Health in prison: looking after women in a man’s world
Prison is basically a man’s world. The prison medical system is basically designed for men. So the ICRC is paying particular attention to the situation of women in prison. Female prisoners constitute a vulnerable group, and their specific health needs are often neglected.
According to the World Health Organisation, there are currently about half a million female prisoners in the world. This corresponds to just 4% to 5% of the prison population. The percentage is even lower in situations of armed conflict. In 2008, the ICRC mad e individual visits to almost 37,000 prisoners in 77 countries, of whom only 960 were women.
Female inmates find themselves in a system essentially run by men for men. Frequently, their specific health-care and hygiene needs are not taken into account, and nor are those of children.
Why female prisoners are more vulnerable than male
All prisoners, male or female, are entitled to medical care according to their needs.
Women have specific health needs, mainly related to reproductive health. These needs vary according to a woman’s age and situation. The needs of a young girl, a pregnant woman, a woman who has just given birth, a mother accompanied by young children or an elderly woman are all different.
According to the latest World Health Organisation report , more female prisoners than male are taking drugs or infected with HIV.
Women are also more vulnerable to sexual violence. Rape, and “transactional” sex as a means of survival, leave more than psychological scars. They also increase the risk of unwanted pregnancy, HIV and other sexually transmissible diseases.
Female prisoners suffer more psychologically than their male counterparts, and are more likely to experience rejection by their families and by society in general. If a woman is isolated from her family, she may no longer receive food or hygiene articles from outside.
Whatever her situation, a female prisoner is particularly vulnerable. It is therefore necessary to pay particular attention to preventing, monitoring and treating her specific health problems, both physical and psychological.
What the ICRC is doing
ICRC delegates visit people detained in connection with armed conflict or situations of internal violence. These delegates include around 40 doctors and nurses (half of them women) whose task it is to evaluate health systems in prisons. In particular, they look at water and sanitation, hygiene, food, the availability of medical personnel and the availability of m edicines. They then endeavour to resolve the most serious health problems. The needs vary according to the region, demanding different responses.
The ICRC’s approach is global – it is not designed on the basis of prisoner categories. However, the ICRC does pay particular attention to the most vulnerable of these groups, and these include women and children. If a prison system is not meeting their health needs, ICRC delegates propose t he solution most appropriate to the context. In some cases, this may mean providing medical supplies, medicines or milk for infants, in order to compensate for deficiencies in a prison health system. In other instances, it is more effective to ensure that women and children have access to medical facilities outside the prison.
The ICRC also works to protect women, asking that they not be housed with men, that they have access to separate sanitary facilities and that they only be guarded by women.
( Read also what the ICRC is doing about HIV/AIDS in prisons)
From Rwanda to Georgia
Dr Raed Aburabi is the ICRC’s coordinator for issues related to health in detention and has visited numerous prisons throughout the world. He highlights two countries, Rwanda and Georgia, where ICRC medical teams have taken action to provide for the specific health needs of female prisoners.
Tens of thousands of people were arrested in Rwanda following the 1994 genocide, including around 1,000 women. The prisoners were short of everything, and the ICRC provided them with food, water and essential medicines. The women had an additional need, which they were too embarrassed to mention to the (male) ICRC doctor until he was accompanied by a (female) nurse: they had no cloth with which to make sanitary towels. Rather than give them unfamiliar imported ones, the ICRC supplied extra blankets and ensured that these were cut up hygienically.
The next problem, as Raed Aburabi recalls, was that many female inmates gave birth. “These women were not getting enough food to breast-feed their babies, so the babies wer e failing to thrive. We supplied milk for the babies, and they soon recovered. Then we made sure that the babies were vaccinated.”
In 1998, Raed Aburabi went to Georgia, where the ICRC had just launched an anti-tuberculosis programme in prisons.
The entire prison system was designed for men. In Tbilisi, 250 women were being held in a separate facility. But for medical treatment, they had to go to hospitals in men’s prisons.
The first thing the ICRC did was to make sure the women received treatment for tuberculosis and that those who had become resistant were monitored especially closely.
Then, the ICRC asked the ministries responsible to give more consideration to the needs of female prisoners. There was a need to find an alternative to the practice of transferring women to hospitals in men’s prisons. “We proposed the setting-up of a separate health centre in the women’s detention facility. We then followed up on this project very closely, and it became one of the prison administration’s top priorities. When I went back to Georgia in 2008, female prisoners had a clinic in their place of detention with trained female personnel, including a doctor, and equipment for conducting gynaecological examinations.