What Is a Rule 35 Assessment and Who Needs One in the UK?

Rule 35 is often misunderstood. You may see terms such as Rule 35 assessment, Rule 35 report, immigration assessment and torture assessment used together online, but they do not all mean the same thing. Rule 35 is part of the safeguards used for people held in immigration detention in the UK. It is designed to bring certain health and vulnerability concerns to the attention of the people responsible for detention decisions.

The current Home Office guidance identifies three main areas covered by Rule 35. These are where a detained person’s health is likely to be harmed by continued detention or detention conditions, where a medical practitioner suspects suicidal intentions and where a medical practitioner is concerned that the person may have been a victim of torture.

What Is a Rule 35 Assessment?

Rule 35 relates to medical reporting within immigration detention. Its purpose is to make sure that certain health concerns are formally brought to the attention of the relevant decision makers. The process operates under the Detention Centre Rules 2001 and applies to people detained in the relevant Immigration Removal Centre setting.

It is important to understand what Rule 35 is not. It is not a general medical assessment for every asylum seeker, it is not automatically required for every person with PTSD and it is not simply a private report that anyone can order online. The detention setting and the person’s clinical circumstances matter.

Who Can Have a Rule 35 Report?

Rule 35 concerns people who are detained within the relevant immigration detention framework. It does not automatically apply to everyone who has an immigration case or everyone who has experienced trauma.

The current Home Office guidance explains that Rule 35 reports are used in Immigration Removal Centres to raise specific concerns about detained people. The process is designed to make sure those concerns are considered as part of the wider detention process.

When Is a Rule 35 Report Required?

There are three main reporting categories under Rule 35.

Rule 35(1): Health Affected by Continued Detention

The first category concerns a detained person’s health. The medical practitioner must report where the person’s health is likely to be injuriously affected by continued detention or any conditions of detention. This can involve physical or mental health concerns, depending on the individual circumstances.

The report should provide relevant clinical information and explain the medical concern. The purpose is to make sure that the possible effect of continued detention is brought to the attention of the people responsible for the detention decision.

Rule 35(2): Suicidal Intentions

The second category concerns suspected suicidal intentions. The current guidance states that the medical practitioner must report where they suspect that a detained person has suicidal intentions. The guidance also requires special observation for as long as those suspicions remain, together with appropriate records of the person’s treatment and condition.

Suicidal thoughts and intentions can present in different ways. The guidance gives examples such as withdrawal, changes in self care, extreme mood changes, feelings of worthlessness and self destructive behaviour, while also stressing that every person should be considered individually.

Rule 35(3): Possible Victim of Torture

The third category concerns a detained person who the medical practitioner is concerned may have been a victim of torture. The clinician considers the person’s account alongside relevant medical information and clinical findings.

This can involve physical injuries, scars, psychological symptoms, previous treatment and other evidence available to the clinician. The purpose is to raise a medical concern through the Rule 35 process rather than to provide a complete expert opinion on every aspect of the person’s immigration case.

Who Can Prepare a Rule 35 Report?

This is one of the most important points to get right.

The current Home Office guidance states that Rule 35 reports must only be raised by a GP. Other healthcare professionals can assist with examination, assessment and preparation, but final responsibility for making the report rests with the GP.

This means a private medical or psychological report should not automatically be described as a Rule 35 report. If someone is looking for professional evidence for an immigration matter, they need to establish which type of report they actually require and who is authorised to provide it.

What Happens During a Rule 35 Assessment?

The process depends on the reason for the report. The clinician may need to understand the person’s medical history, current symptoms, treatment, previous healthcare and the reason for the concern. Where torture is alleged, the clinician may also need to consider the person’s account alongside physical and psychological findings.

Relevant areas may include:

• The person’s account
• Physical injuries
• Scarring
• Psychological symptoms
• Previous treatment
• Medical records
• Current medication
• Clinical observations
• Relevant health conditions
• The effect of detention

The current Home Office guidance explains that reports should contain sufficient information to allow the concern to be understood and considered by the relevant decision makers.

What Evidence Can Be Relevant to Rule 35?

The evidence will depend on the circumstances. Medical records can provide information about previous injuries, treatment and health conditions. Psychological assessments may help explain symptoms and functional difficulties. Physical findings can also be important when relevant to the person’s account.

However, the absence of a particular type of evidence does not automatically answer the question. Some trauma can result in psychological effects without obvious physical signs. The clinician must consider the evidence available and explain the medical basis for the concern within their professional role.

Can PTSD Be Relevant to a Rule 35 Assessment?

Yes, PTSD can be clinically relevant, but having PTSD does not automatically mean that Rule 35 applies.

For example, PTSD may be relevant when considering whether continued detention is likely to affect someone’s health. It may also form part of the clinical picture where there are concerns that a detained person may have experienced torture. The actual Rule 35 category still needs to be considered on its own facts.

NICE recognises PTSD and complex PTSD and recommends comprehensive assessment of symptoms, physical and psychological needs and risk. Its guidance also identifies torture among the traumatic experiences associated with PTSD.

Rule 35 and Torture

Torture is one of the most sensitive areas covered by Rule 35. The clinician needs to consider the person’s account and relevant clinical evidence and explain why there is concern that the person may have been a victim of torture.

The Rule 35 process should not be confused with a full expert medico legal assessment. The Home Office guidance explains that a Rule 35 report is a mechanism for bringing concerns to the attention of decision makers. It does not require the GP to provide the same type of detailed expert opinion that may be expected in a separate medico legal report.

Is a Rule 35 Report the Same as a Medico Legal Report?

No. A Rule 35 report has a specific purpose within immigration detention. A medico legal report is prepared for a legal purpose and may be instructed to answer detailed questions about diagnosis, causation, functional impact or other matters relevant to legal proceedings.

The Home Office guidance makes this distinction clear in relation to Rule 35(3). The report raises concerns about possible torture and provides relevant medical information, but it should not automatically be treated as a full expert medico legal report.

This distinction is important for anyone arranging medical evidence. The wrong type of report may not answer the questions required for a particular immigration or legal matter.

What Is the Difference Between Rule 35 and Rule 32?

Rule 35 and Rule 32 are related safeguards but apply in different detention settings. Rule 35 applies to Immigration Removal Centres under the Detention Centre Rules 2001. Rule 32 applies to residential Short Term Holding Facilities under the relevant Short Term Holding Facility Rules.

The current Home Office guidance covers both processes and explains differences in how reports are prepared and submitted. For Rule 35, the guidance states that the report must be raised by a GP.

What Happens After a Rule 35 Report Is Submitted?

Once a Rule 35 report is submitted, the information can be considered as part of the detention process. The report brings the medical concern to the attention of the relevant Home Office decision makers, who then consider the information alongside the other factors relevant to detention.

A report does not automatically decide what happens next. It does not guarantee release from immigration detention, and it does not automatically determine the outcome of an asylum or immigration claim. The medical evidence is one part of a wider decision making process.

Does a Rule 35 Report Guarantee Release?

No. This is one of the most important points for anyone researching Rule 35.

A report can raise serious concerns about a person’s health or vulnerability, but it does not itself guarantee release. The Home Office considers vulnerability alongside other factors when making decisions about immigration detention.

This is why medical and legal roles should remain separate. A medical professional provides clinical evidence within their area of expertise, while an immigration solicitor or other legal adviser can explain how that evidence may relate to the wider immigration case.

Can a Rule 35 Report Help an Asylum Case?

A Rule 35 report can contain important medical information, but its primary purpose is connected to the safeguards surrounding immigration detention. It should not be presented as a guarantee of an asylum outcome.

Depending on the case, additional medical or medico legal evidence may be needed for the wider asylum claim. A report may need to answer questions that go beyond the purpose of Rule 35, so the correct type of assessment should be identified before evidence is commissioned.

What Happens If a Rule 35 Report Is Not Made?

The absence of a Rule 35 report does not automatically mean that a detained person has no vulnerability concerns. The Home Office guidance explains that other routes can be used to raise concerns where appropriate, including concerns that may not meet the specific Rule 35 reporting requirements.

This is important because vulnerability can be complicated. A person may have serious health concerns even when the specific requirements for a Rule 35 report are not met. Healthcare professionals and legal representatives may therefore need to consider other appropriate ways of raising relevant information.

What Should a Rule 35 Report Contain?

The exact information depends on the category involved. A report may include relevant health conditions, treatment, physical findings, psychological symptoms, the person’s account and the clinical reasons for concern.

For a possible torture case, the clinician may need to record relevant injuries, scars, symptoms and other findings. The report should be clear enough for the relevant decision maker to understand the concern and its clinical basis. The current Home Office guidance provides specific instructions for preparing Rule 35 reports.

Common Mistakes About Rule 35

One common mistake is saying that every asylum seeker needs a Rule 35 report. That is not correct. Another is calling every immigration medical assessment a Rule 35 assessment. These reports can have very different purposes.

It is also incorrect to say that PTSD automatically triggers Rule 35 or that a Rule 35 report guarantees release. A service provider should also be careful about describing a private assessment as an official Rule 35 report unless the professional and setting meet the requirements of the current process.

Final Thoughts

Rule 35 exists to make sure important health and vulnerability concerns are not overlooked when people are held in immigration detention. It can cover serious concerns about health, suicidal intentions and possible torture.

At the same time, it is important to describe the process accurately. Rule 35 is not a general immigration assessment, PTSD does not automatically trigger it and a Rule 35 report does not guarantee release. It is also different from a full medico legal report.

If medical evidence is needed for an immigration matter, the first step should be identifying exactly what type of report is required and who is authorised to provide it. The current Home Office guidance should always be checked because immigration detention procedures can change. The official Rule 35 guidance was last updated on 3 July 2025.