What is the relationship between detention, health, and human rights?
The Human Rights Council stipulates that states should refrain from denying access of all persons, including detainees and prisoners, to all kinds of health services. Despite these regulations, many cases of violations of the right to health are reported in contexts of confinement and deprivation of liberty, such as prisons, detention centres, mental health institutions, juvenile correctional houses, and rehabilitation clinics.
The Office of the United Nations High Commissioner for Human Rights issued a report in 2018 in which Dainius Puras, the Special Rapporteur on the right to health, draws attention to aspects of mental and physical abuse of persons in detention and points out the logistical inadequacy of places of confinement to provide treatment and allow psycho-social healing.
Complaints raised by the Special Rapporteur in this report include:
- deterioration of the physical and mental health of detainees and prisoners due to emotional, physical, and sexual abuse
- non-consensual medical treatment
- inadequate sanitation and nutrition
- discrimination and denial of treatment for migrants and people with sexually transmitted infections
The Special Rapporteur stresses the need to implement a right-to-health framework within contexts of confinement and urges states to adopt the UN Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules).
Why is it important that health workers are involved in this topic?
As professionals, health workers are a focal point within the context of detention and the right to health because they are responsible for providing proper medical care to their patients. In its database of prison-related issues, the Association for the Prevention of Torture (APT) indicates that health workers in prisons and other liberty deprivation centres have professional and ethical obligations to their patients.
A sufficient number of supervised and well-trained health professionals should regularly visit or be based in detention centres and prisons to provide health services. Also, they should give special attention to certain groups such as females, minors, the elderly, persons with disabilities and mental-care needs, and LGBT detainees. Health workers should; therefore, be aware of their obligations and the legal framework that protects the rights of their patients.
What are the most relevant sources?
The issue of health in detention has been raised by non-governmental bodies that stress the necessity to protect the dignity and well-being of individuals deprived of liberty. In his 2018 report, the Special Rapporteur indicates some health provision guidelines in detention such as equality, non-discrimination, and informed consent before treatment. The United Nations issued several conventions in this regard:
- Standard Minimum Rules for the Treatment of Prisoners (1955, revised 2015)
- Principles of Medical Ethics for the Protection of Detained Persons and Prisoners against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (1982)
- Convention against Torture (1987)
- Istanbul Protocol (2004)
Releases by the World Medical Association (WMA) include:
- Statement on Body Searches of Prisoners (1993)
- Declaration on Prison Conditions (2000)
- Resolution on the Responsibility of Physicians in the Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment of Which They Are Aware (2003).
Other statements include the CPT Standards (2009) by the Council of Europe and Good Practices in the Prevention and Care of Tuberculosis and Drug-resistant Tuberculosis in Correctional Facilities (2018) by the World Health Organization. The following associations work closely with the WHO and advocate the right to health of prisoners and detainees by disseminating information and creating a communication platform among stakeholders:
- Health through Walls (HtW)
- International Corrections and Prisons Association (ICPA)
- Santé Prison Suisse (SPS)
- Swiss Prison Doctors
What are the main issues related to human rights in detention?
Issues of human rights in detention settings have been raised in state reports and complaints to the Special Rapporteur. Examples include:
- Lack of medical care leading to unhealthy coping mechanisms or suicide
- Cases of fatal dehydration
- Complicity of doctors in torture programmes or organ harvesting
- Dual loyalty problems, leading to mishandling of forensic reports or following medical procedures/practices, such as experiments and reduced quality of care, that serve the interest of the state at the expense of the detainees’ health
- Punishment of detainees in the name of drug treatment
- Discrimination against immigrants
- Forced sterilization and slavery
- Non-consensual treatment
- Lack of protection of detainees from peer violence and rape
How can the situation be improved?
The Special Rapporteur has stated a number of recommendations that guide the professional conduct of health workers and oblige states to ensure access to all kinds of services in confinement settings. Some recommendations include:
- Full abidance by and implementation of the Nelson Mandela Rules (Standard Minimum Rules for the Treatment of Prisoners)
- Provision of special medical care to individuals with disabilities
- Development and funding of solid national and international measures to improve relationships and health systems within prisons, detention centres, and clinics
- Elimination of discrimination in the provision of healthcare
- Empowerment of detainees and prisoners to gain and exercise autonomy and have the right to communicate and participate in making healthcare decisions and to receive effective support and proper accommodation
Non-governmental organizations, associations, and national and transnational support groups can also benefit from mobilization and training workshops, and receive funds to disseminate good practices, conduct research, and report on cases of violations to higher authorities.
This page was written by Somaya Bahji in December 2018.