LAHORE: The authorities systematically deprived prisoners of adequate healthcare, leaving thousands at risk of disease and death, the Human Rights Watch said in a report released on Wednesday.
Outdated and discriminatory bail laws have led to severe overcrowding, with most prisoners yet to be tried or convicted.
The 55-page report, “A nightmare for everyone: the healthcare crisis in Pakistan’s prisons”, documents widespread deficiencies in prison healthcare in Pakistan and the consequences for a total prison population of more than 88,000 people. It says Pakistan has one of the world’s most overcrowded prison systems, with cells designed for a maximum of 3 people holding up to 15. Severe overcrowding has compounded existing healthcare deficiencies, leaving inmates vulnerable to communicable diseases and unable to get medicines and treatment for even basic health needs, as well as emergencies.
The HRW interviewed 54 people, including former inmates in Sindh, Punjab and Islamabad, among them women and juveniles, lawyers for detainees and convicted prisoners, prison health officials, and advocacy organisations working on prisoner rights. It said the principal cause of overcrowding was the dysfunctional criminal justice system itself. Most inmates are under trial and have yet to be convicted. The majority facing criminal trials are poor and lack access to legal aid. A lack of sentencing guidelines and the courts’ aversion to alternative non-custodial sentences even for minor offenses significantly contributes to overcrowding.
The crisis in prison healthcare reflects deeper failures in access to healthcare across Pakistan, exacerbated most recently by an economic crisis. Poor healthcare intersects with a range of other rights abuses against prisoners, including torture and mistreatment, and is a key symptom of a broken judicial system. Corruption among prison officials and impunity for abusive conduct contribute to serious human rights abuses. Rich and influential inmates sometimes serve out their sentences outside prison in private hospitals, while poorer prisoners pay bribes just to get pain relief medication. The colonial-era laws enable the government and other powerful people to interfere in police and prison operations, sometimes directing officials to grant favours to allies and harass opponents. Poor infrastructure and corruption have left prison healthcare services vastly overstretched. Most prison hospitals lack adequate budgets. Almost all prisoners interviewed described unhealthy and inadequate food, dirty water and unhygienic conditions. The HRW found that women prisoners were among the most at-risk inmates while prisoners with disabilities were at great risk of abuse, discrimination and mistreatment. The prison system lacks mental health professionals, and prison authorities tend to view any report of a mental health condition with suspicion. Psychological assessments for new prisoners are either perfunctory or not done at all.
The HRW has recommended that federal and provincial governments should urgently adopt measures to bring healthcare in jails and prisons in line with international standards, such as the Nelson Mandela Rules. The Sindh province is the only province in the country that has enacted prison rules in line with international standards, but the rules are not enforced well. In addition to addressing access to healthcare and ensuring sanitary living conditions and adequate food, the most important reforms include changing bail laws, expediting the trial process, and prioritizing noncustodial sentences to reduce overcrowding.