Multi-Country-Analysis

Key Problems and Key Recommendations

regarding

4.1 Health Care,

using assessments of nine countries:
 Burkino Faso, D.R. Congo, Ethiopia, Ghana, Guinea, Niger, Senegal,
Zambia, and Zimbabwe.

1.     1. NINE COUNTRY-ASSESSMENTS (excerpts):

Guinea Assessment

Health Care. Inmates do not have their own bed and the adults emerge in the open air very rarely. Prisons do not provide clothes or soap for inmates. In the prison structures, there is neither light nor air enough for the prisoners. With the lack of food, and no medicine, epidemics spread rapidly.

NGOs reported endemic malnutrition throughout the prison system. On a routine visit to a small prison in Telimele, a medical doctor working for an NGO estimated that 10 of the prison's 12 inmates suffered from life‑threatening levels of malnutrition. 

Toilets did not function, and prisoners slept and ate in the same space used for sanitation purposes. Poor sanitation, malnutrition, disease, lack of medical attention, and poor conditions resulted in dozens of deaths. A local prisoner advocacy NGO reported 92 deaths in Conakry's main prison during the year.²

In 2006 an international NGO reported the prevalence rate of HIV/AIDS among incarcerated male minors was as high as 50 percent, suggesting sexual abuse. A 2008 study by a local NGO reported skin lesions on 41 percent of juvenile inmates.

Zambia  Assessment

Health Care. Poor sanitation, inadequate medical facilities, meager food supplies, and lack of potable water resulted in serious outbreaks of dysentery, cholera, and tuberculosis, which were exacerbated by overcrowding. Failure to remove or quarantine sick inmates and the lack of infirmaries at many prisons resulted in the spread of airborne illnesses such as tuberculosis, leading to prisoner reinfection and death. Drugs to combat tuberculosis were available but the supply was erratic. Many prisoners were malnourished because they received only one serving of corn meal and beans per day. The HIV/AIDS prevalence rate in prisons was estimated at 27 percent.

The sewer system in Mpima Remand Prison was completely broken down. Waste matter floated all over around the sleeping quarters in small ponds. This posed a health risk to both the remandees and the prison warders living in proximity to Mpima Remand Prison. Tuberculosis (TB) patients were not isolated from the rest of the inmate population.

Ghana Assessment

Health care. Today overcrowding contributes to a prevalence of serious and communicable diseases such as AIDS, cholera, tuberculosis, cough, asthma, typhoid fever, and itch. Suffocation is a fact that is also recurrent in the midst of the incarceration areas.

Nutritious food and drinking water for consumption and hygiene are of poor quality. Breakfast, lunch and dinner are boiled down to one small meal a day and of the same poor quality.

Bedding problems for prisoners persist. Most of the time they do not have their own bed and mattress. Many of them usually sleep on pieces of mat or old cardboard destined to be thrown away. Soap and clothing are not provided by the prison.

Burkino-Faso Assessment

Health Care. Most of the prisons have a hospital to provide primary health care to prisoners. In case of emergency or a serious case, they are discharged into public hospitals. But the effort of the state remains inadequate because of overcrowding in prisons, and they often are so powerless in cases of terrible suffering. A few organizations (NGOs), such as CURE, provide support in prisons through various donations such as medicines or help for care, but because of overcrowding, it remains insufficient. Since health facilities are overcrowded, of course, it raises problems of hygiene and health.¹ Prisons were overcrowded, and medical care and sanitation were poor. Prison diet was inadequate, and inmates often relied on supplemental food from relatives.

Niger Assessment

Health Care. Nutrition, sanitation, and health conditions were poor, and deaths occurred from AIDS, tuberculosis, and malaria.  The budget for maintenance does not exist. Toilets and showers are very deplorable. Overcrowding makes very sick prisoners. The vast majority of prisoners supplement their daily diet by the delivery of food by their family, or by buying food from local suppliers for those prisoners who have sufficient financial resources from their families. Prisoners have only one meal with poor nutrients. The prisoners who have no family support are forced to work very very hard or serve other prisoners to survive. Only political prisoners or wealthy families can obtain a conditional release for health reasons [legal aid is very, very expensive].

Dem.Rep.Congo Assessment

Health Care. In some prisons, there are health-care dispensaries. For serious cases, sick detainees and sick prisoners are transferred to hospitals in the state. Sanitation is lacking in most prisons. Water is also deficient.
In all prisons except the Kinshasa Penitentiary and Reeducation Center (CPRK), the government had not provided food for many years--prisoners’ friends and families provided the only available food and necessities. Malnutrition was widespread. Some prisoners starved to death. Prison staff often forced family members of prisoners to pay bribes for the right to bring food to prisoners. During the year many prisoners died due to neglect. For example, the UNJHRO reported in February that over a two-month period, 21 prisoners died from malnutrition or dysentery in prisons in Uvira, Bunia, and Mbuji-Mayi.

Ethiopia Assessment

Health Care. Prison conditions were unsanitary and there was no budget for prison maintenance. Medical care was unreliable in federal prisons and almost nonexistent in regional prisons. Sanitary provisions like (open) toilets and douches usually are in a deplorable condition. Only with the help of visitors bringing food is it possible for them to survive. Prisoners lacking the support of their family must work in prison shops in order to earn some money for food or have to render services to fellow prisoners.

Senegal Assessment

Health Care. Overcrowding is a serious health hazard. Prisons lacked doctors and medicine. The ONDH reported a national ratio of one doctor per 5,000 inmates and that the government spent only 450 CFAF (approximately $1) a day per inmate to cover all costs including medical care. There was one mattress for every five detainees. Due to an old and overburdened infrastructure, prisons experienced drainage problems during the rainy season and stifling heat during the summer. Prisons also were infested by bugs, and prisoners suffered sexual assault and extremely low quality food.

Zimbabwe Assessment

Health Care. Poor sanitary conditions persisted, which aggravated outbreaks of cholera, diarrhea, measles, tuberculosis, and HIV/AIDS‑related illnesses. In 2004, a prison officer told us that tuberculosis (TB), an opportunistic disease, spread like wildfire through the cells with an average of 15 prisoners dying each week from the disease. In March 2004, 130 people died from TB at Khami Prison in a single month. Those who are HIV positive and have compromised immune systems are particularly susceptible to getting TB. One of the first things that most people comment on when they describe Zimbabwe's prison cells is the overwhelming stench of human urine and excrement.

In June 2006, MP Claudius Makova told parliament that some inmates at Highlands police station were going for two days without food.  In 2008, things were much worse: a confidential report written for Paradzayi Zimondi advised him that prisoners at Chikurubi Prison went for days without a meal and were occasionally supplied with food "only meant to keep a person alive" such as sadza and salted, unclean water.

2. KEY RECOMMENDATIONS (excerpts)
regarding 4.1 Health Care,

Kampala (1999) Declaration on Prison Health in Africa:
 

Equality of access to health care should be ensured.

The Ministry of Health should take over the responsibility of health in prison and prisons should be included in public health programmes. Adequate finance should be made available and budgeting for prison health care should be a separate line item. There should be transparency and accountability regarding health care. This should be achieved by having a state department responsible for health care and training of officials (including human rights training).

Prisons should be more open to the outside.

Prisons should be open to relevant external actors providing specific assistance as well as independent inspectors who should report to a high authority. Access to prisons by the public should be facilitated to enhance transparency. Open door visits could be organised on a regular basis to sensitise and educate the community about prison.

Sharing experiences and on-site training should be supported.

Regular exchanges should be facilitated between health professionals. Prison officials should be properly trained and progressive attitudes encouraged.

NGOs/civil society groups should

• Assist in health awareness and education including AIDS and STDs.

• Develop networks within the NGOs working in this field to co-ordinate their work, exchange and build synergies.

Basics
•  Primary health care should be a priority.

•  Each prisoner must have a confidential clinical health record giving all essential details of the individuals health profile. It should record all incidences of illness and treatment. It should contain a fitness certificate on discharge. 
•  Discipline regarding maintenance of hygiene and sanitation in institutional environment must be enforced.
•  Health education and counselling should form an integral part of the treatment for all health care management.
•  There should be a public health programme for staff and prisoners alike to prevent disease rather than cure it later. It should be a continuing process.

Priorities

·         Priority must be given to communicable diseases, including HIV/AIDS, tuberculosis, hepatitis,, and local epidemics, as prisons can be breeding grounds with later community infections.

·         Alcohol and drug addictions, and mental illness require increased medical an psychological attention.