28 November 2018

Before HM Assistant Coroner Steven Nicholls
Bournemouth Coroner’s Court
Opened 19 November

On Tuesday (27 November) the jury at the inquest into the death Branko Zdravkovic at The Verne Immigration Removal Centre (IRC) returned a conclusion of suicide. In an unusual step the inquest is not yet closed as the coroner has asked for more evidence from the Home Office on the management of vulnerable detainees, in order to inform a possible public report by the coroner to prevent future deaths.

Branko was born in Slovenia and was living in London. He had been in the UK for eight years and had worked as a waiter prior to detention. He was facing administrative removal at the time of his death.

Branko was described by his partner Nicola as a warm, intelligent person who had a wonderful future ahead of him. He was found hanging in a bathroom at 11:30pm on 8 April 2017. He was pronounced dead in the early hours the next day, 19 days after entering The Verne IRC in Dorset.

When in The Verne, Branko may have been detoxing from alcohol and experiencing depression. The inquest heard how the medical team would try not to accept detainees in this position as it has no inpatient facility to meet these needs.

Four days after entering, Branko was put under suicide and self-harm monitoring procedures, known as ACDT, following statements of suicidal intent. This was closed three days later.

On 5 April he was moved to the care and separation unit despite appearing highly distressed and at risk of self-harm. A second ACDT was opened. The frequency of observations was reduced after two days following a review and Branko returned to the wing. He was subsequently found suspended from a ligature in the communal bathroom.  

The coroner has directed more witness evidence from the Home Office on the procedures to manage the risk of self harm of vulnerable detainees including compliance with Rule 35 (2) of the Detention Centre Rules. This requires clinicians to the report to the Home Office where a detainee is suspected of suicidal intent. Critically the Rule 35 process is a statutory requirement which mandates a review of detention to ensure that those who are at risk of suicide are properly considered for release. Evidence was heard that the statutory reports to the Home Office on those with suicidal intentions were not completed.

Nicola Sanderson, partner of Branko said: Branko’s death has been utterly devastating for me. I’m concerned that those responsible for keeping him safe while he was in detention failed him. It is very depressing that we were not kept fully informed of the details of Branko’s detention. This lack of communication left him in a very isolated situation”

Jane Ryan, solicitor at Bhatt Murphy Solicitors said: It was horrifying that the inquest heard evidence that there is a practice of not doing the required statutory reports on detainees with suicidal intentions.”

Natasha Thompson, caseworker at inquest said: “Branko’s awful and unnecessary death is yet more evidence that immigration detention centres are failing to manage or release those at risk of suicide and comply with their own rules. An unprecedented number of people are dying in immigration detention centres. Support is growing for the call to end the use of immigration detention altogether. We believe this is the only way to prevent further deaths and suffering.”



For further information contact Sarah Uncles on 020 7263 1111 or email

The family is represented by INQUEST Lawyers Group members Jane Ryan and Catherine Shannon of Bhatt Murphy Solicitors and Leonie Hirst of Hirst Chambers.

The Interested Persons represented in the inquest proceedings are the Home Office, The Ministry of Justice, Care UK and EDP Drug and Alcohol Service.

ACDT stands for ‘Assessment Care in Detention and Teamwork’ which is a Home Office self-harm reduction strategy.

The Detention Centre Rules 2001, R35(2) state a requirement to report to the Home Office on the case of any detained person having suicidal intentions and/or being placed under special observations.

Originally a prison, The Verne was an Immigration Removal Centre since 2013. In October 2017 it was announced that The Verne would return to the prison estate. It is now a category C prison.