The Rights of Convicted Prisoners with Tuberculosis
In order to assess the human rights situation of this rather specific group, the Dnipropetrovsk branch of the International Society for Human Rights – Ukrainian Section visited 10 penal institutions; interviewed the heads of some of these institutions; surveyed 1500 prisoners suffering from tuberculosis; 500 people with tuberculosis who had already been released from penal institutions, as well as 112 employees of hospitals within penal institutions where tuberculosis patients are treated. The monitoring group visited patients wards, hospital units, manipulation rooms, laboratories, canteens, shower rooms, toilets, places where parcels or prisoners personal belongings are stored, chapels and churches on the territory of penal institutions, the offices of doctors, nurses and employees of the regime service, as well as of the heads of the institutions, guards rooms, etc..
The overwhelming majority of prisoners with tuberculosis – more than 75% - are aged between 21 and 40. Their sentences in most cases range from between 6 and 10 years (64% of those surveyed), while 29.5% are serving sentences of between 11 and 15 years. Almost two thirds are repeat offenders. 88% first contracted tuberculosis in places of deprivation of liberty. 4.5% had been released early from deprivation of liberty. These are shocking figures especially since those surveyed were in the main seriously ill with destructive forms of tuberculosis and 60% of them had been sentenced more than once, and had therefore been ill with tuberculosis following their release from a penal institution, yet only in 17% of the cases had they been treated while at liberty, and only 6% had received disability group status. Thus, in the intervals between periods of imprisonment, neither they themselves, nor society had paid any attention to looking after their health.
In order to effectively treat tuberculosis patients, the suitable everyday and sanitary and hygiene conditions must be provided. The conditions in which the patents are in fact held can be described as cruel and inhuman.
In the penal hospitals there are some wards with 4-6 beds, in which so-called hospital orderlies from among prisoners with only light forms of the illness are treated. However the overwhelming majority of tuberculosis patients are held in premises where there are between 54 and 100 beds over a space of 60 m². The bed-bunks are two-storey, which shuts out the light, since the top bunk is at the level of the windows which are already small and have grating over them. Its damp in the place, and in winter its cold, while in summer very hot.
For 100 patients, right here in the ward (if such barracks can be called wards) there are 5 washbasins attached to the wall. This means that there is one washbasin for 20 patients, so that patients have to wait in the queue a long time just to have a wash, not to speak of using them to shave or clean your teeth. There was no hot water although it was already quite late in autumn.
The toilets are in a separate not very large location without natural lighting, where, for 104 prisoners, there are only 4 “contraptions” without a cistern, partitioned off only on the sides, with no other walls or doors from the front, this being degrading. Two thirds of the people interviewed said that the state of the lavatory arrangements was good, however 10% stated that the places were dirty, the toilets didnt work, didnt flush, that the taps needed fixing and that sometimes you had to wash using a cup.
The shower rooms were in a separate block which meant that from the wards to the shower rooms you had to cross the courtyard of the penal institution. Some shower rooms were undergoing repairs during our visits and it was clear that after the repairs they would look fairly decent. Other shower rooms, however, were dark areas of around 25 m², in which 4 shower contraptions had been fixed to the walls, also without any partitions, or any places for putting clothes. In front of the shower rooms there was a “bench” on which patients piled their clothes while having their shower. During our visits none of the shower rooms had hot water, the taps needed fixing, and the floors and walls were dirty. Most of the ill prisoners replied that they were only able to have a shower once a week, however half of them said that the taps needed to be fixed, a third commented that the rooms were dirty, and that there were problems with hot water, and only 3% dared to say that in the shower rooms repairs dragged on for half a year.
When asked for a general assessment of the everyday conditions in the medical units, half said that the everyday conditions were satisfactory, almost one third – that they were bad, while 17% wrote that they were good.
To properly treat patients with tuberculosis, the food needs to be good, yet in fact, the food was not only unsatisfactory, prepared from low-quality products, and provided in small portions (noted by over 80% of those surveyed who were at the time in penal institutions, and 97% of those who had already been released, but in our opinion was not fit for consumption. Members of the monitoring group were just about able to swallow a spoonful of soup each, however it was impossible to even attempt the second course. When we asked why the food was like this, we were told that it was prepared by the prisoners themselves and was therefore sometimes not tasty since they were not cooking specialists. During our visits and conversations with the patients, they began complaining in the canteen that often the fish had gone off and stunk, that it was impossible to eat it, and not just impossible for people, but for pigs. The officer who accompanied the members of the monitoring group began trying to find out which unit, and which department those who complained had been from and promised to “deal with it”. Maybe he “dealt with it” since another time there were no complaints although the food was just as inedible. Its probably not worth speaking about the calorific value of the food since you can only really estimate the calories of food which can actually be eaten.
It should be noted that when asked about the quality of the food, around half the patients said that the quality of the food was unsatisfactory and the general catering bad, while approximately one third answered that it was acceptable.
The patients canteen is a big hall of 300 m², dark and without lighting, with the electric lights not turned on during dinner (to economize) and light gets into this dark place only through the doors when patients come in or through the doors of the place where the food is given out. At first when you come in you dont see anything at all, and its only later, as your eyes become accustomed to the dark that you begin to distinguish figures, tables and benches on which people are sitting. Outside warm clothing doesnt get taken off while people are eating since it is cold in the hall.
Patients get extra food through parcels handed in or sent from relatives. These products are stored by the patients together with their personal things in big chequered (“bazaar”) bags in a separate storage room near the wards. There is a table and bench in the room for patients to sit and eat their food. Only two thirds of the prisoners being treated receive parcels, with those who dont being only the ones without family. Judging by the answers received, quite often food from the parcels goes bad.
The diagnosis of tuberculosis in penal institutions would appear to be at a reasonably decent level going by the information from the survey and our interviews, as well as from our own observations. In the penal institutions there are X-ray facilities and reasonably well-equipped diagnostic laboratories. Most of those suffering from tuberculosis are examined using x-rays and by a doctor. Approximately 50% of those ill have laboratory testing, although absolutely all should have this, at least to check for bacilli discharge. Around 20% of them said that specialists from other hospitals had been called to them, either by the hospital itself or by their relatives, or that they had been examined in a tuberculosis unit.
However the treatment is insufficient, as is confirmed both by the patients surveyed, by the medical staff and even by the heads of penal institutions. There are not even enough specific drugs against tuberculosis, and no effective anti-tuberculosis medication of the new generation, nor are there drugs for strengthening the immune system of patients, vitamins, general health-strengthening medicines, etc. Approximately 30% of the prisoners with tuberculosis stated that they were brought medication by their relatives. Up to 10% said that they received medication irregularly, or not at all, although they did need it.
Around 50% do not have adequate information about their disease. They were not satisfied with the dental clinic since as many as 60% of the patients did not use it.
Care for the patients, especially those seriously ill, is unsatisfactory, given not by members of the staff, but by sick prisoners themselves from those who have less serious instances of the disease and whom the administration designates as “hospital orderlies”. In return for this work they are placed in wards not with 100 bed-bunks, but for 6-8 people. At the same time opinions regarding the level of care for seriously ill patients vary widely, with 20% answering that the care is bad, a further two groups of 20% saying satisfactory or good, respectively, and 30% responding that they didnt know what it was and who was rending it. Only up to 30% said that the care was given by orderlies, and up to 20% commented that the ordinaries did not provide it.
The overwhelming majority of prisoners with tuberculosis have been in the hospital from 3 months to a year. A third said that their state of health during that period had improved, while more than a third considered that their condition had either not changed or had got worse.
Around half of the patients consider that the medical personnel treat them decently; a third said that they were either indifferent or dismissive, while 20% could not answer the question.
Almost 10% of the patients had been in the punishment cell, and one out of five said that infringements of the regime would lead to their being discharged from the hospital unit.
Only 20% of the prisoners stated that they considered themselves to be informed about human rights, while others said they were not at all informed, or very poorly. Only 18% had access to literature on human rights and on issues related to their illness, others – either none at all, or very little. Around half of the prisoners with the disease had information about HIV and AIDS. According to some of the patients, they could be visited by close relatives, and simply relatives and friends, lawyers, doctors, priests and others, whereas one fourth said that the procedure for even a visit from a priest was extremely complicated.
This was how the results of the survey carried out among 1500 tuberculosis patients serving sentences looked. However we received entirely different findings from the survey among 500 tuberculosis patients who had been released, but who had at one time been treated for tuberculosis in penal institutions.
The survey was carried out in regional or city tuberculosis treatment units in the area. All those asked were male, aged between 30 and 50, whose sentence had been from 5 to 14 years. Among them 47% had been imprisoned once, 34% - twice, while 23% had served three or more sentences.
All 100% of those surveyed answered that they had first contracted tuberculosis in penal institutions. 64% had been released due to the illness.
All of them had been receiving treatment since their release in tuberculosis treatment units (since this was where we undertook the survey, and we simply did not find people who were not receiving such treatment). All were hospitalized during the treatment in wards for 4 to 6 patients. 53% considered the food to be acceptable, while 48% said it was unsatisfactory. 56% said that treatment outside the penal institution was totally free, while 41% said that they only didnt pay for specific anti-tuberculosis medicines, while for all others they paid, and 3% avoided the question.
47% had tried to find work (or so they claimed, although it is hard to give this full credence), while 51% had not tried, and 2% did not answer the question.
Of the 500 people, 422 (84.4%) had been officially given disability status, while 78 (15.6%) had not been before a medical and social assessment commission, although they considered themselves to be seriously ill.
The tuberculosis patients now at liberty described the everyday and sanitary and hygiene conditions in the medical unit within the penal institution they had been in as follows:
92% said that the wards were damp, in winter cold and in summer very hot. 96% commented that in the unit (outside the ward itself) it was cramped, dark and damp, with access to water difficult, while up to 10% said that it was dirty both in the wards and in the overall unit. To our additional questions concerning the fact that for some reason the majority write about cramped conditions, darkness, dampness and cold, while only a minority about dirt, we received the answer that the patients themselves “are forced” to clean in the wards and to keep it clean.
89% mentioned that the shower rooms dont function for months on end, or there are repairs, or no hot water, while more than 85% say that you can yet to the toilets when you need to, but they dont flush and theyre dirty. 72% of those surveyed said that bed linen was largely provided at relatives expense, whereas only 28 % said that it was at the penal institution medical units expense, and that it was dirty, ripped, and changed only once a month.
The overall assessment of the everyday conditions was as follows: 91% - bad, 9% - satisfactory.
89% spent time in the fresh air everyday, while 11% did not due to the seriousness of their state of health. 97% of the 500 men asked said that the food was bad, with 76% commenting that parcels did not always reach them, and if they did, they were spoiled, ripped and “only half full”. Parcels handed in were received by only 32% of those asked.
When asked about the treatment, diagnosis and care of the patients in penal institutions, of the 500 surveyed 87% said that aside from x-rays, they had had no other examinations, nor had there been specialists from other hospitals or tuberculosis treatment units. 96% stated that the treatment had been carried out with two forms of medication – turbazid and streptomitsin, meaning without any new generation drugs. 84% answered that care for seriously ill patients was given by orderlies, but not from among the medical personnel, but from those also suffering from tuberculosis, but with a milder form of the disease. 93% described the care as bad, while 7% said that it was satisfactory. Only 4% confirmed that relatives were allowed to visit seriously ill patients, with 10% answering that they didnt know, and 86% saying that such visits were not permitted.
With regard to the relations between patients, medical personnel and staff of the regime service, the answers of those suffering from tuberculosis and now at liberty were as follows. 7% indicated that they had been in the medical unit of their penal institution from 6 months to 2 years, and their state of health during that period had improved, while 32% believed that it had remained the same, and 53% said that it had got worse, with 8% finding it hard to say. The attitude of medical personnel to patients was assessed as well-disposed by 9%, as indifferent by 74%, as lacking in respect by 12%, while 5% said that the attitude was aggressive. 8% had been in the punishment cell, with 97% saying that while there, the course of treatment had been suspended, while 3% said they couldnt remember. For 39% of those surveyed, infringements of the regime had resulted in them being discharged from the medical unit. 89% said that priests visited the patients, but not at the request of the latter, coming themselves when it suited them, or by arrangement with the penal institution administration.
With regard to human rights and their observance in places of deprivation of liberty 78% said that they had not been informed while 22% answered that they “had heard something on those lines”. 91% asserted that there was no literature about suffering from tuberculosis and AIDS in the penal institutions, while 4% said that members of civic organizations sometimes brought such material, and 5% did not answer the question. 82% said that they had received information about HIV and AIDS from medical staff, but that this had been extremely meagre, whereas 17% had obtained such information from others in the ward, and 1% had had none.
In comparing the figures from the questionnaires of tuberculosis patients presently in penal institutions, and from patients who have been released from these institutions either after serving their sentence out, or due to their illness, one observes a very large difference. Those released from penal institutions several times more often (from 5 to 12 times) give negative answers, that is, asserting that the conditions were bad; that it was cramped, damp, and dirty in the wards or the unit as a whole; that care of patients was carried out by patients themselves; that the shower rooms didnt work; the toilets needed fixing; the treatment was inadequate; the attitude of the medical personnel to the patients was indifferent, or aggressive; that they were not made aware of their rights that there was very little information about tuberculosis and AIDS. And comparing these figures with our own impressions during visits to penal institutions, one can note that the responses of those who are presently at liberty are closer to the truth. Therefore, one can with a large degree of probability conclude that despite our insistent assurances to those patients in penal institutions of total anonymity of the survey and that they would suffer no negative consequences, the responses to our questionnaires were not always objective.
We also carried out a survey of 112 members of penal institution medical personnel. Those surveyed answered the majority of the questions, however not all answered and not all questions. Overall one should note that the medical staff paid more attention to their own rights than to those of their patients. Only 30% responded that their working space was sufficient and met functional requirements, while others noted that their premises either needed repairs done or were of inadequate area and didnt meet their demands, that the furniture was old and needed to be replaced, that the provision of special uniforms was poor, while it was fairly good as regards gloves and disinfectants. Two thirds of those surveyed replied that there were no guarantees for personnel in the event of infection, while a third considered that the numbers of medical staff were insufficient. Virtually all stated that the level of qualifications of medical personnel was reasonably satisfactory but said that the work was not paid well enough.
The medical equipment, in the opinion of the medical personnel, was in a bad state and out of date, while the provision of medicine for patients was either inadequate (32%), or of an inadequate range (28%). Nor did those surveyed conceal the fact that in more than half the cases relatives helped provide the patients with medicines, that often (according to 62%) there were not enough specialists for consultations. They claimed that where there was a conflict of interests between regime and medical readings, the issue was decided in each case on an individual basis (61%). 54% rated their level of knowledge about prisoners rights as average, while 18% said that it was low.
One may thus conclude that where prisoners with tuberculosis are concerned in the first instance it is their right to health care which is infringed. It is through the violation of this right that effectively their right to life is also violated, since the mortality rate, which is calculated per 100 thousand of the population, in penal institutions stood at 615.4 in 2004, and for the first 6 months of 2005 – at 1,307.7, whereas among the public as a whole, the figure is 23.2 per 100 thousand, being 56 times less.
The same situation applies with tuberculosis. In one juvenile educational colony each year over the last few years 4 -5 young people have contracted tuberculosis – with 350 convicted prisoners this means that the illness readings amount to 1400 per 100 thousand, whereas in society as a whole this figure comes to 80 per 100 thousand, that is, 18 times less. This can be considered a double epidemic, since by international standards if the rate of those who have contracted tuberculosis reaches 40 per 100 thousand of the population this is considered an epidemic in the country.
The right to protection from torture and ill-treatment is violated since the above-mentioned conditions should be deemed ill-treatment. The right to freedom of thought, conscience and religion of prisoners with tuberculosis is infringed since only in some penal institutions are there small chapels and churches where they have the opportunity on rare occasions to speak with a priest of the Orthodox Church, with representatives of other denominations not as a rule allowed into penal institutions.
Proof of violation of freedom of expression can be confidently adduced from our question since the answers from patients who are presently held in penal institutions were significantly different from the testimony of those who had been released from such penal institutions, as well as from the objective impressions of members of the monitoring group. Patients inside penal institutions were intimidated and feared that if they told us the truth the penal administration would punish them – either by suspending the procedure for releasing them in connection with their illness, or by applying other sanctions. Therefore up to 89% of the prisoners, in our view, were afraid to truthfully answer our questions regarding the everyday conditions; only 50% said that it was crowded in the wards, while 30% positively answered that they had no criticism of everyday conditions.
The right to participation in the running of state affairs is violated since convicted prisoners have the right to free, transparent and democratic elections, whereas the elections in penal institutions turn into a huge and banal farce. Our organization took part in monitoring the elections in 2000, 2002 and 2004 in penal institutions. One can make the following conclusion: the voters in penal institutions were not able to receive a full amount of information about the candidates, not to speak of the fact that the candidates did not campaign before the voters in places of deprivation of liberty. Virtually all the voters in penal institutions vote or are forced to vote as theyre told to by the administration of the particular institution.
The right due to prisoners to make appeals to the authorities and bodies of local self-government should be ensured in full measures, yet we would assert that this right is also infringed. Over the year there were only two appeals (and this is given the conditions which are described above!), and these were not to the authorities or to the bodies of local self-government, but to the administration of the penal institution. During the presidential elections in 2004, one of the prisoners together with his ballot paper threw into the ballot box a complaint to the authorities about the bad conditions in the penal institution however the message did not reach the authorities and was handed to the head of the penal institution.
The right of access to information of prisoners is violated. Prisoners only rarely have the opportunity to watch television with there being only one TV for 50-100 patients and, as a rule it is a question of watching some kind of film. Newspapers do not reach the wards at all and the radio doesnt work. over 90% of those surveyed answered that they knew either very little or nothing at all about human rights and their observance in places of deprivation of liberty, and that they did not have access to literature either on human rights or about tuberculosis. During our visits to penal institutions, we did not see any stands about tuberculosis or AIDS, or any kinds of information sheets, and we therefore handed out such booklets, brochures and information sheets during our monitoring visits.
According to international standards prisoners in penal institutions have the right to continue their education and conditions for this are created. In the juvenile educational colony there is a school in which 350 adolescents regularly study, whereas in penal institutions for adults no one even raises the question about the possibility of education although many of the convicted prisoners do not have general school education.
1 To improve the conditions of prisoners with tuberculosis by:
- ensuring that patients are placed in wards for not more than 8 people
- providing adequate lighting in the wards
- ensuring an appropriate temperature in the wards
- providing the patients with regular cold and hot water
- increasing the number of washbasins in the wards
- carrying out reconstruction work on the toilets
- establishing shower rooms in each block of the medical unit and creating proper conditions in them
2. To improve the provision of food to patients by:
- restructuring the canteens
- providing enough lighting in the canteens
- ensuring that the meals for patients are prepared by hired staff – a cook, so that the food can be fit to eat
3. To improve the effectiveness of treatment by:
- ensuring that the patients receive specific medication against tuberculosis, including medicines of the “new generation” in the necessary amounts
- providing patients with medicines for stimulating the immune system and generally strengthening health
4. To draw up and introduce amendments to electoral legislation which ensures that the right of prisoners to free and fair elections is exercised, and which prevents the administration exerting influence over the expression of voters will.
5. To ensure access by representatives of human rights organizations to penal institutions, and to draw up and pass the relevant law to this effect.6. To ensure the observance of the right of prisoners to make appeals to the authorities and to bodies of local self-government, and their right to education.