(UNITED KINGDOM) — Medical Justice on Monday accused the British government’s “one in, one out” scheme of failing to identify and protect torture survivors and trafficking victims held for removal under the UK-France returns deal.
The UK-based charity said the rapid transfer approach, which is designed to send small-boat arrivals back to France in exchange for legal entrants, has led to vulnerable people being detained and routed toward removal without effective safeguards.
Medical Justice described the scheme as part of a deterrence strategy that prioritises speed and removals, and said that approach carries high stakes for people whose ability to explain their persecution may be shaped by trauma, fear and medical symptoms that require careful screening.
Medical Justice findings (January 19, 2026)
The charity’s report, released on January 19, 2026, focused on detainees held under the UK-France “one in, one out” treaty, which returns small-boat arrivals to France in exchange for legal entrants. Medical Justice said the pace and mechanics of detention-and-removal systems can collide with vulnerability screening that is meant to prevent the detention of torture survivors.
Medical Justice said clinical assessments of detained individuals depend on careful history-taking and repeated observation to identify physical and psychological indicators of torture or trafficking. The group argued those clinical processes are undermined when detention is treated chiefly as a staging point for rapid removal.
The report’s key statistic was based on clinical assessments of 33 detainees who were awaiting removal to France. Medical Justice said 18 (55%) showed clinical evidence of torture or trafficking.
Medical Justice said survivors of torture and trafficking face distinct risks in detention because their symptoms can include panic, dissociation, self-harm risk and difficulties recalling events consistently. Those features, the group warned, can be misunderstood as credibility problems if interviews are rushed or if medical evidence is discounted.
The report highlighted failures around “Rule 35,” a safeguard intended to identify people at risk in detention — including torture survivors — so their circumstances can be revisited. Medical Justice described the pattern in assessed cases as “ignored safeguards” rather than meaningful protection.
Medical Justice also documented high levels of suicidality among detainees it assessed, noting many survivors reported that detention in the UK—rather than their past trauma—was the “moment they lost hope.”
How the “one in, one out” scheme operates and concerns raised
Britain’s “one in, one out” scheme refers to a process in which certain people who arrive irregularly are moved quickly into detention and prepared for removal, while others are admitted through legal routes. Medical Justice said that, in practice, fast processing can narrow the window for clinicians, lawyers and caseworkers to recognise signs of torture or trafficking and to document them before removal steps advance.
The charity argued that prioritising speed and removals increases the risk that trauma-related symptoms will be treated as credibility issues rather than indicators of need for protection or support. Repeated questioning, confinement and uncertainty can compound trauma and make it harder to gather evidence, the report said.
- Symptoms that can be misunderstood include panic, dissociation, self-harm risk and inconsistent recall of events.
- Clinical assessment commonly relies on careful history-taking, observation of injury patterns and consistency between accounts and symptoms over time.
- Fast detention-and-removal timelines can curtail those clinical processes and limit opportunities for safeguards to operate.
Medical Justice said it saw a “near total disregard” for the welfare of vulnerable individuals and called the protection system a “futile exercise,” arguing that clinical safeguards in detention are failing to protect these people.
Government response and wider policy context
A Home Office spokesperson defended the policy on January 19, 2026, framing it as a border-control measure that operates on the premise that France is a “safe country” where claims can be addressed.
“Protecting the UK border is our top priority. Our landmark one in, one out scheme means we can send those who arrive on small boats straight back to France – a safe country in which any protection claims can be, and are being, considered. The welfare of people detained is of the utmost importance and we are committed to ensuring that detention and removal are carried out with dignity,” the spokesperson said.
The Home Office statement points to a common tension in asylum cooperation deals: the government’s claim about general safety in a partner country versus an individual’s argument that their personal history, health, or risk profile makes removal unsafe or unfair in their specific case.
Disputes often centre on whether safeguards are meaningful in outcomes — such as release from detention or protection from removal — rather than procedural steps that exist on paper but do not change decisions in practice.
Broader accounts of treatment under the policy have been raised elsewhere, including in degrading treatment allegations linked to the same “one in, one out” framework.
UK political and international context
The UK-France returns arrangement has been presented by the government as part of a broader mix of enforcement and lawful entry options. Britain has also pointed to “safe and legal” routes, though access and eligibility vary, alongside enforcement measures tied to irregular entry.
Discussion of safe and legal pathways has become part of the political justification for tougher border measures.
During a September 18, 2025 press conference, visiting U.S. President Donald Trump praised the UK’s “one in, one out” pilot, telling PM Keir Starmer: “I told the prime minister I would stop it. It doesn’t matter if you call out the military, it doesn’t matter what means you use.”
US context: USCIS & DHS policy developments (January 2026)
Medical Justice’s report comes as U.S. immigration agencies set out their own January 2026 posture that emphasises security-based vetting and “hold and review” steps for certain benefits, including asylum-related processes. The U.S. moves are separate from the UK-France scheme, but both debates revolve around speed, security rationales and what protections remain effective for vulnerable people.
On January 1, 2026, U.S. Citizenship and Immigration Services issued Policy Memorandum PM-602-0194, expanding a “hold and review” protocol. The memo included an official USCIS statement framing the shift as a national security and public safety measure.
“USCIS remains dedicated to ensuring aliens from high-risk countries of concern who have entered the United States do not pose risks to national security or public safety. To faithfully uphold United States immigration law, the flow of aliens from countries with high overstay rates, significant fraud, or both must stop,” the memo said.
In practical terms, a “hold” on adjudications generally means cases are paused while procedures are reviewed, additional checks are applied, or case triage is adjusted. A hold is not the same as a denial, but it can delay decisions and create uncertainty for applicants waiting for interviews, evidence requests or final determinations.
Since December 2, 2025, USCIS has placed a hold on all Form I-589 adjudications regardless of nationality, pending a “comprehensive review” of vetting procedures. As of January 1, 2026, the “hold and review” list has expanded to nearly 40 countries, the memo said.
The memo and related steps also tie into a second feature that can affect applicants: re-checking already-approved benefits. DHS is re-reviewing all immigration benefits approved on or after January 20, 2021, for individuals from these countries, a process advocates warn replicates the “traumatizing” uncertainty seen in the UK system.
For people in the U.S. system, expanded vetting can mean more time before interviews are scheduled, additional follow-up questions, and requests for more documentation. It can also increase the need for applicants to stay current on addresses and notices and to be ready to respond to USCIS communications if cases are reopened or revisited.
Coverage of the U.S. shift has focused on operational uncertainty for applicants and stakeholders under hold and review, including what it may mean for pending asylum filings and other benefits that intersect with asylum status.
The debate over detention conditions and mental health risk has also been prominent in the United States. Reporting on suicide concerns in detention has drawn attention to how confinement, uncertainty and the threat of removal can interact with self-harm risk, including in ICE detention.
Shared questions and implications
The UK and U.S. debates share a question that governments and courts repeatedly confront: whether faster removal systems and risk-based triage can reliably identify medically vulnerable people before harm occurs, and whether safeguards designed for careful, individualised assessment can function inside high-throughput detention and adjudication settings.
Medical Justice’s report argues that, for torture survivors, repeated questioning, confinement and uncertainty can compound trauma and make it harder to gather evidence. The group said the credibility of asylum claims can be affected if screening is rushed or discounted, particularly when trauma symptoms shape how people disclose events.
Governments, including the Home Office and USCIS in the memo, have framed tougher approaches as necessary for border control, integrity, and security. The Home Office described its scheme as a way to send small-boat arrivals “straight back to France,” and USCIS described a goal to stop “the flow of aliens from countries with high overstay rates, significant fraud, or both.”
For medical and legal advocates, the question is not whether states can run border systems, but whether those systems can be run without pushing torture survivors into detention and removal pathways that worsen health outcomes or undermine the fairness of asylum decision-making.
Medical Justice said its evidence suggests the safeguards meant to protect vulnerable detainees are not functioning as intended in the one in, one out scheme, and it described suicidality findings as a warning sign that detention itself can become an acute crisis point for those already traumatised.
Where to find primary sources
Readers trying to verify or track developments can consult official pages that publish primary materials and announcements. USCIS posts policy updates in its newsroom, and the UK government has published information on the returns treaty at gov.uk.
The U.S. State Department also posts policy and travel-related updates at state.gov. Broader reporting and context are available in pieces linked above, including accounts of treatment and policy analysis.
Medical Justice’s report framed the UK scheme as a test of whether vulnerability screening can keep pace with deterrence-driven enforcement. For torture survivors, it argued, that balance can determine whether detention becomes, as detainees told clinicians, the “moment they lost hope.”
Uk’s ‘one In, One Out’ Scheme Has Failed to Protect Torture Survivors,…
Medical Justice has accused the British government of failing to protect vulnerable asylum seekers under its UK-France returns deal. Their report highlights that rapid processing and detention timelines prevent clinicians from identifying torture survivors. With 55% of assessed detainees showing evidence of abuse, the charity warns that the current focus on speed over individual welfare creates life-threatening risks and undermines the fairness of the asylum system.
