Dozens of pregnant women have been held at a controversial immigration centre, some of whom for more than a year, as the government fails to recognise their "vulnerability", the chief inspector of prisons has found.
Nick Hardwick led the inspection into Yarl's Wood, labelling it a "place of national concern" in the scathing report which reveals that conditions at the Bedfordshire facility have deteriorated since its last inspection in June 2013.
Yarl's Wood, which had 354 detainees at the time of inspections in April and May, has had a number of problems since opening in 2001.
The prisons watchdog found that in one case a woman had been held for 17 months. The centre was considered to be under staffed and that healthcare services had declined "severely".
Even though the Home Office's own policy states that pregnant women should not normally be detained, 99 were held at Yarl's Wood in 2014. Only nine were ultimately removed from the UK.
Maurice Wren, chief executive of Refugee Council, called for Yarl's Wood to be closed.
He said: "The fact that people fleeing war and persecution are being locked away indefinitely in a civilised country is an affront to the values of liberty and compassion that we proudly regard as the cornerstones of our democracy."
Mr Hardwick called for "decisive action" to ensure women are only detained as "a last resort".
He said: "Yarl's Wood is rightly a place of national concern. Other well-respected bodies have recently called for time limits on administrative detention, and the concerns we have identified provide strong support for these calls."
Speaking to BBC Radio 4's Today programme, Mr Hardwick said that women should only be detained to facilitate their deportation but in fact twice as many of the women held there are released back into the community as are detained.
He said this "raises questions about why they are detained in the first place".
Mr Hardwick said that it was "disappointing" that the government had not done more to address concerns raised in his last inspection report and that in some areas "things have got worse".
He said: "The critical things that need to change is that the women there shouldn't be detained indefinitely and action has got to be taken to ensure that the most vulnerable women are only held in the most exceptional circumstances."
He added: "I don't think they [the Home Office] recognise really the vulnerability of the women that are there, I don't think they sufficiently understand that.
"And I don't think that they sufficiently understand that the risks of placing anybody in a closed institution are always there."
Inspectors raised particular concerns about the length of time some women were held for and the detention of vulnerable inmates "without clear reason".
At the time of the inspection, 15 detainees had been held for between six months and a year, and four for more than a year.
In the previous six months, 894 women were released back into the community - more than double the number (443) who were removed from the UK.
The report said this "raises questions about the validity of their detention in the first place".
There were some positive findings. HMIP said the facility was clean, most detainees said staff treated them with respect, while recreational facilities and access to the internet were good.
The assessment by HM Inspectorate of Prisons (HMIP) found:
- There are too many men working at the centre, which holds mainly women.
- Care planning for women with complex needs is so poor that it put them at risk and pharmacy services are "chaotic".
- Staff entered women's rooms without knocking.
- Violent incidents have increased, with the number of reported assaults trebling in a year.
- Almost half of female detainees (45%) said they feel "unsafe" due to the uncertainty of their immigration status, poor healthcare and having too few visible staff.
- Four women reported instances of sexually inappropriate comments from staff, one reported "sexual contact" and one reported comments, contact and abuse in a survey. However, in separate interviews, no women said they were aware of staff being involved in any illegal activity of sexual abuse. HMIP said it did not find evidence of widespread abuse.
- Most uses of force on detainees were "proportionate" but inspectors raised concerns about an incident in which an officer repeatedly struck at least two women with his shield as staff attempted to remove a detainee.
Mr Hardwick said most staff "work hard to mitigate the worst effects of detention", adding: "We should not make the mistake of blaming this on the staff on the ground."
Serco, which has operated Yarl's Wood since 2007, said it was "working very hard" to increase female staff numbers.
Julie Rogers, of Serco, which has operated Yarl's Wood since 2007, added: "We are pleased that in (the report), they found that four out of five residents said that 'staff treated them with respect' and that they, 'did not find evidence of a widespread abusive or hostile culture amongst staff'."
John Shaw, of G4S, which provides health services, said the firm is "reconfiguring" the service to address a "growing number of more complex medical requirements" at the centre.
He said: "We have prioritised providing primary care and I am encouraged that inspectors have found that access to those services is good.
"There are now more GP hours delivered at the centre than ever before and no detainee waits more than three days for a non-emergency appointment.
"We are committed to working closely with the NHS to raise the standard of service at Yarl's Wood and improve results for those who require medical care."
An NHS England spokeswoman said it has been working closely with G4S to "ensure that rapid progress is made to achieve the high standards which we expect".
She added they have "action plans" in place to address the concerns raised during a recent inspection and they will be reviewed in the light of the new report.
The NHS England spokeswoman added: "We are committed to ensuring patients can receive both the physical and mental health care they need when required at this centre."