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The Human Rights Center for the Assistance of Prisoners Program for the Amelioration of Prison Conditions
A report by the Human Rights Center for the Assistance of Prisoners
21 February 1998 The Human Rights Center for the Assistance of Prisoners is the first center specialized in prison conditions in the Arab World. The Program for the Amelioration of Prison Conditions monitors and documents conditions in prisons and makes recommendations to the Egyptian Government to improve prison conditions on the one hand and urge donor states to allocate some aid funds to help the Egyptian government to improve the infrastructure of prisons.
The Center’s Team Lawyers: Mohammed Zari Essam Abdel-Aziz Atif Hafez Ali Abu-Shama Research and Publication Unit: Heba Kasim Samar Abdel-Salam Administrative Unit: Adel Salah Hanaa Hashim Amera Hamdi Mohammed Hamdi Director of the Center: Mohammed Zari This report is dedicated to the doctors who fulfill this oath: "I swear to God
May God be my witness." Introduction International human rights instruments endorse the right of prisoners to human dignity without discrimination between them and those outside the prison, as human rights are established rights that are above any other considerations. Those instruments commit states to include in their constitutions all measures necessary to guarantee the well- being of prisoners and detainees. Among these is the right of prisoners to receive medical care, which is linked to the right to life. This imposes that medical personnel dealing with prisoners must provide them with medical care and must maintain their role in defense of human rights and the rule of law. They must also give priority to the interests of their patients over any ideological, political, or religious considerations, particularly in conditions where human rights are violated. Medical personnel, in addition, must document medical violations and call for their redress. This is particularly true as the work of medical professionals reflects a certain understanding of the value of the person and his right to be treated in a way that preserves his dignity and provides him with full medical care. The moral and professional responsibility of doctors entails their provision of these rights. Therefore, the HRCAP issues its fifth report on the role of doctors, as the goal of medicine has always been the welfare and interest of the sick. The report presents the violations of the prisoners’ rights to physical, psychological and mental health committed by doctors in contradiction to the provisions of the law, the Constitution and international human rights standards, as well as to the code of ethics of the medical profession. This report is divided into two parts: the first reviews the legal and constitutional framework governing the role and duties of doctors in the provision of medical supervision and care for their patients, whether inside or outside prison, as long as he has entered a medical relation with a sick person. In this respect, the report reviews the relevant international legislation and rules which affirm the right of every person to good health and the responsibility of the doctor for following up his patients and for providing prisoners and detainees with the medical care they need. Part two describes the violations and wrong doings committed by doctors in Egyptian prisons. It demonstrates the negligence and lack of medical care faced by prisoners in seven Egyptian prisons: Fayoum, Wadi Al-Natroun, Leman Tora, Al-Wadi Al-Gadid, Damanhour, Istikbal Tora, and the High Security Prison (The Scorpion - Al-Aqrab). This part is based on the testimonies of prisoners and their families, in addition to the visits carried out to these prisons by the Center’s lawyers to monitor prisons conditions. The report concludes with a number of important recommendations that aim at improving the medical conditions of prisoners. The Center hopes that the issuance of this report will spur the Egyptian authorities to take the necessary measures to protect prisoners from the abuses committed by the prison administration and some doctors. The report also aims to reassert the need to improve the level of medical care provided to prisoners and detainees, and the importance that doctors adhere to the code of ethics of their profession in the performance of their duties. The HRCAP has affirmed in its previous four reports that the main objective of detaining prisoners is not only to punish them for their crimes, but also to rehabilitate them in order that they can reintegrate into society as normal citizens when they leave the prison. The Center believes that neglecting medical care and dealing with prisoners in a way that disregards their human dignity will not achieve that objective. Part One International human rights instruments have asserted the importance of protecting prisoners and detainees from any violation of their basic rights, notably the right to life and to physical and mental safety. The Universal Declaration of Human Rights adopted by the UN in 1948 asserts the importance that every person be treated in a humane and dignified manner. Article 5 of the Declaration states that "No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment". article 25 asserts that "Everyone has he right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, ..." Also, the International Covenant on Civil and Political Rights adopted by the UN in 1966 states in article 10 that "All persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person." The International Covenant on Economic, Social and Cultural Rights asserts in article 12 the right of everyone "... to the enjoyment of the highest attainable standard of physical and mental health" and that "… the steps to be taken by the State Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: ... (c) The prevention, treatment and control of epidemics, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness." The charter of the World Health Organization also asserts the right of all persons to the best possible health in all circumstances whatever his race, religion, political beliefs, or social or economic conditions, as the right to health is a basic right for the individual. The right of prisoners to be provided with the necessary medical care is also asserted in the Standard Minimum Rules for the Treatment of Prisoners adopted by the first UN Conference for the Prevention of crime and the treatment of offenders, held in Geneva in 1995 and sanctioned by the Social and Economic Council in 1977. Rule 22 states that:
at every institution there shall be available the services of at lest one qualified medical officer who should have some knowledge of psychiatry. The medical services should be organized in close relationship to the general health administration of the community or nation. They shall include a psychiatric service for the diagnosis and, in proper cases, the treatment of states of mental abnormality.
Sick prisoners who require specialist treatment shall be transferred to specialized institutions or to civil hospitals. Where hospital facilities are provided in an institution, their equipment, furnishings and pharmaceutical supplies shall be proper for the medical care and treatment of sick prisoners, and there shall be a staff of suitable trained officers. The services of a qualified dental officer shall be available to every prisoner. Thus, we see that Rule 22 focuses on the importance of the health and state of mind of prisoners, and stresses that a psychologist doctor and a dentist must also be available. Also, rules 24, 25, and 26 stress the role and duty of the prison doctor to provide medical care to the prisoners. Rule 24 states that: The medical officer shall see and examine every prisoner as soon as possible after his admission and thereafter as necessary, with view particularly to the discovery of physical or mental illness and the taking of all necessary measures; the segregation of prisoners suspected of infectious or contagious conditions; the noting of physical or mental defects which might hamper rehabilitation, and the determination of the physical capacity of every prisoner for work. Also, rule 25 stresses that:
On the other hand, rule 32 in the section on discipline and punishment states that: Punishment by close confinement or reduction of diet shall never be inflicted unless the medical officer has examined the prisoner and certified in writing that he is fit to sustain it. The same shall apply to any other punishment that may be prejudicial to the physical or mental health of a prisoner. In no case my such punishment be contrary to or depart from the principle stated in rule 31. The medical officer shall visit daily prisoners undergoing such punishments and shall advise the director if he considers the termination or alteration of the punishment necessary on grounds of physical or mental health. Rule 33 stipulates that:
On medical grounds by direction of the medical officer; By order of the director, if other methods of control fail, in order to prevent a prisoner from injuring himself or others or from damaging property; in such instances the director shall at once consult the medical officer and report to the higher administrative authority. Rules 49 and 52 stress that the prison must have sufficient number of staff and doctors. In this respect, rule 49 (1) stresses that: "So far as possible, the personnel shall include a sufficient number of specialists such as psychiatrists, psychologists, social workers, teachers and trade instructors." Also, rule 52 states that: In institutions which re large enough to require the services of one or more full-time medical officers, at least one of them shall reside on the premises of the institution or in its immediate vicinity. In other institutions the medical officer shall visit daily and shall reside near enough to be able to attend without delay in cases of urgency. In addition, rule 62 stipulates that: "The medical services of the institution shall seek to detect and shall treat any physical or mental illness or defects which may hamper a prisoner’s rehabilitation. All necessary medical, surgical and psychiatric services shall be provided to that end." Rule 63 (1) states that: "The fulfillment of these principles requires individualization of treatment and for this purpose a flexible system of classifying prisoners in groups; it is therefore desirable that such groups should be distributed in separate institution suitable for the treatment of each group." The same rule states that "It is desirable that the number of prisoners in closed institutions should not be so large that the individualization of treatment is hindered." Regarding the care of insane and mentally abnormal prisoners rule 82 states that: Persons who are found to be insane shall not be detained in prisons and arrangements shall be made to remove them to mental institutions as soon as possible. Prisoners who suffer from other mental diseases or abnormalities shall be observed and treated in specialized institutions under medical management. During their stay in a prison, such prisoners shall be placed under the special supervision of a medical officer. The medical or psychiatric service of the penal institutions shall provide for the psychiatric treatment of all other prisoners who are in need of such treatment. Given that the interest of a patient is the core of his relation with his doctor, international organizations and agencies working in the field of medical human rights were keen to add a new perspective to the traditional code of ethics of the medical profession. Therefore, the World Medical Association issued the Tokyo Declaration, which laid down the guiding principles for doctors with respect to torture and other inhuman or degrading treatment in places of detention. The declaration was adopted by the 29th World Medical Association in Tokyo, in October 1975. Article one of this declaration states that doctors shall never approve, condone or get involved in actions of torture or other cruel, inhuman or degrading treatment whatever the crime committed or planned to be committed by the victim and whatever his beliefs or motives might be. Also, the Body of Principles for the Protection of All Persons Under Any Form of Detention or Imprisonment adopted by UN General Assembly Resolution 43/173 deals with the protection of prisoners and the provision of medical care. Principle 24 states that:
Principle 25 stresses the right of prisoners or their counsels to request or petition a judicial or other authority for a second medical examination or opinion. Principle 26 stipulates that the name of the physician who conducts an examination on a prisoner and its results shall be duly recorded. The UN principles, contrary to the Tokyo Declaration, openly condemn all medical personnel who participate in acts of torture or condone or incite them as they represent gross violations of the ethics of the medical profession. This was reflected in the issuance of the Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted by the UN General Assembly on 18 December 1982. Principle one states that:
Principle 2 states that:
Also principle 4 asserts that:
Principle 6 points out that "There may be no derogation from the foregoing principles on any ground whatsoever, including public emergency." In addition, the Convention Against Torture of 1984 stresses the importance of protecting prisoners from being subjected to physical or mental pain. In article 1, it identifies torture as "any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purpose as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed ... when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity." Article 10 of the Convention states that:
Moreover, the Code of Ethics issued by the International Medical Association sets forth the role of doctors and prevents them from performing any harmful act. It states that doctors must offer the medical services in which they are specialist within an absolute technical and moral independence and with sympathy and respect for he human dignity. In addition, Amnesty International alerted governments to the importance of providing medical services to detainees. In a report presented by the organization in 1989 to the Egyptian government, Amnesty International stressed the importance of examining all detainees following their arrest, and set the points to be provided to secure medical care for prisoners. The doctor plays the major role in these, which are as follows: To examine detainees regularly at least once every week, and to intensify these examinations during interrogations and before their transfer or release. Prisoners must be informed, in written, of their right to these examinations. A member of the medical personnel shall undertake the provision of these services to detainees and the keeping of full records on their condition during detention. If a detainee refuses to be examined, his refusal must be written and signed by a member of the medical personnel. Every detainee shall have the right to contact the medical officer at any time upon a reasonable reason. Doctors must keep records for each case they examine including data about detainees such as weight, particular physical signs, psychological state, health complaints. These records shall be treated with confidentiality as is the relation between doctors and their patients. The detainee’s lawyer or family, however, can be informed of his case if he so requested. To enable the family doctor to examine the detainee privately if the detainee, his family or lawyer so requested. Amnesty International made similar recommendations to many governorates, but they were not implemented. In addition, at a meeting held in Singapore in 1975, the International Council of Nurses pointed out to the important role of nurses in providing care for those in detention. Their responsibilities were specified in four tasks: improving the health of the sick, prevention of diseases, relief of pain, and helping the sick to regain their health. The Council concluded by condemning any nurse who uses measures that may cause harm to the mental or physical health of prisoners or detainees. Although nurses are not openly referred to in the Standard Minimum Rules for the Treatment of Prisoners, they are included within the category of those who offer ‘medical services’, as these services do not properly work without the help of doctors’ assistants. Meanwhile, the Code of Ethics and the Charter of Doctors in Egypt, issued by the Minister of Health’s Decree 234 of 1974, stress the importance that doctors perform their role conscientiously and with honesty. Article 5 of this Code states that doctors must be careful and faithful in their conduct and preserve theirs’ and their profession’s dignity. Article 6 states that doctors shall be truthful in their reports and shall give no other testimony than the truth. The Code did not make any distinction between patients inside or outside prisons. Doctors have to do their best for their patients and try to alleviate their pain, treat them with compassion and tenderness, show no discrimination between them on basis of social status or personal feelings (article 14). Article 17 states that doctors must alert the patient and his family to take preventive measures and guide them to do so. Article 21 states that, if necessary, the doctor must accept or call for the opinion of another doctor with the agreement of the patient and his family. The Charter establishes the importance that, in case of the death of a patient, the cause of death must be unidentified, whether it be natural or as a result of a mistake committed by the doctor. Article 23/A commits the doctor, in case of the death of a patient, to report to the competent prosecution department and to request the counsel of a forensic doctor. Regarding the domestic legislation, the Egyptian Constitution states in article 42 that:
Egyptian laws also include many provision that provide considerable protection to prisoners. Article 40 of the Penal Code states that no one shall be arrested or detained unless upon an order by the competent authorities, that he must be treated in a way that preserves his human dignity, and that he shall not be physically or morally harmed. In addition, Presidential Decree 396 of 1956 on prisons laid down the general rules for the medical care for prisoners. The executive regulations established the procedures to be followed to fulfill this care. Article 33 of the decree states that each prison shall have a doctor or more, one of whom must be resident, to undertake the medical tasks stipulated in the internal regulations. Each central prison must have a doctor. In case of the lack of one, a governmental doctor must be assigned to work as the prison doctor. However, this article is criticized for not specifying the number of doctors in proportion to the number of prisoners. Article 34 states that a prisoner sentenced to hard labor and proved unable to work by the prison doctor shall be referred to the head of the medical department of prisons to be examined by the general director of the competent medical directorate to consider his transfer to a general prison; the transfer decision shall be implemented after the approval of the prison’s general director and the Public Prosecutor. Also, article 35 stated that a prisoner who has received a final ruling and proved by the prison doctor to have a mental disorder shall be referred to the head of the medical department of prisons for examination. In case the latter decides that the prisoner should be referred to a mental hospital for examination, the prisoner shall be immediately referred and, if proved to be mentally disordered, shall be kept there upon a decision by the Public Prosecutor until he has cured. When he cures, the hospital administration shall inform the Public Prosecutor, who will order his return to prison and the period he spent in hospital shall be reduced from his term. The prison shall then observe his state and report to the head of the medical department of prisons. Articles 36 and 37 deal with conditions for release on medical grounds. Article 36 states that each prisoner proved to be afflicted with an illness that puts his life at risk or may cause him to become totally disable, will be referred to the head of the medical department of prisons to be examined jointly with a forensic doctor to consider his release. The release order shall be implemented after the approval of the general director of prisons and with the consent of the Public Prosecutor. Article 37 asserted that if a prisoner is seriously sick, the prison administration must inform the administrative department where his family lives so that they can visit him. In case of death of a prisoner, his family shall be immediately informed in the same manner and they shall receive the body upon their request. If they wish to take it to his home town, the government shall take all medical requirements at its own expense and the family shall undertake the transportation of the body. If the death was caused by an epidemic disease the body shall not be transferred. Also, Minister of the Interior’s Decision 97 of 1961 on the internal regulations of prisons stipulate that the prison doctor is responsible for the following:
Article 33 states that: The prison director or prison chief shall implement the recommendations of the prison doctor regarding the treatment or food of a prisoner as dictated by his health condition. If the prison director or prison chief does not agree with the doctor’s recommendations, he has to inform the Prisons Authority. Some jurists see that the second paragraph of article 33 of the prison regulations gives the prison director or prison chief the right to not follow the doctor’s recommendations and instructions, a situation which turns the responsibilities of the doctor into useless talk and actually undermines his jurisdiction as long as a non-medical body has the power to revoke his instructions.
On the other hand, articles 40 - 44 state the responsibilities of the prison pharmacist as the person in charge of keeping all medicines and medical and surgical equipment: Article 41 states that the pharmacist shall prepare the medicine ordered by the doctor and examine the milk received by the prison. Article 42 states that the pharmacist shall not provide any medicine without a written permission by the prison doctor. Article 43 stipulates that he should record in a special book incoming and outgoing medicines and medical and surgical equipment. Article 44 asserts that the prison doctor shall undertake the pharmacist responsibilities in case of absence of the latter. Moreover, articles 45 - 49 of the internal regulations stipulate the sanitary procedures to be followed in prisons, among which are: During their imprisonment, prisoners’ hair must be cut and they must bathe with hot water and soap (article 45). New prisoners must be placed under medical observation for ten days (article 46). The prison director must inform the medical department and medical inspectors if a prisoner is afflicted, or suspected to be afflicted, with a contagious disease (article 47). The cell where an infectious disease appeared must be disinfected (article 48). To segregate prisoners with contagious diseases and to mark their utensils and blankets, article 49. Part Two "Medicines from outside the prison are forbidden. The prison doctors forget about the professional ethics and have turned into officers bearing their same qualities of arrogance, injustice and carelessness" From the testimony of an inmate held in Istikbal Tora Prison. "There are many cases of contagious diseases in the same cell, and the doctor examines them verbally only. In most cases, he accuses the prisoner of pretending to be sick and orders the guards to beat us and take us back to the cell." From the testimony of a detainee held in Wadi Al-Natroun II Prison. These two accounts reflect the lack of medical care in most of Egyptian prisons and the major role played by doctors in this state of affairs. It is true that there are not enough doctors in each prison, but even those available do not fulfill their role for the care of sick prisoners or take care that the healthy ones do not contract diseases. The following pages deal with violations committed by doctors in many Egyptian prisons in contravention of the ethics of their profession and their duty to provide the necessary medical care regardless of the beliefs and political orientation of the prisoner. The medical profession dictates that doctors are to blame if they fail to provide the needed medical care or do not continue providing it when this would cause harm to the patient.
Fayoum Prison (The tuberculosis prison) (1) Fayoum is one of the prisons closed to visits in Egypt. Visits have been banned since 11 November 1996 despite a judicial ruling issued on 15 July 1997 ordering the opening of the prison. Fayoum Prison is located in the Damo area, Fayoum, around 90 Km far from Cairo. A large farm surrounds it, then there is a wall followed by the officers’ quarters, which is composed of two-floor villas ending with a 7-meter concrete wall curved from the middle. The prison’s population includes over four thousand detainees distributed along 12 blocks, 9 of which are assigned for political detainees and two for criminal detainees. The remaining block is used for disciplinary purposes. Inmates are distributed in blocks according to their region of origin. Each block has 18 cells of 6 x 4 m. each. Cells has five windows of 40 x 100 cm. covered with an iron net and an open toilet. Each cell is lit by three lamps, which are usually out of order. The walls of the cells are painted in light gray. The prison inmates complain that cells are overcrowded with as many as 25 prisoners placed in each one. according to reports, poor living conditions, lack of medical care, and the poor food provided have led to the spread of many diseases such as chest allergy, asthma, and TB, which affects at least two in each cell. Skin diseases such as scabies, skin allergies, abscesses and rash, are widespread and the situation is aggravated by the lack of spare clothes. Each prisoners receives one uniform and one set of underwear. Prisoners also suffer from headaches and other troubles as a result of their generally weak condition and the lack of movement. Reports affirm that since the prison was opened on 15 May 1995, there are no doctors and prisoners have not been examined at all. In case a prisoner is seriously sick, a male nurse form the central security forces is brought to see the patient and to give him some pain killers. This practice has led to the death of some inmates, including: Ahmed Fathi, aged 25, from Assiut, died in June 1995 Mohammed Emara, 27, from Suhag, died in June 1995 Both were in block 3 and died the same week 3. Salah Abdel-Rahim, aged 33 from Suhag, died in October 1995 4. Ahmed Abdel-Hasseb, aged 35, from Assiut, died in December 1995 Following the death of many prisoners, a military officer, Captain Mohammed Sharaf, was appointed in January 1996. Testimonies received by the HRCaP affirm that the doctor passes by the blocks once per month only. when he approaches a cell, the guard shouts ‘attention’, which means that inmates have to stand up facing the wall and with their hands raised above their head until the doctor comes and asks if there are any sick prisoners. Then he examines them verbally. Prisoners remain four meters away from him and they are insulted and accused of pretending to be sick. The prison administration followed the doctor’s instructions and segregated those seriously ill in block one: those with TB are in cell number 9, diabetics in cell number 8 and those with scabies in cell number 7. Sick prisoners, however, do not receive the medical care they need. They are kept segregated in the block for long periods without any medicine or medical supervision until the prison administration orders them back to their cell. This exposes healthy prisoners to contract diseases. The Fayoum Prison Hospital Opened in June 1996, the hospital consists of two wards: the first for political prisoners and the second for criminal prisoners. Each ward has 11 beds. Reports indicate that the hospital contains the most modern medical equipment, but no political prisoner is admitted to the hospital and the equipment is not used for the treatment of prisoners. The clinic Detainees go to the clinic twice per week. The guard selects ten sick prisoners according to his will and to the condition of the prisoner. Examinations Examinations are conducted in a formal way. Prisoners are not allowed to come closer than four meters to the doctor. A male nurse, Atta, talks to the prisoners. Reports reveal that he ill-treats the prisoners and always beats and insults them. In addition, he reportedly steals expensive medicines. Early in 1997, Major Doctor Mostafa Sami joined the hospital. He dealt with sick prisoners in a better way than Dr. Mohammed Sharaf. He used to examine prisoners, prescribe them medication and make sure that it was properly distributed. However, after the theft of some medicine from the prison pharmacy, he changed his treatment and became rude and offensive with the prisoners, accusing them of the theft. He also prevents sick prisoners from being held in the segregation block and shouts to every inmate who complains about his chest saying that "there is no TB in Fayoum Prison." According to reports, up to March 1997 sick inmates received the same food as the rest of the prisoners. This consists of some beans or lentils half cooked, two eggs, five loaves of bread and some cheese or jam per prisoner. after March 1997, the prison hospital started to offer a special meal to sick prisoners. Each sick inmate started to receive four eggs and a quarter of chicken per week, but this applied only to those with TB. However, in the first days of Ramadan, some cases of food poisoning occurred and diarrhea spread among the prisoners due to the bad quality of the food. Reports add that the medicaments called Banzanil and Pharmalgin, in addition to specific medicines used for TB and diabetes, used to be given on a weekly basis to those afflicted with scabies in the segregation block. Since a long time now, the prison administration has stopped giving medicine to those in segregation. Segregated inmates receive the same clothes as the rest of the prisoners. They are given only one uniform so that, according to one of the inmates, they have to wash part of it and when it dries, they wash the other part. In addition, prisoners are not allowed to go out for recreation or to expose the blankets to the sun. Also, medicine from outside the prison is not allowed, although they have asked the doctor and the prison administration to be permitted to bring medicines from outside. Since the closure of the prison for visits, inmates have lost a source of proper food and medicine. Visits used to take place in inhuman circumstances and last for six minutes only, during which time prisoners were subjected to ill-treatment and insults. The prison administration used to allow one meal and one kind of fruit only per visit. The guards used to seize the rest of the food brought by the family. In early 1997, Mohammed Mohammed Shehata, detained since December 1995, was suffering from severe kidney pain. When the guard in charge was informed, he came with the male nurse, Atta, officer Shaaban Abbas and two policemen. They ordered the sick prisoner to get out of the cell. When he did, the officer beat him and ordered him to crawl in the corridor. Atta then injected him a pain killer and he was put for two weeks in the disciplinary cell. The same took place with detainee Mamdouh, who had renal problems and was seen walking out of the clinic in December 1997. The guards beat him severely claiming that if he could walk, he must be pretending to be sick and must be disciplined. The HRCAP was able to document 31 cases of prisoners afflicted with various diseases and who do not receive medical care. This is in addition to the negligence of the prison doctor and administration in providing medical supervision and proper food to sick prisoners. Below is a list of these 31 prisoners:
Wadi Al-Natroun I and II Prisons (2)
Wadi Al-Natroun I Prison Wadi Al-Natroun I is located on kilometer 92 of the Cairo-Alexandria desert road, about half a kilometer from the main road. Inmates in this prison suffer from various forms of ill-treatment, such as poor living conditions and lack of medical care. The number of the prison inmates has reached about 1,620, all political prisoners, distributed along three blocks and 54 cells. Nevertheless, there is only one doctor for all of them. The clinic It is open only once weekly, usually on Saturdays, sometimes twice. The guard collects one sick inmate from each cell, blindfolds them until they reach the clinic, located in the administrative building. During this procedure, they are beaten and ordered not to make any noise because they are close to the administration. The doctor examines the cases verbally and they have to maintain a distance of three meters from him. He prescribes them only pain killers. There are reportedly no rules governing the relationship between the doctor and the sick prisoners. It is left to the conscience and nature of the doctor. The detainees point out that until June 1997, Dr. Mamdouh Ful was the medical officer in Wadi Al-Natroun I Prison. He used to pass by the cells, examine the prisoners and refer the sick to the Tora Prison Hospital. In addition, he used to segregate those with TB or scabies in separate cells. He used to help sick prisoners to obtain the medicines that were not available at the prison pharmacy from their funds in the canteen, and received and examined the serious cases at any time. Since Dr. Mamdouh Ful was transferred and Dr. Ashraf Zaki took charge, sick prisoners rely only on the medicine brought to them by their families, although the prison administration does not always allow it. In his testimony, detainee A. said to the HRCAP:
Wadi-Al-Natroun II Prison Located on kilometre 97 of the Cairo-Alexandria dessert road, prisoners in Al-Wadi Al-Natroun II endure poor living conditions and lack of medical care. Many of them have contracted diabetes, TB, asthma, scabies and skin diseases. Each cell includes at least three sick prisoners. Testimonies received by the HRCaP from Wadi Al-Natroun II affirm that the prison doctor, Mostafa Fouda, always accuses the prisoners of pretending to be sick and orders the guards to beat them and take them back to their cells. In serious cases, he gives them four aspirins. Sick prisoners do not receive any additional food and are seldom allowed to go out for recreation. When they do, they are blindfolded and allowed only five minutes, during which they are insulted. In a flagrant example of the lack of medical care in Wadi-Al-Natroun II, in mid-October 1996 detainee Abdel-Nasser Sayid Hassan, aged 29, held in block one, suffered from a severe stomach ulcer. His cell mates asked for the doctor all night, but to no avail. He died on the same day. The same happened on 27 May 1996 when the condition of detainee Hassan El-Banna Abdalla Abu-Al-Dahab, from block two, deteriorated during the night. His mates kept calling the guard and the doctor but in vain. His condition deteriorated to the extent that he was finally taken to the Tora Prison Hospital, where he died. Some detainees report that once, before dawn, an inmate was suffering from severe pain. When the guard came, he said to them that there was no doctor available and ordered them to sleep. He took the number of the cell and in the morning the whole cell was beaten up. Following is a list of sick cases which the HRCaP was able to document: 1. Mohammed Ghalib Mohammed Mohammed Othman Resident of Suhag, detained since 14 October 1994. He suffers from troubles with the thyroid gland and needs surgery. He applied to the prison doctor and the prison administration to have the operation done at his own expense, but received no reply. 2. Mohey El-Din Emara Abdella Arrested on 14 December 1994. He suffers from scabies and does not receive any treatment. He reports that most of his mates in the cell have contracted scabies. 3. Al-Sayyid Mohammed Abdel-Sayyid Resident of Dakahlya, arrested on 19 May 1994. In 1990, he underwent heart surgery. His family visited him on 30 April 1997 and noticed a deterioration in his health. The HRCAP demanded that he be placed in a prison hospital, but received no reply. 4. Gamal Ali Hosni Resident of Beni Suef, arrested on 18 July 1996. He suffers from serious troubles in the back and shoulders in addition to a prickly sensation in the left hand. He asked to be referred to a specialized doctor or be taken to a prison hospital, but his application was rejected.
Leman Tora Prison Hospital (3) The Leman Tora Prison Hospital occupies a block within the Leman Tora Prison. It comprises two buildings: the first, a two-story building with two blocks for criminal prisoners. Between them is the office of the hospital director, where the files and records of sick prisoners are kept. There is one operating theater and another room for the doctors. The second floor contains two blocks for political prisoners. The second building has only one story and is assigned for those with TB. Information received by the HRCAP indicates that the current hospital director, Colonel Fathi Mohammed Ahmed Ahmed, uses one block only in each floor of the first building to receive both criminal and political prisoners. The block is about 25 x 9 x 8 m. The block has ten windows located opposite to each other, above the beds. Each window is about 3.75 square meters (2.5 x 1.5 m.). The block door is 1 x 2.2 m. and has an opening of about one hundred square centimeters. Each block has three toilets of 1 x 1.5 m., one of them with a shower. The toilets are very dirty and the water is cut most of the time. Lighting Before September 1997, blocks did not have any light. With occasion of a visit to the hospital by the ministers of health and interior, light was installed. While the light was being installed, sick prisoners were moved to the Istikbal Tora Prison Hospital. Block capacity Each block contains 25 beds. However, the number of sick prisoners exceeds this number, forcing some of them to sleep on the floor or to share the beds. The number of sick prisoners reaches sometimes 60, and may be as high as 120. In such cases the prison director transfers some of them to the prison even if they have not completed their treatment. The blocks are extremely dirty and rubbish is only removed every three or four days, when Captain Ayman orders it. The condition of sick inmates in the hospital Sick prisoners held in the hospital suffer from poor living conditions and lack of medical care. The doctor is absent most of the time and no one can substitute him, especially at crucial times. Testimonies reveal that before having any surgery, the condition of inmates is not properly investigated and they are not examined by X-rays. The hospital director, in addition, constantly tries to terrify sick inmates out of having an operation. Inmates’ testimonies add that under former hospital director, Dr. Colonel Mostafa El-Shahawi, some infractions were committed. He used to pressure sick prisoners to work as informers and fill ‘repentance forms’ in exchange for receiving treatment and medication. However, he used to allow sick prisoners to be transferred to Kasr El-Aini University hospital to continue their treatment and to have the necessary X-rays and examinations. He also agreed to allow some cases to be treated at their own expense and to permit those with psychological problems to remain in hospital until their cure. Reports indicate that since Col. Fathi took charge the situation has become worse. In January 1998, he transferred those with psychological disorders to their prisons before they had completed the treatment. He did not allow any prisoner to be examined outside or to have X-rays at Kasr El-Aini Hospital. He also sent back to their prison the cases of TB, therefore stopping their treatment, and refused to let prisoners buy medicine at their own expense. He used to pass by the hospital blocks to threaten sick prisoners with being sent to ‘closed’ prisons to be tortured. Food Food presented to sick prisoners in the Leman Tora Prison Hospital is as follows Daily: some beans, lentils and rice, three eggs and three loaves of bread. Weekly: A piece of cheese, twice a week (Mondays and Thursdays) Some stewed vegetables, three times a week (Saturdays, Tuesdays, and Thursdays) Some jam, four times a week (Saturdays, Sundays, Tuesdays, and Wednesdays) Reports reveal that the food during Col. Mostafa El-Shahawi, though bad, was considered good compared to that given under the new director, Col. Fathi. The quality of the food has worsened. Canteen The hospital has a canteen where sick prisoners can buy sugar, tea, tomato, tuna and salmon tins, cheese, oil, and soap. Detainees say that prices at the canteen are reasonable. Inmates can buy the articles they need with the money transferred to them by their families. The cafeteria The cafeteria provides cooked food such as fish, chicken, potatoes, and pasta. Orders are sent daily and are paid for with cards which range in value from PT 25 to LE 5. Visits The HRCAP received complaints from families of sick prisoners held in Tora Prison Hospital that the hospital administration refuses to let them visit their sick relatives on the claim that they have been transferred from prisons which are closed upon a decision by the Minister of the Interior. This practice prevents sick prisoners from seeing their relatives or receiving food and medicine. The HRCAP sent appeals to the Prisons Authority and the Minister of the Interior to allow visits by the prisoners’ families, particularly to those whose health is deteriorating. Those prisoners who receive visits complain that they are only given a small part of the food brought by their families, and that medicine is not allowed. The following are a list of names and some details of prisoners held at the Leman Tora Prison Hospital: 1. Mahmoud Mohammed Sayid Mohammed Resident of Minya, arrested on 13 September 1994. When he contracted TB, he was held for one year and a half in Leman Prison Hospital. His family last visited him on 11 February 1997, before he was transferred from Leman to Fayoum Prison. Following a worsening in his condition, he was taken back to the hospital and was not allowed to receive visits on the claim that he had been transferred from a closed prison. His family is still unable to see him in spite of a judicial decision issued on 15 July 1997 ordering that the Fayoum Prison be opened for visits. 2. Montaser Amin Mohammed Abdalla Resident of Assiut, arrested in 1992. He suffers from schizophrenia, delusions and convulsions, particularly after he was tortured by the security forces in Assiut and transferred to Abu-Zaabal Prison, where he spent five years during which he suffered more ill-treatment. 3. Shaaban Zaher Abdalla Resident of Assiut, arrested in 1994. He suffers from epilepsy and neurosis as a result of the torture he was subjected to when he was transferred between the prisons of Abu-Zaabal, Fayoum, and Wadi Al-Natroun, in addition to his being deprived of breaks or medication while in the prisons. He is a well-known case by the prison administration. He was recently transferred to Fayoum Prison, where his physical and mental health has deteriorated. He needs to go back to hospital to complete the treatment. Among the cases of paralysis who are held in Leman Tora Prison Hospital and need medical care and treatment are:
Paralyzed prisoners depend on the help of their sick mates to go to the toilet in spite of the existence of nurses and hospital attendants. Case studies 1. Osama Mohammed El-Toni, political prisoner Sentenced to 15 years in prison is connection with the case of the Imbaba riots. He suffers from partial paralysis as a result of a malignant trauma on the spinal cord. He needs urgent surgery. During the time of former director Mostafa El-Shahawi, the hospital administration allowed him to have X-rays at his own expense and a date was set for surgery two months later. However, four months have now elapsed and he has not had the surgery. 2. Ghareeb Ali Ahmed El-Kayal, criminal prisoner He received a 10-year imprisonment sentence in a drugs case, of which he has spent seven years and a half. He suffers from hemophilia and bleeds constantly, in addition to atrophy of the right arm and enlargement of the liver. After his deposit money at the prison was consumed, he applied to the President of the Republic, the Prime Minister, the Minister of the Interior, the Public Prosecutor, the Minister of Justice and the Minister of Health for medical aid. The Minister of Health replied, granting him LE 600 for medicine over a period of six months. However, due to bureaucratic complications, his treatment has stopped, causing his health to worsen. His only hope is that the competent authorities will consider releasing him on medical grounds in conformity with article 36 of Law 396 of 1956 on prisons. 3. Ali Sameer Ali Omar, criminal prisoner He received a six-year imprisonment sentence in connection with case 9248 of 1993/Al-Sayida criminal. His stomach ulcer causes him to bleed constantly. He has appealed to the prison administration to be transferred to Kasr El-Aini University Hospital in order to have an operation. He is in strong pain and his condition is deteriorating. Other documented cases inside hospital:
On 3 February 1998, the HRCAP sent requests to the Public Prosecutor, the Minister of the Interior and the Head of Prisons Authority to provide medical care for these sick prisoners, but so far it has received no information indicating any improvement in the conditions of prison hospitals. Al-Wadi Al-Gadid Prison (4) Al-Wadi Al-Gadid was opened on 5 February 1995. It is located in the town of Al-Kharga, Al-Wadi Al-Gadid governorate, 630 km far from Cairo. The prison has 216 cells distributed along 12 blocks, 11 of which are for political detainees and one for criminal prisoners. Each block has 18 cells in the shape of the letter H. Cells have an area of 24 square meters (4 x 6 m.) and 4 meters height, and contain an open toilet of one square meter. They have five windows that measure 60 x 40 cm., located three meters above the floor. The windows overlook internal shafts that contain the drainage pipes, therefore they do not allow sunlight or fresh air inside the cells. Each cell hosts between 20 to 25 inmates. Since the opening of the prison, inmates suffer variously from poor medical conditions. Diseases such as scabies, various allergies, TB, and liver diseases have spread as a result of contaminated water, lack of personal hygiene and medical care, and poor living conditions. Reports received by the HRCAP indicate that prisoners have not been allowed to go out for recreation for almost one year. Although medical care has improved, it is still insufficient. Doctor visits used to be rare, which caused several cases of death. To prevent that, the doctor now passes by the cells when inmates call him for emergencies and in serious cases. Reports indicate that the doctor sees the prisoners placed in the disciplinary cells and sometimes interferes to prevent the torture of prisoners with poor health. Although article 6 of the code of ethics of the medical profession affirms that doctors shall not produce false reports or testimonies, and although article 35 of the prisons regulations states that the doctor must write a report on a prisoner’s injury, information received by the HRCAP reveals that the doctors of Al-Wadi Al-Gadid Prison violate these provisions. In his testimony to the Center, Al-Sayid Ahmed Al-Sayid said: When I arrived to the prison, they took me, together with other detainees, entirely naked, to a cell where we remained for days without clothes or mattresses. We stood there from morning to evening; we were beaten and ordered to crawl on the floor, which caused the death of some prisoners. Also, when a prisoner dies, the guards take two inmates, blindfold them and force them to sign a document stating that the death was due to natural causes and not the result of beating or torture. No doctor writes otherwise and mentions that the death was caused by torture. Inmates at this prison also complaint about the unavailability of medicine at the prison and their being prevented from having medicine brought by their families. Al-Wadi Al-Gadid Prison Hospital Located in a separate block within the prison, it consists of two floors, the first used as an additional disciplinary block and the second as a hospital. Sick inmates suffer from lack of medical care and the negligence of doctors and nurses, in addition to the unavailability of medical equipment necessary to carry out X-rays, examinations and surgery. Other complaints include bad quality of the food, shortage of medicine, and the refusal of the prison administration to allow prisoners to bring medicine at their own expense or to obtain it through their families. Below is a list of documented cases of sick inmates in Al-Wadi Al-Gadid Prison who applied to the administration to be referred to a specialized hospital to obtain the necessary medication or to undergo surgery. Their applications were neglected. In addition, the HRCAP sent requests to the Public Prosecutor, the Minister of the Interior and the Head of the Prisons Authority to provide them with medical care: 1. Yasser Mohammed Younis Ali Resident of Cairo, arrested on 4 July 1992. He suffers from TB, piles and constant bleeding. The prison administration refused to allow him to receive medicine. 2. Yasser Abdel-Basit Abdel-Sadik Zahran Resident of Cairo. Arrested on 19 November 1992. He needs medication as he suffers from renal colic, but the prison administration refuses to allow him to have medicine brought from outside the prison. 3. Abdalla Ahmed Farghali Abdel-Tawab Resident of Fayoum. Arrested on 19 September 1993. He suffers from TB and needs to be transferred immediately to a specialized hospital. 4. Badawi Abdel-Raouf Mohammed Ma’touk Resident of Fayoum. Arrested on 2 January 1997. He had a heart condition before his arrest and his health has deteriorated after his detention. He has contracted TB and needs specialized care. 5. Al-Sayid Mohammed Al-Garhi Khalifa Resident of Fayoum. Arrested on 8 April 1992. He suffers from a sliding disc and is not allowed to receive any medicine. 6. Mohammed Mahmoud Ali Abu-Ghoneima Resident of Cairo, arrested on 5 March 1991. His health has deteriorated and he is unable to speak. During a visit, his wife found him on a wheelchair and when she tried to know the reason for his sickness, she was sent away by the prison administration. 7. Ramadan Ali Mohammed Hassan Salim Resident of Beni Suef. Arrested on 29 July 1992. He has a heart disease, in addition to the polio from which he has suffered since childhood. 8. Alaa Mohammed Abdel-Hameed Hussein Resident of Minya. Arrested in January 1995. He contracted TB and chest allergy. The prison administration refused to allow him any medicine.
9. Salah Sayid Abdel-Ghani Resident of Minya. Arrested on 15 December 1994. He suffers from a sliding disc and pain in his right foot and needs an urgent operation. 10. Ihab Othman Al-Sehrawi Resident of Dakahleya. Arrested in 1995. During a visit by his father, he was brought on a stretcher. He asked his father to bring him medication for his stomach ulcer and a supporting neck for the neck vertebra. 11. Roubi Mohammed Roubi Resident of Fayoum. Arrested on 25 February 1992. He suffers from scabies and needs medicine which the prison administration does not provide. 12 Ahmed Abdalla Ahmed Abdel-Warith Resident of Ismaelya. Arrested on 29 August 1993. He contracted TB and scabies. The prison administration does not allow him to receive medicine from outside the prison. 13. Nabeel Fathi Shamroul Aged 32, resident of Cairo, diabetic. 14. Emad Mohammed Ali Al-Asseili Aged 23, resident of Cairo, suffers from rheumatism. 15. Alaa Mohammed Seddeek Aged 34, resident of Suhag, suffers from high blood pressure. 16. Osama Ahmed Abdel-Fekki Aged 27, resident of Giza, diabetic. 17. Abdel-Samee Kareem Aldin Aged 34, resident of Cairo, suffers from problems of the urinary system. 18. Alaa Aldin Mohammed Saber Aged 27, resident of Minya, suffers from problems of the urinary system. 19. Mahmoud Ateta Abdel-Naeem Aged 25, resident of Qena, suffers from chest allergy. 20. Omar Mohammed Mahmoud Aged 24, resident of Cairo, epileptic. 21. Gamal Ahmed Mohammed Aged 26, resident of Minya, suffers from renal problems. 22. Ghareeb Mohammed Hassan Aged 27, resident of Qena, epileptic.
23. Adel Mohammed Awad Aged 28, resident of Cairo, epileptic. 24. Kamil Abdel-Wahab Ali Aged 60, resident of Suhag, diabetic. 25. Abdel-Nasser Nouh Aged 35, resident of Suhag, suffers form enlargement of the liver. 26. Osama Al-Bori Khalilfa Aged 26, resident of Assiut, suffers from chest allergy. In addition, the HRCAP monitored 146 cases of TB, which spreads in the prison as a result of overcrowded cells, not segregating afflicted prisoners, and not providing them with the necessary medication. These cases are illustrated in the table below:
Although, TB cases in Al-Wadi Al-Gadid Prison have reached five hundred and those affected have been segregated in two blocks, the prison doctor does not see them daily as stipulated in article 26 of Ministerial Decree 79 of 1961, which states that the prison doctor must supervise sick prisoners daily. This adds to the unavailability of medicine and the lack of adequate food. Moreover, the HRCAP was able to obtain information on cases of death that took place in Al-Wadi Al-Gadid Prison as a result of administrative negligence and the failure of the doctors to provide the necessary medication. These cases are as follows:
Case study The HRCAP was able to obtain a medical document from the Medical Department of the Prisons Authority that reveals that Al-Wadi Al-Gadid’s prison doctor, Mostafa Al-Shahawi, committed a fatal negligence. Although article 28 of the Minister of the Interior’s Decree 79 of 1961 states that it is among the responsibilities of the prison doctor to record the data related to the medical condition of prisoners to avoid any error, the death of detainee Mohammed Ahmed Mohammed Al-Robi, aged 34 and a peddler living in Fayoum and arrested on 23 March 1992, proved otherwise. Said detainee was transferred between the prisons of Tora and Al-Wadi Al-Gadid. On 27 January 1997 and following a serious deterioration in his health, he was placed in Al-Wadi Al-Gadid Prison. He was suffering from neurosis, uncontrolled urination, paralysis of the left leg and acute anemia. Detainees’ testimonies affirm the responsibility of the administration and the prison doctor for the deterioration of his health, which caused him to die in hospital after having been left for many days without any medical supervision. The negligence of the prison doctor continued even after his death. He, deliberately or not, wrote down on the death certificate the name of the deceased as Mohammed Ali Al-Robi, the name of another detainee in the prison. The family of the latter were forced to receive the body and bury it despite their claims that it was not that of their son. On 5 May 1997, the family of Mohammed Ahmed Mohammed Al-Robi went to visit him in prison. They were told that he had died on 20 February 1997 and that he had been mistakenly buried in the village of Sonouris, Fayoum, under the name of Mohammed Ali Al-Robi. They tried to obtain a death certificate, but the health office refused to give them one on the grounds that the deceased name was Mohammed Ali Al-Robi. On 26 May 1997, the HRCAP brought an urgent lawsuit against the President of the Republic, the Public Prosecutor, the Minister of the Interior, and the Chief of Al-Wadi Al-Gadid Prison. The Center demanded an urgent examination of the body of Mohammed Ahmed Al-Robi by a medical committee made of professors of the anatomy departments of the faculties of medicine of Cairo University, Ein Shams and Al-Azhar to identify the cause of death and whether or not there had been criminal negligence. It also demanded that the family of the deceased be allowed to receive the body. The case is still being heard by the court. On 29 May 1997, the family of the deceased was able to obtain a document from Al-Kharga Prosecution Department stating that the document issued by Al-Wadi Al-Gadid Prison contained a mistake. In August 1997, they obtained a death certificate by the name of Mohammed Al-Robi.
Damanhour Prison (5) Living conditions in Damanhour Prison do not differ from those existing at the above mentioned prisons. Inmates suffer from deteriorating living conditions, lack of medical care and medicine, insufficiency of food. In addition, they are not allowed to receive the food and medicine brought by the families during visits. The prison inmates complain that the prison doctor visits them only once a week, on Thursdays. He examines the sick prisoners verbally only and prescribes them some analgesics. In addition, those sick with contagious diseases are not segregated. Damanhour Prison Hospital The Damanhour Prison Hospital is one of the best prison hospitals and contains the most modern medical equipment. The hospital is located inside the prison, on the ground floor. It includes two blocks: one for political prisoners and another for criminal prisoners. There are, in addition, four rooms: the director’s office, a doctors’ room, an operating theatre, and a storage room where bedcovers are kept. The block has a surface of about 120 square meters (15 x 8 meters) and its height is 3.5 meters. Of its 18 beds, only nine are ready to receive patients. The rest are not furnished in spite of the availability of covers. The hospital has three squat toilets, three bathrooms and a shower. There is also a wheelchair for those inmates who are paralyzed. The hospital management consists of:
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