have been on hunger strike. You state that only one person was placed in the control unit, but not because of his hunger strike. This may be the case for this one person, but we known several people by name that are there or have been there.
ad5; I can state that I have been systematically opposed by DCR, in such a way that it has become clear obstruction, and opposition to my function as a trusted doctor.
I refer you to the earlier examples regarding Mr Bah, but I can give you more examples if you wish, under certain conditions, as the people in this group are extremely fearful.
My examinations of Mr Bah took place in a room where guards walking past – which they did regularly – could look in without any hindrance.
This while there is a medical examination room with all facilities such as scales etc. As far as contact with the medical service, your story is simply not right. You already stated this through your spokesperson, but as you have been able to read in the letter, I have had contact once in DCR, despite my pressing requests over the telephone and in person when I was present.
The telephone operator can witness the amount of times I called and the amount of times I was called back; precisely 1 time where the medical services stated that by order of the board my requests to return my calls would not be honoured.
Every day that one of our patients was in DCR we tried to have a consultation over the telephone with the medical services or the person in charge. Until now without any results.
As far as your conclusion goes you can understand that I cannot support it. Reality is opposite to what you describe.
With regard to your last item ‘recent developments’ I must begin by stating that your information is incorrect. You say that Mr Bah physically attacked DCR staff on 19 May and spat at them. Neither Mr Bah nor the guards made any mention of this to me as trusted doctor and you may be able to imagine that after 3 days of thirst strike it is virtually impossible to spit. Physical attacks are technically impossible for a man in such a weak physical condition that he can hardly stand on his feet; he wasn’t transferred to JMC one day later on 22 May 2013.
As you can see our reading of events is quite far apart. It may be sensible to set up an independent inquiry and we would appreciate it if we could get cooperation from your detention centres so that we can come to a professional cooperation. For us the health and the interest of the patient is at the centre of our concerns.
Some remarks to conclude.
It would be a wise decision to have a duty of notification for the judicial institutions with a duty solicitor when a detainee goes on hunger or thirst strike.
These solicitors can then inform those involved, among other things about the possibility of an independent trusted doctor. In other words, it would be good to set down a protocol for this process.
With regard to Mr Bah a final remark; he is an intelligent human being, is aware of his rights and obligations and has, as you no doubt are aware, functioned as whistle-blower a few times.
If so desired, I can provide information in confidence, of course provided Mr Bah authorises me to do so.

Kind Regards
For the independent team of trusted doctors,
Signed 22 May 2013
drs. E.S. Bonsen

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