1. Jean-Pierre Restellini, MD, LLB Head of the National Commission for the Prevention of Torture (Swiss NPM) and Acting 2nd Vice-President of the CPT “The immigration removal process and preventive monitoring” Medical assessment Pre (fit to fly) and post (failed) removal

2. FIT TO FLY Why should the question be asked?  because there is a relatively high medical risk  all preventive steps should be taken to avoid serious medical consequences, particularly death Geneva march 2012European NPM Project’s2

3. Different types of flight 1. Flights operates by commercial airlines 2. Flights organised by FRONTEX 3. Special flights organised at national level Geneva march 2012European NPM Project’s3

4. Usual recommendations for all flights Pregnancy (until the 36th week; after the 28th week of pregnancy necessity of a medical green light) Acute cold and severe feverish illness Severe heart or lung-related illness: breathing difficulties, recent heart attack, angina pectoris, cardiac insufficiency, pneumothorax, etc. Recent stroke Severe anemia Geneva march 2012European NPM Project’s4

5. Usual recommendations for all flights (2) Recent surgery, especially abdominal and thorax operations History of thrombosis or pulmonary embolism, hereditary coagulation disorder, cardiac insufficiency or chronic vein insufficiency Certain acute psychological / psychiatric troubles Geneva march 2012European NPM Project’s5

6. Usual recommendations for all flights (2) Recent surgery, especially abdominal and thorax operations History of thrombosis or pulmonary embolism, hereditary coagulation disorder, cardiac insufficiency or chronic vein insufficiency Certain acute psychological / psychiatric troubles Geneva march 2012European NPM Project’s6

7. Additional risks linked to: 1. Security measures which are sometimes dangerous in themselves 2. Major stress caused by tight immobilisation (especially if the detainee physically resist !) 3. Total immobilisation for a prolonged period of time Geneva march 2012European NPM Project’s7

8. Medical examination before the flight 1. Some (prison) doctors refuse to perform it 2. Systematic or only in case of suspected medical problems? 3. What should the examination involve? When should it be carried out? Geneva march 2012European NPM Project’s8

9. Doctors/nurses on board 1. Presence necessary in all cases? 2. Profile? Equipment? 3. Independence? Geneva march 2012European NPM Project’s9

10. FAILED REMOVAL Geneva march 2012European NPM Project’s10

11. FAILED REMOVAL 7th General Report on the CPT's activities covering the period 1 January to 31 December 1996 This is a risk situation, sometimes leading to ill-treatment either at the hands of the escorting team or when the detainee arrives back at the custodial institution. (…) It is important that all the events leading up to this outcome be properly documented and that any complaints on the part of the detainee be included in the records. Geneva march 2012European NPM Project’s11

12. FAILED REMOVAL 13th General Report on the CPT's activities covering the period 1 January 2002 to 31 July 2003 … all persons who have been the subject of an abortive deportation operation must undergo a medical examination as soon as they are returned to detention (whether in a police station, a prison or a holding facility specially designed for foreigners). In this way it will be possible to verify the state of health of the person concerned and, if necessary, establish a certificate attesting to any injuries. Such a measure could also protect escort staff against unfounded allegations. Geneva march 2012European NPM Project’s12

13. 13Geneva march 2012European NPM Project’s