Haiti: keeping detainees healthy – a public health challenge
The ICRC, which has visited detainees in Haiti continually since 1994, is engaged in a huge effort to help the Haitian authorities address the problems stemming from prison overcrowding and poor conditions of detention. The health of detainees is one of the major challenges that the authorities are striving to meet with the help of the ICRC, among others, in order to contain the spread of infectious diseases such as tuberculosis and HIV/AIDS.
Sandra Martin is a general practitioner at the ICRC. She works closely with the authorities and prison doctors to improve access to health care in Haitian places of detention.
Why tackle the issue of health in detention?
A prison is a place that’s both closed and open. Detainees not only share that space, they also come in contact with the outside world, because they are monitored and assisted by prison officers and support staff and visited by their families.
In prison, infections can spread very quickly if no system is in place to prevent diseases and treat them whenever and wherever they occur. For example, when detainees are admitted to prison, they may be carrying an infectious disease. When prison staff and families come in contact with these detainees, they risk contracting the disease and transmitting it to people on the outside, or vice versa. This clearly indicates that prison health is a real challenge to public health.
What are the issues affecting health in Haitian prisons?
Access to health care remains the major issue, mainly because of overcrowding and the shortage of prison health-care workers.
Take, for example, the civilian prison in Port-au-Prince, the largest penal institution in Haiti. Most of the time, the detainees are locked in overcrowded cells, with no toilets. Many of them fall ill. The close quarters foster the spread of diseases such as cholera, scabies and flu, as well as tuberculosis, which is endemic in Haiti. Unfortunately, there are not enough medical workers in the prison to detect and care for the detainees effectively.
Overall, prisons are overpopulated and understaffed. It’s essential to increase the workforce in order to remedy the existing problems to the extent possible. This will ensure greater attention to the needs of detainees, particularly in terms of health care. For example, the shortage of staff has direct repercussions on security management, which in turn affects access to care.
What solutions have been implemented or proposed by the ICRC?
Since 1994, the ICRC has worked closely with the Haitian authorities, and has offered them its expertise in improving conditions of detention. The ICRC trains prison medical workers in controlling the diseases that are most common in detention and in the management and use of medicines. It also supervises these workers.
In emergencies, the ICRC facilitates the recruitment of additional medical staff and distributes medicines and other medical supplies. That’s what happened during the cholera epidemic: the ICRC helped the Prison Administration Directorate to step up medical care in the affected prisons by hiring 10 additional nurses. In addition, the prison dispensaries were regularly supplied with medicines, oral rehydration salts and intravenous fluids.
In April 2011, a hygiene-promotion team, composed of a nurse and an ICRC water and habitat engineer, was set up to train and raise the awareness of detainees and prison officers about the impact of hygiene on health in prisons. This team is also prepared to take action in places of detention in case of emergency.
With ICRC support, a health project on preventing and treating infectious diseases in the prison environment was signed in 2009 between the GHESKIO centre (a Haitian private institution working on HIV/AIDS research and treatment), the US non-governmental organization Health Through Walls, and the Ministry of Justice. The implementation of this project led to a significant drop in deaths from tuberculosis in the civilian prison in Port-au-Prince. This positive outcome is very encouraging. Our goal is to get the Haitian authorities to extend the project to other prisons around the country.
You mentioned the good cooperation with the authorities. What does the ICRC expect from the authorities and other parties in the future?
We would like to see a comprehensive health-promotion plan for detainees drawn up and implemented by the relevant authorities, possibly within the framework of a round-table meeting that brings all interested parties together. We must continue to press for greater synergy and coordination between the Haitian authorities and organizations working in the field of prison health. In addition, stronger working relationships between the justice and health ministries can only boost efforts to address the health of detainees. The ICRC, meanwhile, will continue to offer its expertise and to play the role of facilitator and mobilizer for other parties wishing to link up with a plan of action implemented by the Haitian authorities in the field of prison health.