Dying in prison: Failed infrastructure, or premeditated neglect?

In the past two months, at least five people died in police custody after being arrested on politically related charges. Four of the detainees belonged to the conservative Jama’a al-Islamiya group, while another was accused of belonging to the banned Muslim Brotherhood organization.

Three of those Jama’a al-Islamiya members died in the past 10 days alone.

The police say that the deceased were already in poor health before they were detained, but their families accuse prison authorities of deliberate medical negligence.

Jama’a al-Islamiya leader Essam Derbala passed away on Sunday after he was jailed pending investigations into charges that he belonged to the banned National Alliance Supporting Legitimacy (a coalition of groups organized in support of former President Mohamed Morsi after his ouster). A few days earlier, on Wednesday Jama’a al-Islamiya leader Morgan Salem died in the maximum-security Aqrab Prison. Two months prior, their colleague Nabil al-Maghraby died in the same prison. Ezzat al-Salamouny died on August 1, the same day that Ahmed Ghouzlan passed away in Abadeya Prison in Damanhour.

The official Facebook page for the Construction and Development Party — Jama’a al-Islamiya’s political arm — published a statement denouncing “the assassination of Essam Derbala” through medical negligence. The page also published a series of tweets from people affiliated with the National Alliance Supporting Legitimacy accusing the Prisons Authority of withholding access to Derbala’s diabetes medication, and refusing to transfer him to the hospital when his health deteriorated.

Medical sources told the privately owned Al-Masry Al-Youm newspaper that the preliminary forensic report listed diabetes and high blood pressure as the cause of Derbala’s death, and also stated that prison doctors had been checking on Derbala throughout his detention.

Authorities face the same accusations of negligence in the recent deaths of the four other detainees. In each case, families and colleagues claim the Interior Ministry was reluctant to give prisoners access to medication, and refused to transfer them to a hospital when they were in serious condition, thus leaving them to die in their jail cells. Similar charges were levied when former Muslim Brotherhood MP Farid Ismail died of a heart attack in his jail cell in March.

Al-Nadeem Center for the Rehabilitation of Victims of Violence released a report in June to mark the first anniversary of President Abdel Fattah al-Sisi’s election. The report alleged that in addition to the 272 people killed by police forces during Sisi’s first year in office, there were also at least 97 cases of serious medical negligence during that period in Egyptian jails and prisons (though not all cases resulted in death).

Due to this negligence, detainees and prisoners suffered from liver and spleen problems, bleeding, lung disorders such as pneumonia, heart attacks, muscular atrophy, kidney failure, scabies, food poisoning and other ailments — all cases that were reported in just the first six months of Sisi’s presidency, the report said.

The recently rising number of deaths inside jails and prisons poses the question of whether this negligence is a deliberate strategy employed by the authorities, or a flagrant indication of deteriorating infrastructure and services in the Egyptian prison system.

Al-Nadeem’s Suzan Fayyad believes that both scenarios could be valid.

Random arrests and long pre-trial detention periods ultimately lead to packing small prison cells with far more prisoners than they’re designed for, which increases the possibility of spreading disease, she says.

She also believes that the Interior Ministry is adopting a policy of intimidation by withholding medication and access to treatment at hospitals. In addition, prisoners may be thrown into purposely neglected, unsanitary cells as a form of punishment. Fayyad says that Al-Nadeem also has documentation of the authorities refusing access to sanitary materials like trash bags and pesticides, thus preventing prisoners from cleaning their own cells. She cites these issues as deliberate violations of prisoner rights.

In its annual report released on Monday, the National Council for Human Rights (NCHR) said that the overcrowding of jail cells has increased by 400 percent, with that number reaching 160 percent inside prisons. The report also said that there was a brief period where no deaths were reported in detention facilities (though that period was not defined), but that this number is again on the rise.

The NCHR demanded a quick solution to the crisis, saying that most of these deaths are due to worsening living conditions. The council did not rule out torture as a potential cause of some of these fatalities, though, cautiously stating that “nothing proves that the deceased actually died from torture; but nothing proves the contrary, either.”

Poor hygiene in jail and prison facilities, and the refusal to provide basic sanitary materials, can lead to widespread skin diseases among the inmate population, while overcrowded cells foster respiratory problems, and the lack of clean water leads to kidney and liver problems, says Fayyad. And if detainees or inmates already had a prior condition, then that would likely be exacerbated in this context, potentially resulting in life-threatening conditions like kidney failure. This situation is then compounded by the authorities’ unwillingness to provide proper medical treatment, Fayyad argues.

The reasons why detainees are denied access to medication or proper medical treatment are not always clear.

Esraa al-Taweel, a photojournalist who has now been detained for 70 days pending investigations into terrorism-related charges, said in a letter published by the privately owned newspaper Al-Shorouk said that her cell is only 3 by 5 meters large, and filled with maggots and cockroaches. She wrote that the prison doctor has not allowed her to continue physiotherapy sessions under the pretext that she suffers from a permanent disability that cannot be treated.

Taweel suffers from a back injury incurred when she was shot during a protest. The wound resulted in temporary paralysis, but her condition improved following intensive physiotherapy treatment before her arrest. According to her family, her condition has begun deteriorating again since the treatment stopped.

Since publishing the letter, Taweel has faced more restrictions and threats of being transferred to another prison, according to her family. As additional punishment, she was asked to drink from a water tap that smelled like sewage water, they said. She has since been examined for a second time by the same doctor. When Taweel told him that he could not give her an adequate diagnosis, as he is an orthopedic doctor and not a neurologist, he replied, “You know nothing about medicine. Go to your cell.”

A similar account comes from Ranwa Youssef, whose husband, journalist Youssef Shaaban, is currently serving a 15-month sentence for protest-related charges. In a statement posted to her Facebook account, she claimed that her husband is being refused treatment for Hepatitis C. In her last visit to the prison, Ranwa asked what the procedure was to get medical tests for Shaaban. She was told that doctors were available to perform those tests, but did not have the medical equipment they needed. Prison authorities urged Ranwa to bring the needed equipment on her next visit.

But when she did so upon her return to the prison, officials refused to allow the tests to be conducted, claiming it was illegal to take medical samples inside of prisons.

“For four or five hours, moving from this officer to that officer, we failed to do the tests for Youssef,” Radwa wrote.

Reda Marey, a lawyer at the Egyptian Initiative for Personal Rights (EIPR), says that prison bylaws do in fact allow prisoners to receive medical treatment inside prisons, and the Interior Ministry is obliged to provide them with all necessary medical equipment. However, Marey says prison authorities complain about a shortage of equipment and medications. Therefore, he thinks it would only be logical for the Interior Ministry to allow family members to bring these items into the prison during visits.

However, ministry officials tend to refuse prisoners access to medications brought from the outside, typically claiming that the nature of the medications was unknown, or that prison doctors were unavailable to determine their suitability, or administer them and provide aftercare.

“The real problem is that medical resources inside prisons are very poor or non-existent,” says Marey. “The law stipulates that at least one doctor should be present in every prison hospital, but with the rising numbers of prisoners, one doctor is not enough.”

“Prisoners register for medical treatment, and they each wait too long for their turn. If someone’s condition is seriously deteriorating, this wait could result in death — especially given that doctors are not present inside prisons all the time,” he warns.

The issue of transferring seriously ill inmates to hospitals, whether inside or outside the prison, is yet another problem, Marey explains.

This is “not in the hands of prison doctors, who can only recommend that a certain patient be transferred. The recommendation is then sent to the Prisons Authority, which makes the final decision. Security considerations have the upper hand here,” he says.

Amending prison bylaws has not solved that problem, the lawyer continues. Older bylaws stipulated that in case of conflict between the prison officials and the doctor, the issue would be referred to the head of the Prisons Authority. In the new bylaws, the medical department of the Interior Ministry has the final word — but despite this change, the ultimate decision is still based on security calculations, not on medical grounds.

Furthermore, “prison doctors are police officers who studied at the faculty of specialized policemen, so they belong to the Interior Ministry, and thus they won’t necessarily fight to transfer patients to hospitals when needed,” Marey claims.

But ultimately, prisoners are under the responsibility of the Prisons Authority, meaning that if an inmate dies after failing to receive treatment for a worsening medical condition, then this is a case of negligence. In Fayyad’s words, “death due to negligence is premeditated murder.”

Rashwan Shaaban, an assistant coordinator at the Doctors Syndicate, says that the syndicate has the right to refer any doctor to a disciplinary committee, including prison doctors.

“But the syndicate is not willing to use its powers unless it receives a certain complaint against a specific doctor in a specific case,” he says. “And most of the complaints we received [in these cases of negligence] did not include names of doctors.”

According to Shaaban, the syndicate sent several appeals to the prosecutor general and to the interior minister to investigate these recent allegations, but received no response.

The syndicate also coordinated with the NCHR to conduct joint visits to prisons, but these efforts were rejected by the Interior Ministry.

“Finally, the syndicate board decided to refer the head of the Prisons Authority’s medical department to investigation. He was notified with the date of the inquiry, but he did not attend,” Shaaban claims. “There is zero cooperation from the Prisons Authority or the Interior Ministry. They deal with us as if they are above the law, and above medicine.”

Mostafa Mohie 

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