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Afghanistan: Improving health care in prisons

03-07-2014 Feature

In Kandahar’s overcrowded Sarposa prison, addressing the medical concerns of inmates is a daily challenge. But thanks to the services being offered in a small, blue-and-cream painted clinic in the prison compound, the health status of the prison population is now stable.

The clinic, serving both the adult blocks and a juvenile rehabilitation centre, was extensively renovated by the ICRC in March 2013. Since then, the ICRC has regularly provided the provincial Ministry of Public Health with drugs and medical supplies for the clinic and paid the salaries of the staff. This is part of a much broader programme undertaken by the ICRC to make better health care available to detainees in Afghanistan.

"We struggled for years to fund and run the clinic," said Dr Poukhla, a representative of the ministry in Kandahar, during a recent interview. "The inmates were complaining, but now they are quiet because the health services are functioning properly at last."

Staff meeting in the consultation room. Dr Bahkt second from left. Visiting ICRC doctor Stijn Bex second from right. /CC BY-NC-ND/ICRC/J. Barry

A new doctor sets priorities

Detainees entering the clinic in the compound of Sarposa prison, Kandahar. 

Detainees entering the clinic in the compound of Sarposa prison, Kandahar.

In October 2013 a 30-year-old physician, Dr Bakht Mohammad Ziaee, was appointed to run the clinic, replacing a detainee doctor.

The position requires both tact and humanity, qualities that Dr Bakht and the other staff have in large measure.

"It's not an easy job to do," the doctor admitted. "The detainees think we are on the side of the authorities, and people outside the prison think we are on the side of the detainees."

"But we are not on any side. We are just doing our duty as medical professionals."

"I had two priorities when I took this job," Dr Bakht continued. "First, I had to organize the clinic management because you cannot care for patients without good management, and then I had to organize the data collection." In both tasks he was supported by the ICRC, which gave guidance and training.

Besides Dr Bakht, there are three nurses, a pharmacist and a night duty nurse working in the clinic, which is open from 8 a.m. to 2 p.m. with a 24-hour standby for emergencies.

Good hygiene has health benefits

Sarposa prison, Kandahar. Dr Bahkt sees on average 1,500 patients a month in the prison clinic 

Sarposa prison, Kandahar. Dr Bahkt sees on average 1,500 patients a month in the prison clinic.

Taking care of detainees’ health in overcrowded jails is not simply a matter of seeing patients and handing out medicine. In Sarposa, considerable emphasis is laid on raising awareness of hygiene among the entire prison population and on offering vaccinations for female prisoners and their accompanying children. A dentist, a dermatologist and an ear, nose and throat specialist give consultations on a regular basis. A midwife visits the women detainees.

It is not only the prisoners who benefit from the clinic’s services. Guards are also treated there.

"One of the biggest challenges has been to wean patients off the idea that you need an injection for everything," remarked Dr Bakht as he led four visitors around the spotless clinic one recent morning. "Slowly those who come here are realizing that treatment does not need to include injections to be effective."

As Dr Bakht was speaking, patients started arriving. It was around 9 o'clock and although the clinic had already been open an hour, they were the first to turn up. That morning a bread distribution had delayed the inmates from leaving their cells.

As the first two patients entered the doctor’s tiny consulting room, a nurse was waiting to record their details. "Itching is a huge problem," murmured one of the detainees as he sat down. "But it’s much better now," he added, as Dr Bahkt measured his blood pressure.

Hygiene promotion sessions, supervised in the clinic by an ICRC field officer, Bashir, have been largely responsible for this improvement. The number of detainees suffering from scabies has declined significantly since the sessions were introduced.

On average, Dr Bahkt sees around 1,500 patients a month. Common colds, diarrhoea and respiratory tract infections can be treated on the spot. Detainees who fall seriously ill are referred to Mirwais Regional Hospital in Kandahar.

Aiming to achieve similar success in other detention facilities

The ICRC is carrying out similar activities at several detention facilities in the country. Working in cooperation with prison authorities and the health ministry, ICRC medical staff make regular visits to prisons throughout Afghanistan to monitor the health of detainees, and the services on offer. ICRC engineers are helping to improve prisons’ infrastructure by refurbishing kitchens, improving sanitation and water supplies and, as in the case of Sarposa, undertaking a major renovation of health facilities. Hygiene promotion is taking place in regional and provincial prisons, and financial support is provided for medical staff. In Herat prison, the second biggest in Afghanistan, the renovation of the clinic has almost been completed and health services similar to the ones on offer in Sarposa will begin soon.

"These efforts give the ICRC a more visible face," said Richard Saddier, who is in charge of the Health care in Detention programme in Kandahar. "Our discussions and interactions with the detainees and prison authorities are far richer as a result."