Health in prisons

Prisons are places of constraint where, at best, living conditions can be both physically and psychologically demanding. Detainees are subject to varying degrees of stress. Natural concerns about separation from family and friends and future uncertainties are made worse by poor living conditions – food, water, hygiene and sleeping accommodation. The risk from tuberculosis, HIV and other infections is high in facilities overcrowded with disease-prone people. Prison health-care systems are often under-resourced.

Some prisoners may also be exposed to physical, psychological and sexual abuse. In conflict situations or times of political unrest, violence, torture and extra-judicial killing tends to increase. Torture has short-term and lasting physical and psychological consequences on victims and their families

The ICRC is concerned with the welfare of anyone detained in connection with armed conflicts or internal disturbances that require intervention by a neutral organization. Its objective is to ensure acceptable conditions of detention and safeguard the physical and mental welfare of prisoners. It monitors their situation in detention and, where appropriate, prior to detention through direct visits to the victims and dialogue with their captors.

The ICRC emphasizes the responsibility of the detaining authority to respect and protect detainees. It draws attention to any breaches of international law and standards and recommends remedial action. In emergency situations where the basic needs of detainees cannot be met by authorities, it can provide temporary assistance in the form of water and food supplies or basic medical items.

ICRC doctors, nurses and delegates who visit places of detention to evaluate factors bearing on the health of the detainees need to have experience in prison and public health issues, knowledge of environmental hygiene, epidemiology, nutritional needs, and of the inter-relationship between nutrition, sanitation, health care, violence and overcrowding.

Their aim is to advise on improvements to the overall functioning of prison health systems, rather than individual diagnosis and treatment. However, they do advise on the general treatment of diarrhoeal disease (cholera), tuberculosis, beri beri, typhus, skin diseases (scabies), sexually transmitted diseases, HIV/AIDS and other infections that thrive in prison environments.

When torture and other forms of ill-treatment are evident, ICRC physicians document individual situations to strengthen the case for formal intervention by the organization. This documentation is not in itself part of any judicial investigation, but aims to trigger such action by the relevant authority.  

ICRC staff should be fully trained to deal with cases of ill-treatment. They need to have a sound knowledge of the physical and psychological effects of torture and of victim treatment. The ICRC can also train prison and forensic doctors on the medical documentation of torture so that they can deal with it on an ongoing basis.