Health Assessments

What are they?

Our Health Assessments recognise, document and respond to the physical and psychological harms suffered by refugees and people seeking asylum who have survived torture, other human rights abuses or serious ill-treatment. They aim to identify corresponding health and safeguarding needs, and to connect people to appropriate healthcare, support and rehabilitation.

They are carried out by trained clinicians and form part of the survivor’s medical records. A copy of the assessment letter is also given to the patient.

Who are they for?

Our Health Assessments are for refugees and asylum seekers who have experienced serious human rights abuses or other forms of ill-treatment. This includes survivors of torture, inhuman or degrading treatment, trafficking or modern slavery, as well as victims of severe violence – both physical and psychological – from community or family members. For more information about our Health Assessments remit and definitions of key terms, see below.

They can be offered to survivors who are at any stage of the asylum process, although early identification and documentation is best for the patient and reduces strain on NHS services. For further information on safe routine enquiry, click here.

Why are they needed?

Every year, thousands of survivors of torture, trafficking and violence seek asylum in the UK. Many will register with a GP or interact with other clinical services while they are here.

Despite this, the UK’s healthcare system has no means of identifying survivors, and little experience of asking about or recording the harm caused by human rights abuses or victims’ corresponding health needs.

For patients, this means that physical and psychological traumas are left untreated, and safeguarding risks – including re-trafficking, self-harm, and suicide – are missed. For clinicians, this can lead to repeat consultations, avoidable crisis presentations, and A&E attendances.

Our Health Assessments recognise and document harm within mainstream clinical services, improving access to healthcare and safeguarding, and reducing pressure on overstretched systems.

Our clients include survivors of torture, inhuman and degrading treatment, trafficking, modern slavery, organised crime, gang or community violence, and serious domestic abuse. The pain and suffering that our clients experience can be both physical and psychological, and it can arise as a result of both acts and omissions. Pain and suffering may emanate from a single event or be cumulative, where the collective impact of multiple acts of abuse meets the threshold of severity and harm.

Our clients have often experienced complex traumas and violations from different sources and at different times of their lives, including from both State officials and private individuals or groups. In many cases, the harms they have suffered are compounded by their experiences of the asylum process.

As a member of the International Rehabilitation Council for Torture Victims, we define many of the terms we use in accordance with widely recognised definitions of international law. As a clinical organisation, however, our focus is on the harm that has been suffered and the ongoing health needs of our clients rather than the strict legal categorisation of the harms that we see.

Torture

At TortureID we use the definition of torture that is found in the UN Convention Against Torture (UNCAT), Article 1(1):

“the term "torture" means any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or suffering arising only from, inherent in or incidental to lawful sanctions.”

Torture therefore involves the deliberate infliction of serious physical or psychological harm for a specific purpose. The State is either directly involved in the act – where it is carried out by a public official who is acting in an official capacity at the time – or is complicit in it because the acts are carried out with their knowledge or acceptance, and they are either unable or unwilling to prevent it from happening.

Other human rights abuses

By “other human rights abuses” we mean inhuman and degrading treatment or punishment, which are described in UNCAT as “other acts… which do not amount to torture as defined in article I, when such acts are committed by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity” (Article 16).

“Inhuman treatment” involves the infliction of severe pain or suffering that can be either physical or mental.

“Degrading treatment or punishment” is treatment that grossly humiliates the victim. It can depend on a number of factors, including the duration of the treatment; its physical and psychological impact on the victim; the victim's age, race or sex, and the presence of other vulnerabilities.

Serious ill-treatment

Not all of our clients experience pain and suffering at the hands of public officials who are acting in an official capacity. By “serious ill-treatment” we mean actions or behaviours which, if they had been committed by a State actor, would amount to torture, inhuman or degrading treatment or punishment.

We define rehabilitation in accordance with the UNCAT (Article 14(1) and General Comment 3) to mean

“the restoration of function or the acquisition of new skills required as a result of the changed circumstances of a victim in the aftermath of torture or ill-treatment. [Rehabilitation] seeks to enable the maximum possible self-sufficiency and function for the individual concerned, and may involve adjustments to the person’s physical and social environment. Rehabilitation for victims should aim to restore, as far as possible, their independence, physical, mental, social and vocational ability; and full inclusion and participation in society.”

Our understanding of the term is therefore broad, holistic and encompasses legal and social elements. While we are a clinical organisation, we recognise that recovery from torture and other forms of violence does not occur in a clinical vacuum: the wider recovery context, including the impacts of external, non-clinical factors such as the asylum process and safe housing, can affect rehabilitative processes and health outcomes for our clients.

Rehabilitation

Safeguarding

As a UK-based clinical organisation, our definition of safeguarding is aligned with that used in the NHS:

“Safeguarding relates to the measures taken for the protection of an individual’s health, wellbeing and human rights to enable them to live free from harm, abuse and neglect, and is fundamental to the provision of high-quality health and social care.”

In the context of our Health Assessments, this can involve identifying risks that a client might harm themselves or others, and taking appropriate action to keep all parties safe.

This information is for people who have been referred to TortureID for a Health Assessment. Please note: we currently only take referrals from a few specific organisations where arrangements are in place. We cannot take referrals from the public.

What is a TortureID Health Assessment?

TortureID is a medical charity that works with refugees and asylum seekers who have experienced human rights abuses and other serious forms of violence. A TortureID Health Assessment is a longer appointment (60 minutes) with a clinician (doctor or psychologist) who has the training and skills to ask people about their experiences and to write about these in a letter.

1. Before my appointment

The person referring you to us will explain why they think it is a good idea for you to see us and will ask for your permission to refer you.
The person referring you will explain where and when the appointment will be.
The clinician that you are seeing may ask you to read some information before your appointment starts, so it is helpful to arrive at least 20 minutes early.
If you want someone to come with you to the appointment, this is ok.
An interpreter will be arranged if you need one. You can ask for a male or female interpreter.
Try not to worry about the appointment. The clinician will understand that you might be stressed and they will explain everything to you when you arrive. Try to get some sleep the night before your appointment, and try to have something to eat and drink.
If you have any medical letters, lists of medication or letters about your asylum claim that you think might help the clinician to understand what has happened to you, please bring these with you.
Sometimes the clinician will offer to examine you. It might help to wear clothes that are easy to move or remove. You are free to refuse an examination.

2. During my appointment

You will be seen in a private room.
The clinician that you are seeing will spend some time explaining the appointment and obtaining your permission to ask questions and to write a letter about the assessment.
If you have brought someone with you, the clinician will discuss with you whether it is best for the person to be in the room with you during the appointment or waiting for you outside.
They will ask you questions about your physical and mental health and any NHS care that you are receiving.
They will ask you about your bad experiences. You do not have to talk in detail and tell the clinician everything if you do not feel comfortable.
The clinician might suggest that they look at any scars or injuries you have and ask your permission to examine you. They might make some drawings or take photographs. You do not have to agree to be examined or photographed if you are uncomfortable doing this.
If you become upset or feel unwell during the appointment, the clinician will notice this and slow down questions and offer you a break. Our clinicians know that the appointment might be difficult for you and you do not need to feel embarrassed or ashamed about becoming upset.
At the end of the appointment the clinician will check that you are ok to leave and explain what happens next. They will give you information about how to get help if you are feeling worse or unwell.
The clinician will keep any information private if you ask them to. If you change your mind about a letter being written, the clinician will respect this. The only time when the clinician might break your confidence is if they think that you might hurt yourself or somebody else.

3. After my appointment

The clinician will write a letter about your appointment. This usually takes about 2 weeks to produce.
The letter will be sent to the person who referred you. They will arrange to share the letter with you.
If there is anything incorrect in the letter, you can explain and the clinician will check their records and make a correction if they can.
TortureID recommends that you give a copy of your letter to your GP. The letter will have some recommendations for your GP to consider.
If you give the letter to your GP it will be a permanent part of your GP record.
You can use your letter to explain your health problems to other organisations and people – for example solicitors, social services, the Council and the Home Office. See below for information about this third-party use.
If you need a copy of your letter in the future there might be a copy in your GP record (if you gave it to your GP). You can register on the NHS app to get a copy of your letter. If there is not a copy in your GP record, TortureID will have a copy as long as we have seen you within the last 6 years. Please email admin@tortureid.org.
Your letter and personal details are stored in our secure systems for 6 years, after which we delete them. For more information about how we look after your personal information, please see our client privacy notice.

When a Health Assessment is produced, a copy is given to the client, and they are free to use it in any way they see fit. This means that the Health Assessment letter may be shared with third parties, including legal representatives, Home Office officials, adjudicators and judges, housing authorities, education providers and social services.

If you are in possession of a Health Assessment letter, you should be aware of the following:

Our Health Assessments are written primarily for a clinical audience. They are not medico-legal reports, and although we collect some information about a client’s asylum claim during the assessment appointment, we do this because the reasons for claiming asylum, and the asylum process itself, are often major factors affecting health, wellbeing and prognosis.
Our Health Assessments are intended to support the provision of rehabilitative care and support. Additional medical examination, assessment or documentation undertaken at a later stage may identify further findings or information.
Although a Health Assessment appointment of one hour is considerably longer than a standard GP appointment, there is still a limit to the amount of information that can be obtained and documented within that time. Distress, difficulties with trust or rapport, problems with concentration and memory, and the extent or complexity of previous ill-treatment may limit the information that can be elicited. Where an interpreter is required, or where English is not the individual’s first language, this may further affect the amount and detail of information that can reasonably be obtained during the assessment.
All our clinicians work to the best of their ability and in accordance with professional standards. It is seldom possible, however, to conduct a comprehensive physical and psychological examination within the limited time available for the assessment appointment.
It is rarely possible, within the time allotted, to confirm that all information provided has been recorded fully or accurately. Information obtained during the assessment is not independently verified. While our clinicians are trained to be aware of the documentation standards set out in the Istanbul Protocol, time limitations mean that Health Assessments are not generally intended to be fully Istanbul Protocol-compliant reports. The limited duration of an assessment may also mean that there is insufficient detail to undertake an in-depth analysis of all possible alternative causes of injuries or symptoms. However, where appropriate and where the available information allows, clinicians may provide medical opinion regarding the degree of consistency between reported injuries or symptoms and the account provided.

Finally, third parties should be aware that a Health Assessment reflects a particular point in time. An individual’s health may improve, deteriorate or remain stable, and should therefore be kept under review as appropriate.

Obtaining copies

Sometimes physical documents can be lost or destroyed. In many cases, a copy of the TortureID Health Assessment letter will also be held within the GP record. Otherwise, if further copies are needed (including electronic copies, which may display photographs more clearly), please email admin@tortureid.org.

Please note: written consent from the client will be required before documents can be released.

Where it is possible, we collect information about how our Health Assessments have been used by our clients and referrers, and the impact that the Assessment had.

A recent review found that:

All Health Assessments that had been requested by GPs during the first three months of 2026 had been included in the client’s medical records. Many of the recommendations made for rehabilitative care and support had been followed or were in the process of being followed.

Clients had used a copy of the Health Assessment letter to help them with claims for asylum and housing:

“[a] significant piece of evidence in getting Section 4 asylum support appeal allowed on medical grounds. This makes the difference between homelessness and having accommodation and support for this man”

“[V]ery supportive evidence. Client was moved into adequate accommodation”

“[T]he judge refers explicitly to the TortureID letter and it is a deciding factor in remitting her appeal back to the Home Office to consider whether support should be provided based solely on her vulnerability”