Third Meeting of Officials Responsible for Penitentiary and

Prison Policies

Washington, 17-18 September 2012

Health in Detention and Prison Settings

Dr Mark STEINBECKMedical Delegate, ICRC

ICRC mission statement

• The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance.

ICRC and detention in 2011

• 1,869 places of detention • in 75 countries and in 5 different

international courts• holding 540,828 detainees of whom• 28,949 were individually visited by ICRC

delegates• and of whom 14,790 were registered and

visited for the first time in 2011

ICRC and detention• Monitoring visits• Family links• Family visits• Physical assistance to detainees• Physical assistance to authorities• Technical and structural assistance to

authorities

• Therapeutic feeding• Medical care

Declaration of Alma-Ata, 1978International Conference on Primary Health Care

• "The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector."

Moscow Declaration2003 International Meeting on Prisons and HealthWHO / Russian Federation

• "Delegates noted that penitentiary health must be an integral part of the public health system of any country. In this connection, it is necessary for both prison health and public health to bear equal responsibility for health in prisons."

Recommendation C(f)Second Meeting of Officials Responsible for Penitentiary and Prison Policies in OAS Member StatesAugust, 2008

• "Steps should be taken to promote the recognition and protection of the health needs of persons deprived of liberty, defined as the enjoyment of the highest possible level of physical, mental, and societal well-being in a manner consistent with community standards of care. This includes, among other things, timely medical attention in all various specialties, emergency care, and confidentiality in the handling of the patient's medical records and information."

Principal Actors

Detention Authorities (MOJ; MOI; MOD)• They are responsible for the health of the

detainees: curative and preventative – including healthcare services and food

Detainees – Inmates / Prisoners • They are also responsible for their health:

hygiene; exercise

Minister of Health • Is responsible for the service quality inside

the places of detention, directly or indirectly

But it's not just the prison …

• Prison health cannot be addressed in isolation from the health of the general population as there is a constant interaction between the prison and the surrounding community, be it through the guards, the administration, the health professionals, visitors and the constant admission and release of prisoners.

• Prison walls may keep the prisoners inside the prison but community health and prison health freely intermingle. Therefore, prison health must be seen and treated as part of public health.

Main physical problems

1) Overcrowding 2) Insufficient food and nutrition3) Bad hygiene condition – Infectious

diseases4) Life in prison: access to open air, living

conditions, no major activities5) Status of health of the prisoners before

incarceration6) Risk factors – drugs, violence, unsafe

sex7) Torture

Main systemic problems

1) Lack of resources 2) Motivation of the medical team3) Difficulties in accessing the health

services 4) Confidentiality and medical ethics5) The link between the health services in

the prison and outside the prison. 6) Which Ministry is in charge?

MOH because

(1) Patients not prisoners

(2) Integrated overview of health in the country

(3) Medical ethics

Thank You

www.icrc.org