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Bahrain must provide prisoners with full access to adequate medical care

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The Bahrain Center for Human Rights (BCHR) is deeply concerned over the wellbeing of detainees in Bahraini prisons and their access to adequate medical care, including cases where the detainees are suffering from serious diseases, thus violating their right to medical care, and putting their health, and in some cases their lives, at risk.

BCHR was able to document 89 cases, both current and ongoing since 2011, of detainees who are suffering from a wide range of illnesses in prison, amid concerns and allegations that they do not have adequate access to medical care.

Among the list, there are 10 persons who are suffering due to injuries caused by police use of excessive force prior or during arrest, including four persons where the injury resulted in disability to the detainee. They were injured by security forces using shotguns, and many of them suffered from injuries to their head, eyes, and chest. What’s common between these detainees is that most of them allege that they are deprived of medical care, which could be related to the authorities’ attempts to hide their alleged abuse, especially in cases where the detainee has suffered disability due to the injury. For example, Abbas Ali Hasan lost his eye after being hit by shotgun bullets and is still suffering a lack of medical care for his other eye, which is at risk.

The list also includes at least eight persons who are still suffering the consequences of torture on their health, including one person who is suffering a disability resulting from torture.

In addition, there are at least four special needs persons including one person who lost vision due to lack of treatment after detention, which raises the total number of people suffering disability while in detention to nine persons. Finally, at least four persons have recorded a deterioration in health including psychological health after imprisonment, which could be attributed to the prison conditions.

As per the information received by BCHR, at least 61 detainees are suffering illnesses that could be due to a natural cause, although their health conditions have deteriorated due to the limited or lack of medical care. The largest group is that of 17 detainees who are suffering from sickle cell disease (SCD), which is a widespread inherited blood disorder in Bahrain, and is the 9th most common cause of death in Bahrain, according to the 2012 Ministry of Health statistics. SCD causes a lot of health problems to patients, which vary in each individual case; however, pain episodes or crisis are the most common complication of SCD. It can be treated with pain medication, while some people may need to be admitted to the hospital for intense treatment. Since 2011, Bahrainis with SCD have suffered from denial of medical access, inadequate medical care, and ill treatment while in detention, resulting in the death of two detainees, Mohammed Mushaima and Jaafar Al-Durazi, while in custody in 2012 and 2014, respectively. (For more information, see this report.)

According to BCHR’s records, prisoners regularly suffer from back problems, heart problems, vision problems, bone injury and diabetes, among other illnesses, as demonstrated on the below chart:  

Number of detainees suffering from different types of health problems

As per family complaints received by BCHR, some detainees have reportedly been denied adequate medical care for months or even for years. Some detainees are only allowed to go to the prison clinic, which lacks specialised doctors and equipment. This lack of specialised medical care leads to further deterioration in their health. Other detainees are allowed to visit the hospital, whether Salmaniya Hospital or Bahrain Defense Force Hospital. However, some of them are only allowed to go for their first or sometimes second appointments; they are denied follow-up appointments on a regular basis. In many cases, detainees are only given painkillers, instead of receiving any medical treatment for their health conditions. Moreover, in many cases, the treatment appears to be deliberately delayed, which leads to further deterioration in the detainee's’ health.

   

Some of the detainees who are taken to the hospital report that they are subjected to harassment and ill-treatment by the guards accompanying them. Furthermore, BCHR has received reports that whenever political prisoners are taken to the public hospitals, they are handcuffed all the time including while receiving treatment. Some of them have been seen with chains on their legs as well. BCHR consider these excessive restrictions to be a form of humiliation and unnecessary measures used against political prisoners.

That being said, even if detainees receive some medical care, poor prison conditions play a role in furthering the deterioration of their health conditions. As per a recent report of the Prisoners and Detainees Rights Commission on its visit to Jau prison, it noted that “Medical staff were knowledgeable but lacked specialized training, and there was no medical consultant other than the psychiatrist who only attended twice a week. There were some delays in responding to emergency cases or when transporting the prisoners outside Jau Prison because the ambulance driver was not always available. There was no qualified paramedic but an assistant paramedic. The clinic was old and small and did not match the specifications of medical clinics.”  

As documented previously by BCHR, Dry Dock Detention Center, Jau Prison, and Isa Town Women’s Prison, all have poor living conditions. They all have been substantially overcrowded for the past few years, due to the large number of arrests and detentions that occur in Bahrain over politically motivated charges. In Jau Prison, due to overcrowding, some inmates end up sleeping on the floors alongside waste and cockroaches. Prison  cells  and  toilets  are  unsanitary,  the  healthcare  facilities are inadequate and the clinic is not equipped to deal with emergency situations. Damaged or unclean bedding is rarely replaced, and many inmates go without these basic necessities. Furthermore, detainees have to deal with physical abuse and ill-treatment from the guards, and even allegedly torture in some cases, just like during Jau prison events in March 2015, when detainees protested poor prison conditions.

It is important to note that some detainees carry out hunger strikes multiple times to receive adequate medical care, such as Ali Al-Bannaa, Abdullah Al-Samoom, Ayoub Adel, Habib Ayoub Al-Mughani, Jaafar Eid, and Qasim Hamada, but they don’t always end up receiving the medical care that they need.

Detainee Ebrahmi AlMiqdad fully chained in hands and legs

 

Sample Cases:

The following are sample cases of detainees suffering due to lack of medical care or improper detention conditions that are adding more risk to their deteriorating health:


1. Nabeel Rajab

BCHR’s President Nabeel Rajab has been held in solitary confinement since his arrest on 13 June 2016 with very poor and unsanitary conditions in pre-trial detention, in addition to ill-treatment. This is causing further deterioration to his physical and psychological health. On 28 June 2016, he was transferred to Bahrain Defense Hospital due to irregular heartbeats and high blood pressure; but he was transferred back to the police station the next day, though his health was still unstable. He lost 8 kgs in two weeks, and he continues to suffer from heart, gallbladder and blood pressure problems. His heartbeat was at 53bp, whereas a normal one ranges between 60-11. He cannot drink or eat well, or even use the toilet, due to the poor unsanitary conditions of his detention. Rajab also needs to have two different surgical operations to treat gallstones and an enlarged gallbladder. Rajab suffers from an enlarged prostate. He also needs to be seen by a hematologist. His operations were scheduled for August, but he has not yet received treatment. For more information, see here.

 

2. Akbar Ali Ahmed Al-Kishi

In 2012, Akbar Ali Ahmed Al-Kishi was arrested and sentenced to over 60 years in prison based on confessions extracted under torture. According to information received by BCHR,  Al-Kishi was reportedly subjected to torture again in March 2015, during Jau prison events, including beatings directed towards his head, which led to the severe deterioration of his psychological health, to the extent that he started to have hallucinations. He tried to commit suicide more than once. Due to the efforts of his mother, he was taken at some point to a psychiatrist, but according to his mother, he was not given any real attention by the doctor, and this didn’t help him at all. His mother says that there is no improvement in his mental state; he has been like this for a whole year and 3 months. For background information, see here.

 

3. Mohammed Faraj (22 years old)

Mohammed Faraj was arrested on 27 October 2014 and sentenced to 7 years in prison. Faraj suffers from Relapsing Remitting Multiple Sclerosis. His treatment requires injections three times a week and a regular intake of medicine. At first, the administration at Jau Prison - where he is held - refused to accept his injections and medicine that his family tried to provide many times. Afterwards, he was allowed to have the injections but not on a regular basis. As a result of that, his illness reached his spinal cord, and he was prescribed Gilenya pills by a specialist doctor. This would require him to have regular check ups in the hospital, which he is not allowed by the prison’s administration. Lately, his family demanded to contact him, as they didn’t hear from him for over 15 days. For more information, see here.

 

4. Elias Faisal Al-Mulla (25 years)

Elias Faisal Al-Mulla was arrested on 11 May 2012, and sentenced for 15 years in prison. In March 2015, during Jau prison events, Elias was reportedly subjected to torture, and was allegedly beaten repeatedly in his stomach by the security forces. In May 2015, he started to have a severe stomach ache. On 1 August 2015, he was taken to the hospital because he was continuously vomiting a lot of blood. In the hospital, he had a right hemicolectomy (open right colectomy), a surgery involving the removal of the right ascending part of the colon, and then attaching the remaining part of the large bowel to the small bowel, without the knowledge of his family. On 5 August 2016, he was diagnosed with colon cancer stage 3, but he was taken back to prison the same day, without knowing of his diagnosis. Al-Mulla didn’t suffer from any diseases in his colon before, nor does he have a family history of such diseases either. He started chemotherapy on 8 October 2015, and took 7 doses in total, then his 8th dose was canceled. He also took chemical pills and vitamins. Though he was supposed to take a dose every 3 weeks, his appointments were often postponed, because his immunity was too weak due to chemotherapy. For that reason, he was given injections to improve his immunity. However, he was sometimes not given all the pills that he needed, other times not given the pills at all, and at times not given the immunity injection as well. In addition, the poor prison conditions put him at risk of getting more sick due to his weak immunity. During his chemotherapy, he wasn’t given the food recommended to him by the doctor. Also during chemotherapy he suffered from general fatigue; pain all over his body, particularly in the joints, and in his legs; stomach ache; broken teeth; hair loss; vision loss;weight loss; back pain; his skin changed color and peeled off; paresthesia in his fingertips; irregular body temperature; and dizziness.

He still suffers from stomach aches (pain in the place of the surgery), pain all over his body and particularly in the joints, paresthesia in his fingertips, vision loss, and hair loss.
Al-Mulla was supposed to have an operation on 23 June 2016, of which his family doesn’t know the details. He refused to go, because he was feeling fatigued, and because he is mistreated by those who accompany him to hospital. In addition, he still feels pain in the place of the last surgery. His last family visit was on 11 July 2016, before which his family wasn’t able to contact him for 20 days. He needs to be taken to a specialist doctor for his vision and teeth; and he needs an appointment for a CT scan, and an operation. His health is deteriorating, and his family is afraid that if his cancer reaches stage 4 that he may be at risk of losing his life due to inadequate medical care.

 

5. Taiba Darwish (42 years old)

In March 2016, Bahraini authorities sentenced Taiba Darwish to five years in prison on charges of harboring wanted fugitives. Prior to her detention, doctors diagnosed Taiba with uterine fibroids. The symptoms worsened after her arrest, for which she was allowed some treatment, but it didn’t continue throughout her detention. In April 2016, pain and bleeding from her uterine fibroids returned. Darwish was allowed to go to the military hospital for treatment; however, no doctor was present during her medical examination. Doctors instead sent questions to Darwish via a police officer who then reported back to the doctor. Authorities did not give Darwish any medical reports from her examination. After her examination, doctors told Darwish they would provide her with two-months’ worth of treatment. Doctors said they would remove Darwish’s uterus if the fibroids did not respond to the treatment after two months. Before her April visit to the military hospital, Darwish’s test results showed no new fibroids in her uterus. Her existing fibroids had begun to shrink. Darwish later reported to prison warden Mariam Al-Baloudi that she felt humiliated by the doctor’s threat to remove her uterus. Al-Baloudi took no action as a result of these complaints. In addition, Darwish has problems with her kidneys, and continues to suffer from pain in her back and kidneys. Authorities promised Darwish access to treatment for this problem; but they have yet to allow medical care for her kidneys. Darwish’s prognosis has affected her psychological state. Darwish’s family worries about the lack of medical treatment Darwish is receiving while in detention. The family is also concerned about the verbal abuse inflicted on Darwish while they were present at a visit. Darwish reported to her family that authorities have subjected her to abuse worse than what the family witnessed.


6. Ali Al-Moaaily (51 years)

Ali Al-Moaaily was arrested in 8 May 2016, and was reportedly subjected to torture by security forces. His alleged torture led to the deterioration of his health; his heart muscle has gotten weaker, and his lungs filled up with excess fluid. In addition, on 4 June 2016, he had a stroke in his left side. He didn’t receive adequate medical care, as he was taken to Salmaniya hospital for only two days while in handcuffs, then was taken back to prison on 6 June 2016. His family visited him on 6 June 2016, and his voice seemed weak, and he was barely able to move. He also suffers from other diseases such as high blood pressure, herniated disc in his back, chronic pain in his legs, which puts his health at risk.  He was taken in a wheelchair to renew his detention.

 

7. Jaffar Ali Oun (29 years old)

Jaffar Ali Oun has been in detention at Jau prison since Jun 2014. He has reportedly been subject to torture on different occasions since his arrest including during the events of March 2015. He was allegedly beaten on his head, ears, and back with plastic hoses, iron rods and wires until he was bleeding. His family reported in August 2016 that he has been suffering from a growing swelling in the head in the past three months, described as “a second head of Jaffar.” As per the family’s reports, Oun has been requesting for months to go to the hospital, but the prison authorities are only taking him for emergencies to the prison clinic. He was given an appointment at the military hospital but was never taken to his appointments. Whenever he asks about the appointment date he is told that it cannot be shared with him due to “legal reasons.” Since the swelling on his head has not been diagnosed by a medical specialist, there is a great concern over its nature and possible effects on the life of Oun.

 

Recommendations:

The Bahrain Center for Human Rights (BCHR) reiterates the importance of upholding the international conventions related to the protection of individuals subjected to incarceration, specifically article 1 of the Basic Principles for the Treatment of Prisoners, which states that “all prisoners shall be treated with respect due to their inherent dignity and value as human beings.” The government should abide by the unconditional prohibition of torture stated in the UN Convention Against Torture (CAT) (ratified 1998), and the International Covenant on Civil and Political Rights (ICCPR) (ratified 2006) article 7. The government should also abide by the Standard Minimum Rules for the Treatment of Prisoners, including article 10 which states that “all accommodation provided for the use of prisoners and in particular all sleeping accommodation shall meet all requirements of health, due regard being paid to climatic conditions and particularly to cubic content of air, minimum floor space, lighting, heating and ventilation;” and article 22 which states that “Sick prisoners who require specialist treatment shall be transferred to specialized institutions or to civil hospitals. Where hospital facilities are provided in an institution, their equipment, furnishings and pharmaceutical supplies shall be proper for the medical care and treatment of sick prisoners, and there shall be a staff of suitable trained officers.”

Based on the above, the Bahrain Center for Human Rights (BCHR) calls on the government of Bahrain to:

  • Immediately and unconditionally release detainees held for politically motivated charges, and convicted using confessions extracted under torture;
  • Put an end to the the practice of systematic torture and ill treatment of detainees;
  • Improve the daily living conditions in detention centers and prisons;
  • Immediately and unconditionally provide all prisoners with adequate, and timely, access to medical treatment;
  • End the practice of denying prisoners medical attention as a means of intimidation and punishment for exercising their human rights;
  • Abide by the international standards for the treatment of prisoners;
  • Sign the Optional Protocol to the Convention Against Torture (OPCAT), which states that there should be a committee which supervises prison conditions and allows for surprise visits; and
  • Hold accountable all, particularly those in high positions, who are involved in the practice of supervising or ordering of torture and ill-treatment of detainees.

 

For reference: A list of the examined cases of prisoners suffering illness in detention.

 

 

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