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Prisons and Health Prisons and Health The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Prisons and Health Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan ISBN 978-9-289-05059-3 World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00. Fax: +45 45 33 70 01. E-mail: [email protected] Web site: www.euro.who.int 9 789289 050593 > Prisons and Health Edited by: Stefan Enggist, Lars Møller, Gauden Galea and Caroline Udesen Prisons and health ABSTRACT This book outlines important suggestions by international experts to improve the health of those in prison and to reduce both the health risks and risks to society of imprisonment. In particular, it aims to facilitate better prison health practices in the fields of: (i) human rights and medical ethics, (ii) communicable diseases, (iii) noncommunicable diseases, (iv) oral health, (v) risk factors, (vi) vulnerable groups and (vii) prison health management. It is aimed at professional staff at all levels of responsibility for the health and well-being of detainees and at people with political responsibility. The term “prison” covers all institutions where a state holds people deprived of their liberty. Keywords HEALTHCARE SYSTEMS HUMAN RIGHTS MEDICAL ETHICS PREVENTION PRISONERS PRISONS VIOLENCE ISBN: 978 92 890 5059 3 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2014 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. 2Cover: Photo by Maxim Dondyuk, www.maximdondyuk.com Contents Acknowledgements ............................................................................viii About the authors ...............................................................................ix Abbreviations ...................................................................................x Foreword .......................................................................................xi Human rights and medical ethics 1. The essentials about prisons and health .......................................................1 Key points ..................................................................................1 Background ..................................................................................1 The duty of care ..............................................................................1 Why prison health is important ..................................................................2 Difficulties with isolation of services. .2 Essential components of a prison health service .....................................................3 Good governance for prison health ...............................................................4 References ..................................................................................4 2. Standards in prison health: the prisoner as a patient ............................................6 Key points ..................................................................................6 Basic principles ...............................................................................6 Relationship between the prisoner and health care staff ..............................................6 Organization of prison health care ................................................................7 European Prison Rules .........................................................................8 References ..................................................................................9 3. Prison-specific ethical and clinical problems .................................................11 Key points .................................................................................11 Introduction .................................................................................11 Health care staff in prisons ....................................................................11 Disciplinary measures .........................................................................13 Physical restraint ............................................................................13 Intimate body searches ........................................................................13 Prisoners who stop eating or go on hunger strikes ..................................................13 Torture and inhumane or degrading treatment .....................................................16 References .................................................................................16 4. Violence, sexual abuse and torture in prisons .................................................19 Key points .................................................................................19 Introduction .................................................................................19 Definitions of violence in prison .................................................................19 Violence in prisons ...........................................................................20 Sexual violence in prisons .....................................................................20 Torture and ill-treatment .......................................................................21 Prevention of violence in prisons ................................................................22 Prisons and health The role of the prison health services ............................................................24 References .................................................................................24 5. Solitary confinement as a prison health issue .................................................27 Key points .................................................................................27 Introduction .................................................................................27 What is solitary confinement? ..................................................................27 How does solitary confinement affect health and well-being ..........................................27 Particularly vulnerable groups ..................................................................29 Long-term effects ............................................................................31 When and why is solitary confinement used in contemporary penal systems? ............................31 How do international law and human rights bodies view solitary confinement? ...........................32 Conclusion ..................................................................................32 References .................................................................................33 6. Health in pre-trial detention .................................................................36 Key points .................................................................................36 Introduction .................................................................................36 Defining pre-trial detention ....................................................................36
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