Prison Healthcare IssueN 3 Autumnews 2002 PrisonPrisonPrison Healthcare HealthcareHealthcare News Newsletter of the project to promote better and in Eastern Europe and Central Asia News

Editorial NEW DEVELOPMENTS Expert meeting of the Council of Baltic Sea States WELCOME to the third makes radical recommendations issue of Prison Healthcare News. Since the Twelve countries were Prevention of ᭤ That the level of newsletter was launched represented at the Communicable in in the Spring of 2002 its Second Diseases. Prison and prison should be no readership has grown to Interdisciplinary public health experts higher than that in over one thousand comparative groups individuals and Expert Meeting on attended and institutions in forty-five Prevention and discussed a range of in civil society countries. Our aim is to Control of new developments in ᭤ That the diagnosis, strengthen the links Tuberculosis Among the Baltic States and treatment and cure between prison which was in Russia. The meeting rate of tuberculosis healthcare and public health services. These held in St Petersburg ended with a decision in prison should be links are important for between 25 and 27 to make three equal to that in civil many reasons. Infectious November and recommendations to society disease control depends organised by the the heads of ᭤ That no cases of HIV on continuity of treatment Council of Baltic Sea government of the between and the transmission should world outside. Prisoners States Task Force on Baltic Sea States: occur in prison. are citizens even when in prison and they are entitled to the same Prison health budget moves to Health Ministry standard of as those outside prison. The budget for prison National Health Service. Prison Service and the Overcrowded unsanitary health care in England The amount of money National Health Service prisons are a health threat and Wales will move spent on prison health to make the transition and the voices of those from the Home Office care will also increase. easier. For the past two whose main concern is public health should be (the Ministry of the The reason for the years the standards and heard when policies about Interior) to the Ministry change is to improve policies of the prison are being of Health in April 2003. health services for health care service have discussed. The move is the first prisoners and to ensure been brought more in Most subscribers to the step of a five-year that there is continuity of line with the standards newsletter come from the process. At the end of care for everyone of the National Health world of prisons. We would like to have more the five years prison including prisoners. Service and the process readers from the public health services will be Training will be provided will continue. health sector. So please fully integrated into the for staff in both the pass your copy of the newsletter on to your colleagues working in public health and ask Contents them if they want to subscribe. We shall be pages 2-3 page 6-7 very glad to add their The PHN Interview Highlights from CPT reports – names to our list. Dr Dumitru Laticevschi Greece, Georgia, Belgium from Moldova page 7 Vivien Stern, News in Brief Announcement Editor University of London pages 4-6 page 8 International Centre for Anton Shelupanov, Developments in Recent Publications Prison Studies Assistant Editor Central Asia Our readers write... Pri2 son HeaNewsletter ofl thet projecth to promotecare better prison and public health inN Eastern Europeews and Central Asia The PHN Interview PHN interviews Dr Dumitru Laticevschi from Moldova, Director of a medical non- governmental organisation called Medical Reforms in the Penitentiary System.

Please tell us a bit about your background – where represent a distilled accumulation of the most Q you studied, and trained and what your specialism is? excluded individuals, who outside the prison walls I graduated from the Medical University in Chisinau, have difficulties in accessing health services, and who the capital of Moldova, where I specialised in . carry a heavy burden of morbidity with “social I am still working part-time as a surgeon in a hospital diseases”. Because prison finds itself holding and in Chisinau. serving these segments of the population, the Prison Health Services could be an opportunity to improve How did you become involved with providing the state of public health. Unfortunately, they are often Q healthcare for prisoners? in no position to do anything so positive. After my specialised studies were finished I worked as a surgeon at the Central Prison Hospital. This is when Do you feel that a higher level of co-operation I first encountered the world of non-governmental Q between civilian and prison healthcare systems is organisations (NGOs) who were dealing with prison important? health. Then I became involved and contributed to an Clearly, yes. There should be uniform standards for assessment of the prison health situation in Moldova treatment and care, and there should be continuity of made by the Caritas Luxembourg Foundation. After treatment between prisons and the general health that I became a founder member of the organisation care. But the relationship should be one of co- “Medical Reforms in the Penitentiary System.” And it operation, not subordination of one to the other. developed from there. You talked earlier about the epidemics of TB, HIV In your opinion, what are the most serious prison Q and STDs. Obviously there is a link with measures Q health issues in the region? the prisons can take to reduce the likelihood of The health of a person depends enormously on the transmission. How successful have such harm-reduction environment in which he or she lives. Most prisons in programmes been in the Moldovan prison system? the region are badly designed, unnecessarily For a dreaming optimist – not spectacular. For a overcrowded, poorly maintained and barely supplied sceptic – unbelievable. Currently there are two prisons with essential nutritional food and pharmaceuticals. where needle exchange is done to minimise the risk of The health policies are often outdated. The epidemics intravenous transmission of HIV by injecting drug- of TB, HIV, and sexually transmitted diseases (STDs) users. Education campaigns, distribution of condoms, are the litmus paper, which despite nice words, bleach and educational materials are done in all intentions and efforts reveal the critical situation in institutions. As a result of these campaigns and prison health. availability of harm reduction materials we have achieved a measurable decrease of risky attitudes and What is the first step that needs to be taken to begin behaviour. Prisoners understand what makes them Q resolving them? vulnerable to disease and HIV is much less Accepting the need for change is the first step. In its stigmatised than before. existing form, the system fails to fulfil its objectives. What can be done to increase the effectiveness of How, in your opinion, do these issues relate to Q harm reduction measures? Q public health? I‘ve heard a saying that it is much safer for They relate directly to public health. Prisons do not him to have an intravenous shot, than to smoke represent a cross-section of society. Rather they “grass” or drink alcohol: because there is no smell and PrNewsletterison of the project to promote betterH prison andea public health in lEasternt Europeh andcare Central Asia News3

less risk of being caught. I think that a system is imperfect if it makes the risk of getting HIV (or ) through an injection a “safer” choice. News in Brief Legal medical use of drugs and alcohol would News in brief certainly save lives. I am a dreamer, but I remember From Lithuania the words of my colleague Karlhenz Keppler – a prison Associated Press reported an outbreak of HIV at doctor from Vechta (Northern Germany), who used to NewsLithuania’s Alytus prison, wherein 263 prisonersbrief were found say, “It is not a problem. Dreams just need travel News in brief to be infected. Before the outbreak, Lithuania had only plans”. 300 registered cases, the lowest rate in Europe. Prisoners have said that the virus was spread though the shared In your view, how seriously is the issue of mental Newsuse of an infected syringe, in after a “safe” brief one was Q health being taken within prison healthcare? confiscated from the prisoners by the authorities. I think that the mental diseases are massively under- Source: Associated Press, 22 August 2002. diagnosed. And they are not given enough attention. Unless they are severely ill, these mentally ill patients NewsDevelopments in Russiain brief suffer quietly. It is not the fault of the doctors. Mental Speaking to a Council of Europe conference in health is not a major part of their training and practice. Strasbourg on 6 November 2002, Russian Deputy Justice Minister Yuri Kalinin outlined health problems in Russia’s How do you see the role of NGOs in prison Newsprisons. He reported that outin of the 905,000brief people being Q healthcare? Is their involvement important? held in places of in Russia 405,000 of them are currently suffering from some form of disease. More than Because of their independent position, NGOs can 90,000 have the active form of tuberculosis; 102,000 are raise sensitive issues, confront problems and they can drug addicts; 72,000 suffer from chronic alcoholism and be a catalyst for change. They can attract funds and News in brief 236,000 suffer some form of mental disorder. expertise for the needs of prison healthcare, which Mr. Kalinin also noted improvements to prison would otherwise be unavailable. What they can not conditions. The number of prisoners being held had been (and should not) attempt to do is to take over the role reduced by 200,000. Overcrowding in pre-trial prisons Newshad therefore been reduced in by 50 perbrief cent. There were of the prison health services. A lot can be achieved through mutually reinforcing co-operation. 132,000 prisoners for a capacity of 114,000 and the amount of space allotted to each prisoner had increased The purpose of this project is to improve the Newsfrom 2.5 to 4 square metres. in brief Q structures of public and prison health care Source: Council of Europe. world-wide, with a particular focus on Eastern Europe and Central Asia. What are your wishes for HIV in US prisons the project? NewsThe latest published figures in from the briefUnited States So much can be done in this area, where relationships indicate that the percentage of prisoners infected with have still to be built! Good luck! HIV is falling. In 1995 2.3 per cent of all prisoners were infected. In 2000 the proportion was 2 per cent. Most of Newsthese are held in State prisons in with abrief small number in Federal prisons. The proportions are higher for women. The non-governmental organisation, Medical 3.6 per cent of women in State prisons were HIV positive compared with 2.2 per cent of men. In the District of Reforms in the Penitentiary System, was created in NewsColumbia 41 per cent of womenin prisoners brief were HIV 1997 as an attempt to deal with the unsatisfactory positive and in New York 18.2 per cent fell into that category. New York State held in its prisons nearly a state of affairs in the prison health system. Three- quarter of all the 25,000 infected prisoners. Florida and fifths of its founder members were prison doctors. NewsTexas held around 10 per centin each ofbrief the infected prisoners. The initial idea was to offer state of the art The overall rate of HIV infected people in prison (0.52 knowledge to prison doctors, but soon it evolved into per cent), is about four times the rate in the US general Newspopulation (0.13 per cent). in brief formulating projects aiming at reforming the prison The AIDS-related rate has fallen significantly in recent health care system. See Newsletter no 2 page 5 for years. In 1995 there were 1,010 AIDS-related deaths. In 2000 there were 174. more information on its work. NewsSource: US Bureau of Justice Statistics,in HIVbrief in Prisons 2000. Pri4 son HeaNewsletter ofl thet projecth to promotecare better prison and public health inN Eastern Europeews and Central Asia

FOCUS onLinking Central Prison Asia and Public Health

The seminar was organised by Penal Reform New developments in International and the Soros Foundation of Tajikistan as part of the project to improve prison healthcare in Tajikistan Eastern Europe and Central Asia. The organisers The first ever seminar on the links between prison and reported that the seminar was successful in: public health was held in Dushanbe on 13 and 14 ᭤ Opening up the Prison Health Service towards the August. The seminar was entitled ‘International general public, the Ministry of Health and non- standards for health care provision to prisoners’. Both governmental organisations; prison doctors and prison directors from all over ᭤ Starting a discussion on the sensitive issues of Tajikistan were represented at the conference. Also HIV/AIDS transmission in prison, drug use and represented were the Presidential Administration, legal harm reduction; advisers of the Presidential Administration, the ᭤ Drafting a new plan for future co-operation Ministry of Interior, the Ministry of Health and non- between the Prison Health Service and the governmental organisations. Ministry of Health; Tajikistan faces many of the problems found ᭤ elsewhere in the Central Asian region, with Producing a broadly agreed set of overcrowded and under-resourced prisons, health recommendations incorporating input from all care under pressure and isolated from the public participants from all the sectors: Prison Health, health service, and an upsurge in drug addiction and Ministry of Health, Ministry of Interior, the infectious diseases, especially HIV. However, prison Presidential Administration and non-governmental reform is under discussion and a decision has been organisations, which will be fed into the reform taken to transfer the management of prisons from the process. Ministry of the Interior to the Ministry of Justice. Recommendations The seminar The key recommendations were: The specific objectives of the seminar were to: ᭤ A uniform standard should be established for ᭤ Introduce the participants to the international collection and analysis of public health data standards on human rights and medical care in covering prison and civilian healthcare; prisons; ᭤ The Ministry of Health should provide technical, ᭤ Share the positive experience of other ex-Soviet consultative, diagnostic and treatment assistance countries in reforming the penitentiary health to the prison health system; services; ᭤ Prison health workers should have access to the ᭤ Introduce successful examples from other postgraduate training scheme of the Ministry of countries of co-operation between prison health, Health; civilian health services and non-governmental ᭤ The Ministry of Health should assist with central organisations. procurement of medical equipment and high Three working groups looked at the possibilities of co- quality drugs for the prison health service; operation between the prison and civilian healthcare ᭤ A legal framework should be drafted governing sectors and produced practical recommendations. the co-operation between the Ministry of Health The experience of Kazakhstan in bringing together and the Prison Health Service. prison and public heath services, particularly in the treatment and prevention of TB , was presented to the seminar. The involvement of non- governmental organisations in the provision of health Follow-up study tour to care in the prisons of Moldova was also presented. The model of harm reduction programmes in the Kazakhstan prisons of Moldova, with such measures as the As a follow-up to the seminar a seven-day study tour provision of clean needles, as well as bleach and to Eastern Kazakhstan was organised for Tajik condoms, was also discussed. representatives in October 2002. Representatives PrNewsletterison of the project to promote betterH prison andea public health in lEasternt Europeh andcare Central Asia News5

from Kyrgyzstan and Uzbekistan also participated. Each country delegation was made up of officials from both prison health and public health. East Kazakhstan was chosen because of the wide range of prison establishments it contains and the progress it has made in prison reform. The Head of the Medical Department of the Penitentiary System of Kazakhstan, Dr Marat Akhmetov, led the tour along with representatives of Penal Reform International. In the East Kazakhstan oblast there are 13 penitentiary institutions holding 12,000 prisoners. It is the only region in Kazakhstan that has every type of From left to right: Marat Akhmetov (Head of the Health Care Department of institution connected to prison health, including a the Penitentiary Administration of the Ministry of Justice of Kazakhstan), central prison hospital, a TB colony, juvenile, female Raushan Abdildaeva (Deputy Head of the Central Prison Hospital, Ministry of and male colonies of different regimes and settlement Justice Kyrgyzstan), Norboba Rakhimov (Deputy Head of the Prison colonies where some prisoners serve the final part of Administration of the Ministry of the Interior of Uzbekistan, responsible for their sentences. pre-trial detention centres), Makhmud Mazhidov (Head of the Medical Unit of the Central Prison Administration of the Ministry of Justice of Tajikistan) Medical reforms a priority and Gulnara Kaliakbarova (Healthcare Issues Consultant for the Prison healthcare project in Central Asia, Penal Reform International, Almaty) East Kazakhstan is also a region where medical reforms have been a priority of the administration and Feedback on the study tour there is good co-operation between the Ministry of Health and Ministry of Interior, and now Ministry of Aspects of the study tour that the participants found Justice. The civilian TB dispensaries give assistance particularly striking were the to the prison system on TB issues on the lines set by ᭤ openness of the Kazakhstan penitentiary system; a joint agreement on co-operation between the ᭤ co-operation between prison and healthcare Ministry of Healthcare and the Ministry of Justice. systems (especially on TB issues); Prisoners in the use the civilian TB ᭤ activity of reforming the delivery of healthcare dispensaries. There is also a positive experience of provision to prisoners; co-operation between the prison system and NGOs in ᭤ development of the DOTS strategy in penitentiary East Kazakhstan, including a medical monitoring institutions; initiative with one NGO. Due to the combined efforts ᭤ of the prison and civil healthcare systems the quality of the relationships between prison staff morbidity rate of TB has decreased from 3,434 in and prisoners; 1999 to 2,908 in 2001; the mortality rate has ᭤ level of governmental support of prevention and decreased from 345 in 1999 to 174 in 2001. treatment of TB among prisoners. The aspects which participants felt would be most Prison reform also a priority useful to them in their home countries were: ᭤ Lessons about the organization of healthcare Prison reform is also a feature of the East Kazakhstan provision of prisoners; region. Prison conditions have improved. ᭤ Relationships between staff and prisoners are better. The way co-operation has been developed There is a sound legal basis for closer co-operation between prison and civil healthcare systems; between the prison and civilian health services. Also in ᭤ The improvement in the living conditions of the region is an HIV/AIDS prevention programme that prisoners; includes providing information to prisoners, ᭤ The legislative materials and joint orders between psychological and individual support and training in the Ministries of Justice Interior and Health changing behaviour. The programme is based on regulating the legal basis of healthcare provision close co-operation with the HIV/AIDS Republican for prisoners; Centre. ᭤ The level of co-operation between penitentiary The region has also created a new complaints system and NGOs. system for prisoners and there is co-operation with municipal bodies for the development of small farms Thanks to Gulnara Kaliakbarova and Leonora Lowe of Penal to aid the provision of food to prisoners. Reform International for providing reports on these developments. Pri6 son HeaNewsletter ofl thet projecth to promotecare better prison and public health inN Eastern Europeews and Central Asia HIV and drug abuse HIV infection increases prevention in the prisons in Tajikistan of Turkmenistan Speaking at a conference in Dushanbe in October, Galina Karmanova, Programme Officer in Turkmenistan for UNAIDS, described a programme of prevention of HIV/AIDS and drug abuse in the prisons of Turkmenistan. Kyrgyzstan Turkmenistan has the lowest prevalence of HIV/ AIDS of all five Central Asian states, with one HIV and one AIDS case reported. However, the facts about infection amongst intravenous drug-users is not yet known. For the past two years prevention activity has been carried out in the prison, jail and detention centre in Akhal province by ‘Force for Change, a non- govermental organisation. In the women’s prison a youth group has been doing similar work. The The number of people registered as infected with programme has also covered a juvenile prison in Mary HIV has increased ten-fold in the last 18 months. province and a centre for children in According to official figures, in 2000 there were only Ashgabat. seven cases of HIV and one of AIDS in Tajikistan. The activities include raising awareness about HIV Now 75 cases are officially registered. The cases infection and drug abuse, and the provision of are mostly of young people who were diagnosed condoms, bleach and disposable syringes to the after being tested in prison. This number, according medical departments in the prisons as a harm to Zukhra Khalimova of the Soros Foundation in reduction strategy. There have also been study visits Tajikistan, could just be the tip of the iceberg and to Bulgaria, Lithuania and Kazakhstan. the real figure may be nearer 2,000. Plans are underway to expand the programme to Dashoguz province and two prisons in Lebap Source: Eurasianet 29 October 2002. province.

Highlights from reports of the European Committee for the Prevention of Torture and Inhuman and Degrading Treatment or (CPT)

The only region of the world with a supra-national but to give an insight into what standards the CPT inspection mechanism for its places of detention is expects and what role it expects prison healthcare Europe. The European Committee for the staff to fulfil. Prevention of Torture and Inhuman and Degrading Treatment or Punishment (CPT) is the only inspection mechanism of places of detention that Visit to Greece allows citizens of a state to inspect the institutions In November 2002 the Council of Europe published of another state and report their findings. From the report of the visit to Greece which was carried out time to time, Prison Healthcare News will be in 2000. The CPT welcomes the introduction of a new bringing to the attention of our readers comments Prison Law which sets out the general principle that made by the CPT on prison health in the countries care in prison should be at the same level as care in they inspect. We shall be doing this not to the outside community. The transfer of responsibility highlight the shortcomings of the countries visited for prison health care from the Ministry of Justice to PrNewsletterison of the project to promote betterH prison andea public health in lEasternt Europeh andcare Central Asia News7

the Ministry of Health was being considered and the health care in prisons based on the principles of: CPT expressed its support for such a move. ᭤ equal care between the prison and the The CPT looked at the arrangements for screening community; on reception into prison in the prisons visited and ᭤ the consent of the patient to treatment; noted that medical screening on arrival is of the ᭤ the confidentiality of medical records; utmost importance. In the Greek prisons visited there ᭤ were delays before the screening was carried out, the professional independence of medical staff. sometimes as long as a week. This, the Committee Report to the Georgian Government on the visit to Georgia carried out noted, was not at all satisfactory. New arrivals should by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 6-18 May 2000, be screened on the day of arrival or at the very latest Strasbourg, 25 July 2002. on the following day. The CPT was also not satisfied with the practices on medical confidentiality. In one prison, a prison staff Visit to Belgium member acting as a nurse and the prisoners assisting The CPT visited Belgium at the end of 2001 and the him had access to medical records. At another, report was published in October 2002. The delegation medical information was given by nurses to prison was not satisfied with practices it found at the prison staff. Neither of these practices was acceptable, nor in Andenne. The principle of medical confidentiality were they in accordance with the new Prison Law. was not respected because all consultations with HIV-positive prisoners were still being segregated in medical personnel took place in the presence of a a prison hospital in spite of recommendations made member of the prison staff. The CPT recommended by the CPT on earlier visits that the practice of that measures be taken to ensure that medical segregation has no medical justification and should consultations take place out of the hearing of prison cease. In addition, although there were many drug- staff and, unless the doctor specifically requests it, out users continuing to take illicit drugs in prison, there of the sight of prison personnel. was no prevention and treatment policy about drug The delegation was also dissatisfied with the use at all. No advice was provided on the risk of HIV practice of prison doctors undertaking activities that or hepatitis being contracted as a result of needle- were incompatible with their function of caring for sharing and there were no programmes to help patients. The two doctors at the prison were also prisoners withdrawing from drugs. undertaking urine analysis to detect drug use at the Report to the Government of Greece on the visit to Greece carried out request of the Prison Director or a judge. In the CPT’s by the European Committee for the Prevention of Torture and Inhuman opinion, carrying out such tasks is incompatible with or Degrading Treatment or Punishment (CPT) from 23 September to professional ethics and puts at risk the relationship 5 October 2001, Strasbourg, 20 November 2002. between the patient and the doctor. Report to the Belgian Government on the visit to Belgium carried out Visit to Georgia by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 25 November to The CPT visited Georgia in May 2001 and published 7 December 2001, Strasbourg, 17 October 2002. the report in July 2002. The delegation described the living conditions in Prisons Number 1 and 5 as very poor and recommended that the slatted metal blinds AnnouncementsConference / Call for papers covering the windows be removed to allow the entrance of light and air. Human Rights, Human Wrongs, Human The CPT noted that health care in the Georgian AnnouncementsCosts: Health of prisoners and detainees in prison system is the responsibility of the Ministry of Australia in the 21st Century Justice health care department and is provided independently of the prison department. There were AnnouncementsDate 2 – 3 April 2003 few links between the Ministry of Justice health care Venue Mercure Hotel, Brisbane department and the Ministry of Labour, health-care More information http://www.pha.org.au/ and Social protection. It was very difficult to transfer Announcementsconferences/frame_conferences.htm prisoners to public hospitals. It was also clear to the delegation that the principle that prisoners should Telephone (02) 6285 2373 receive the same standard of care as provided in AnnouncementsAddress PHAA, PO Box 319, CURTIN, ACT 2605 outside society was not observed in Georgia. The CPT recommended that the Georgian Email [email protected] authorities should draw up a comprehensive policy in Announcements Pri8 son HeaNewsletter ofl thet projecth to promotecare better prison and public health inN Eastern Europeews and Central Asia

Protect Yourself Recent publications (available in Russian) Two pocket-sized books for male and female prisoners, Health Information and Education Magazine endorsed by the Russian Ministry of Justice, have been (available in Russian and English) published by Médecins Sans Frontières and the AIDS This publication is published by the St Petersburg Public Foundation East West. Both publications give concise Fund for the prevention of tuberculosis, AIDS, alcoholism practical advice on how to protect one’s health when and drug addiction and the Uolaf Palme Centre in Sweden. incarcerated. Advice covers such aspects as dental care, The magazine contains a number of articles with useful personal , skin diseases, sexually transmitted health information and statistics, as well as features, diseases and other infectious diseases such as HIV and TB. campaigns, historical notes and publication reviews. It The two brochures also carry information specific to male features a competition of children’s pictures about the harm and female health. which drugs do. For copies, contact: AIDS Foundation East West (AFEW), 15/5, For copies, contact: St Petersburg Public Fund for the prevention of Chayanova Street, Moscow, 125267, RUSSIA. Telephone: +7 095 tuberculosis, AIDS, alcoholism and drug addiction, Russia 93013, 2506377. Facsimile +7 095 2506387 or email [email protected] or see St Petersburg, PO Box 271 or email [email protected] www.afew.org

request assistance from Contact: Mr Stanislav I. Zhadan, Governor of SIZO 1, (815-55) Our readers write … anyone who may be in a 724-34, ul. Trudovaya, 24-A, position to grant it. Apatity-9, Russia, 184209. Nigar Filiyeva from the From Murmansk. Several days ago the x- Guennadi Tcherniavski, Chair, Independent Research We congratulate you upon ray equipment in SIZO 1 in Russian section of the and Practical Legal the realisation of a Apatity (Murmansk Region) International Association for Center (IRPLC) in Baku, necessary project. We Human Rights for the Murmansk ceased functioning. The region. Telephone / Facsimile Azerbaijan. hope for interaction and equipment is 25 years old. (815-55) 7688-26, POB 242, We have received one issue the publication of It is repaired on a daily Apatity-9, Murmansk region, of your health journal on materials that do not only RUSSIA, 184209. Email: basis by engineers from [email protected] prison and distributed it highlight the problems but KOLENERGO. The amongst the specialists on also promote the governor of the SIZO this issue. They have solutions. All non- cannot acquire a new piece greeted this initiative by you governmental of equipment and so far and also they got organisations in the no-one has been able to Sir John Crofton, retired acquainted with your Murmansk region have help him. Professor of Respiratory project. We consider this now had the opportunity In the history of charitable Diseases and project very beneficial and to read Prison Healthcare work there are many Tuberculosis, University of important, especially for the News, and we intend to examples of selfless Edinburgh. soviet type prison system highlight the issues raised assistance and we have no I do think your new journal that governments are by the editors in our own doubt that this problem is extremely useful and I undertaking to make publications. shall sooner or later be am most encouraged to changes. This issue is very The working group of resolved by our collective note that symposia have actual in Azerbaijan. the Russian section of the efforts. We would like the been held for people Penitentiary reforms in International Association assistance of the editors interested in prison medical Azerbaijan has received for Human Rights for the services. It will help to of Prison Healthcare successful changes, Murmansk region is very build up the climate of News and of the public however there are a lot of concerned with the state opinion which may drawbacks in health system of specialist equipment to acquire a functioning gradually result in things of prison. We understand used for monitoring x-ray apparatus for the actually happening… I that this is not a problem of tuberculosis patients in the SIZO and for those hope you will spread your the prison but also of the pre-trial prisons of the people whose guilt has influence as widely as whole society… region and would like to not yet been established. possible.

The Prison Healthcare Project is funded by the Open Society Institute contactContact details detailsand is run in conjunction contact with Penal Reform International details Prison Healthcare Project, International Penal Reform International, Head Office DISCLAIMER Opinions expressed in Centre for Prison Studies, King’s College Unit 450, The Bon Marche Centre this publication do not necessarily London – School of Law, 8th floor 75-79 241-251 Ferndale Road reflect those of the International Centre York Road, London SE1 7AW, UK London SW9 8BJ, UK for Prison Studies, Open Society details contact details Institutecontact or Penal Reform International. Tel: +44 (0)20 7401 2559 Tel: +44 (0)20 7924 9575/9853 Fax: +44 (0)20 7401 2577 Fax: +44 (0)20 7924 9697 Design and Print: Intertype Website: www.prisonstudies.org Website: www.penalreform.org contactEmail: [email protected] details contact details