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Inquest concludes into Prison death at HMP Leeds


The Inquest touching upon the death of 29 year old Karar Ali Karar, who died on 5 September at HMP Leeds, concluded on 7 October 2021 before Senior Coroner McLoughlin and a jury.


At approximately 10 am on 4 September 2019 Mr Karar was discovered in an unresponsive condition in his locked cell on the segregation unit with a ligature around his neck made from a bed sheet attached to the window bars. Unusually, his hands were tied behind his back and his ankles were tied together. The ligature was cut off by prison staff and cardiopulmonary resuscitation was commenced by healthcare staff with paramedics in attendance. Mr Karar remained unconscious and was transported to Leeds General Infirmary where his death was certified at 00.40 on 05/09/19.


Mr Karar was the 21st prisoner to die at Leeds since September 2017.

Mr Karar spent 120 days in the segregation unit, over two periods, prior to his death. During the first, staff did not create a mental health care plan within 30 days, and the Prison and Probation Ombudsman investigation found that there was a missed opportunity to hold a Medical Recommendations Against Segregation Case Review, and some Initial Segregation Health Screens were inaccurately completed.


Mr Karar spoke limited English and there were concerns that staff should have used an interpreter when dealing with complex issues.


The family were extremely concerned that staff underestimated Mr Karar’s risk to himself during the time he spent in segregation. For example, they were concerned that healthcare staff in the prison had concerns that Mr Karar was anxious about being deported but did not formally record this or share it with other staff. The family also had concerns that Mr Karar may have been murdered by prison staff.


Following consideration of 25 witnesses’ evidence, the jury reached a conclusion of suicide, alongside a narrative, which noted their belief that there appeared to be an initial lack of urgency in response to the observations to Mr Karar’s cell upon notice of a ligature on 4 September.


Daniel Lemberger Cooper acted for the family of Mr Karar, and by Anita Davies of Matrix Chambers.

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