Manston health concerns raised with Home Office weeks before outbreak

The Home Office was warned about the need to improve infection control measures at Manston, its site for people arriving in small boats, weeks before the UK’s worst diphtheria outbreak in decades, the Guardian has learned.

Freedom of information disclosures from Thanet district council, obtained by the Guardian, have revealed a catalogue of concerns about failures in public health measures at the centre near Ramsgate, where initial checks are carried out on asylum seekers.

The site had as many as 4,000 people held there towards the end of last year, although it is designed to hold 1,000, with a maximum capacity of 1,600.

An email from Thanet public health officials to Home Office officials after an outbreak of 20 cases of gastroenteritis at the beginning of September 2022, which resulted in two children being taken to hospital, said: “There are so many new emerging pathogens at the moment that it seems sensible for the site to be prepared and have the right things in place if something happens again that is potentially more serious.”

An email response to this warning from the Home Office’s clandestine threat command said: “Contents duly noted and we will endeavour to get this remedied.”

At the end of November, Home Office sources confirmed there were 50 diphtheria cases linked to Manston. Hussein Haseeb Ahmed, 31, from Iraq was among those who became ill with diphtheria. He died in hospital on 19 November.

Usually, there are only a handful of diphtheria cases each year in the UK, due to high levels of vaccination.

Home Office sources said they believed those infected had the disease before reaching the UK. However, in a freedom of information disclosure obtained by the Guardian from the UK Health Security Agency last month, officials said that while it was thought the majority of cases were contracted abroad, it was possible a small number were transmitted “within UK settings”.

The FoI disclosures detail escalating concerns about health conditions on the site between September and November last year. A public health director said he was “shocked” by the conditions there.

Concerns included:

• Handwashing was advised as a key infection control measure but there was a shortage of sinks and access to running water and some toilets had no handwashing facilities at all.

• Some toilets were blocked and overflowing with excrement.

• The chief medical officer, Chris Whitty, became involved in the crisis and ordered UKHSA officials to produce a rapid assessment of infectious disease risk on the site.

• Confusion surrounding the release of people from Manston who may have had infectious conditions.

An email on 7 November stated: “There is a lack of clarity over the release of those with infectious diseases into the community and how this is managed.” It added that without a clear protocol, the situation could become “impossible to manage”.

On more than one occasion, there were reports of people being released from Manston and abandoned in the street.

An email on 4 November said asylum seekers were a vulnerable population and that “the prolonged journeys these individuals have made and the crowded, closed conditions of the Manston site, including limited shared sanitation facilities, provides an environment which is highly conducive to the rapid spread and outbreak of various infectious diseases”.

A risk assessment rated the risk of gastrointestinal disease, measles, diphtheria, scabies and other skin diseases as “very high”.

Emma Ginn, the director of the charity Medical Justice, which works to improve the health of people in immigration detention, said: “Given the concerns from public health officials regarding overcrowding, toilets overflowing with excrement and inadequate handwashing facilities, it is extremely alarming that the Home Office went on to detain thousands more asylum seekers in such conditions.

“The subsequent diphtheria outbreak could hardly have come as a surprise. The Home Office received explicit advice from public health about the risks, but continued to detain highly vulnerable people in seemingly unlawful conditions.”

Andy Baxter, the assistant general secretary of the Prison Officers’ Association, said: “In October 2022 the POA were consistent in their message around health risks at Manston, both for residents and our hard-working members. It is very worrying that when the POA went public around diphtheria and scabies on site, the UKHSA and the Home Office tried to minimise our concerns.

“The POA raised concerns that people with undiagnosed diphtheria were being moved into communities; it now appears our concerns were well founded.”

A Home Office spokesperson said: “We continue to work closely with UKHSA in discharging our public health duty. Significant improvements have been made to facilities at Manston in recent months and the site remains well resourced for future arrivals. UKHSA’s own risk assessment deemed that expansion of healthcare services have improved our ability to identify, diagnose and manage infectious disease.

“The Home Office provides 24/7 health facilities at Manston as well as having robust contingency plans to deal with health issues such as communicable diseases.”