ICRC expert goes ‘behind bars’ to improve Sindh’s prisons

Detention doctors need training to deal with situations like hunger strikes.

KARACHI:

By building high concrete walls to secure their perimeter, prisons may socially cut off detainees but they cannot keep them completely immune to public health issues, cautioned a doctor who is working with the International Committee of the Red Cross (ICRC) on detention health.

With over 20 years of experience with the ICRC, Dr Raed Aburabi has visited 72 countries in an effort to bring local authorities on board to improve healthcare for detainees. In an interview with The Express Tribune after concluding a two-day seminar on healthcare in detention, Aburabi highlighted some main issues experienced in prisons worldwide.

“If the country is experiencing a particular epidemic, for example tuberculosis (TB), then it holds true for the population within the prison as well,” he said. In fact, according to Aburabi, the spread of TB in the prisons of some countries is 40 to 100 times higher than on the outside.

Also present at the seminar was Sindh IG for Prisons Ghulam Qadir Thebo. When asked about some of the top health concerns in prisons across Sindh, he said, “The most severe is hepatitis, with more than 30% of the detainees being infected.” TB is another issue followed by skin diseases and Aids.

Healthcare in prisons is a complex matter - it not as simple as a person with the flu visiting a doctor and then getting a second opinion if they do not feel better. There are multiple layers of security and safety involved. The detainee has no choice but to be seen by the doctor on duty. The detention doctor must remain unbiased while treating the person, seeing them solely as a patient and not a prisoner.

“The balance between healthcare and security is a very sensitive one,” said Aburabi. “Keeping that in mind, our aim is to form a constructive dialogue with the authorities in order to improve public health in prisons - it is as simple as that.”

Of course, change cannot be expected overnight. Authorities have their constraints to take into account as well. Be it resources, capacity, the skills and know-how to implement the changes and perhaps most crucially the attitude to want the change.  According to officials, Sindh has 26 functional detention centres with an inmate population of 13,000 to 14,000. Two years ago it was over 20,000 detainees. Previously, jails had a capacity of 8,500 but it was raised to 10,800. According to Thebo, additional barracks and jails are under construction and within a year over crowding would not be a problem.

Aburabi was not at liberty to divulge details on the state on the prisons he had visited, both internationally as well as in Pakistan. “We write down what we see in our reports,” he said. “They are sent directly to the relevant authorities. However, the whole process remains confidential.” The ICRC must be seen as unbiased.

But there were some generic problems he was willing to shed light on. He said that most problems were common for detention doctors across the globe. For example, most doctors do not have any formal training on how to deal with certain scenarios ,ie, hunger strikes. “Many doctors need an opportunity to upgrade their knowledge with regards to their situation and discuss issues with others to find a solution,” Aburabi stressed. “They [detention doctors] are often forgotten and do not end up getting invited to most seminars and conferences. It is important to expose them to international practices and ideas.”

According to Aburabi, the coordination between the department of prisons and health was another major issue. “When a detainee needs to be hospitalised or requires psychiatric treatment, they are shifted to public hospitals,” he said. “But the health department has no direct link with prison affairs and therein lies another issue.”  In Sindh, doctors are deputed from the health department to prisons. While the prisons department has 40 vacancies for doctors, Thebo believes that the current set-up is perhaps better as it is decentralising the power of prison officials.  “Once doctors become part and parcel of the prison set-up they will lose their human touch,” said Thebo. “They will also begin to feel and behave like the security personnel. I feel that doctors from the health department will pay more attention to human rights.” Thebo agrees with Aburabi and said that doctors at detention centres need to be trained in order to deal with different situations and patients.

After the lengthy discussion at the seminars, Aburabi and his team made a list of suggestions and concerns shared by the authorities. This list will be processed and the ICRC will identify areas where they can offer assistance or propose solutions.

Published in The Express Tribune, December 4^th, 2011.