AFEW International asks international organisations to take immediate action

AFEW International together with other European NGO asks international organisations to take immediate action and protect prisoners from coronavirus as soon as possible.

Text of the statement 

Appeal by European NGOs involved in the field of prison health and in the defence of the right to health protection for prisoners

The signatory organisations, which are involved on a daily basis in the protection of the right to health of prisoners, are alarmed at the unpreparedness of penitentiary administrations to deal with the spread of the coronavirus on the continent and, in most countries, the lack of consideration of the specific situation of prisons in national preparedness plans and systems for dealing with public health incidents. They recall that more than 1.5 million people are detained in prison facilities on the continent on any given day and that under international treaties, States are obliged to take the necessary measures to protect the life and health of those they detain.

The deficiencies observed pose a threat not only to prisoners and staff working in the institutions but also to the general population[1]. Prisons are generally considered to be amplifiers in the spread of infectious diseases[2].

Although levels of exposure to the health crisis vary greatly from one country to another, due to the great disparities in the characteristics of prison systems and the performance of national hospital systems, it appears that, overall, the prison issue is too largely ignored at European level, even though prisons are places with a high risk of transmission. Moreover, some states are tempted to adopt measures to isolate detainees from the rest of the population, in disregard of the rights of detainees and their relatives, and at the risk of preventing the population’s adherence to health instructions given by authorities.

Consequently, taking amount of the risk factors in the prison context, the signatory NGOs intend to alert the international organisations concerned, first and foremost WHO and the Council of Europe, to the serious shortcomings observed on the ground and urge them to put pressure on governments to take special health measures and reduce significantly the prison population as soon as possible.

Once again, the national contexts are highly contrasted and the picture drawn below should not be interpreted as reflecting a uniform situation. However, in view of the urgency of the situation, it is intended to underline the seriousness of the consequences that would result from failure to manage the coronavirus disease outbreak in prison and the imperative need for international organizations to act immediately to redirect national policies in this area.

  1. Prisons represent high-risk environments for the transmission of infectious diseases

1.1 Conditions of occupancy and organization of prison facilities. Prisoners are permanently in a situation of great promiscuity, whether in cells, production workshops, yards, etc. All aspects of prison life involve the movement of prisoners in groups, in more or less large numbers. The facilities are often poorly ventilated. In many European states, this situation is aggravated by regional or national situations of prison overcrowding[3]. From this point of view, the risks of spreading of the virus in the prison systems of post-soviet countries are particularly significant: i.) the prison population there is particularly large; ii.) remand prisons are often overcrowded and organised in collective cells, while correctional institutions are mostly organised in barracks housing 80-150 convicts, if not more; iii. ) once convicted, prisoners are transported for weeks or even months to their assigned correctional institutions; these transports take place in appalling hygienic conditions and involve repeated stops along the route.

1.2 A population at high risk of communicable disease and facing serious risk factor for coronavirus severity. In particular, the notification rates of tuberculosis in European prisons are up to 30 times higher than in the general population[4]. Prison populations in Europe are aging at an unprecedented rate[5]. Several countries in Europe, especially in Eastern Europe report HIV prevalence among prisoners at rates greater than 10 %[6]

1.2 A frequently failing medical system. Although the level of development of prison medicine varies greatly, the organisation of care in prisons is never designed to deal with a crisis situation. Even more critically, especially in Eastern Europe, services are very often under-equipped, understaffed and unable to cope adequately with the ordinary burden of common diseases. Moreover, they generally suffer from a very poor linkage with the general health system, leading to significant delays. Almost everywhere, the unavailability of escorts is a recurrent problem for the transfer of patients to the hospital.

  1. WHO guidance against COVID-19 spread are hardly implemented in prison.

WHO has provided States with guidance for public health measures that can slow the transmission and spread of COVID-19[6]. Accordingly, many States have taken measures to prohibit gatherings, to close down most public places and impose quarantine on the population to ensure social distance. However, although all countries are not on an equal footing in this respect, most measures recommended by the WHO are not, for the most part, implemented in prisons[7].

2.1 The reduction of prisoners’ contact with their relatives: mostly adopted response by prison administrations. Domestic authorities have generally limited themselves to providing information about the virus and drastically limiting prisoners’ contact with the outside world[8]. Some, like France, have suppressed collective activities within the prisons. However, these measures do not appear to be of such a nature as to adequately prevent the risks of contamination, which may be caused by new entrants, extractions of prisoners to the courts, staff working in the prison, etc. These measures can have perverse effects: prisons are particularly vulnerable to fake information/myths that may circulate by word-of-mouth or online. The increasing isolation of the prison environment accentuates the impact of rumours[9].

2.2 The maintenance of recurrent situations of regrouping of people: a favourable environment for the spreading of the virus. At present, detainees are generally still faced with multiple and routine gathering situations, for roll call, work, showers, etc.. Prison staff are in daily contact with a large number of detainees, conduct body and cell searches.

2.3 Failure to implement the required prevention interventions. From this point of view also, authorities do not seem to consider the risks of internal propagation within the prison. Detainees are frequently not in a position to observe hand hygiene instructions[10]. Masks for symptomatic individuals or health staff are not available[11]. Environmental cleaning is done under usual conditions.

  1. COVID-19 case management

The laconism of the prison preparedness and response plans disseminated, or even the absence of any public information on the subject, indicates that prison medical services have not, at this stage, been prepared for an influx of COVID-19 cases. In view of the serious failures of the services concerned in the management of common pathologies in ordinary times, the lack of preparedness suggests an improvised and therefore potentially chaotic management of COVID-19 cases.

3.1 Intervention protocol and articulation with civil medicine. In most of the countries, no information was available on the intervention protocols defining the division of roles between prison medicine and civil medicine.

3.2 Capacities of penitentiary medical facilities. Apart from exceptions[12], the available information does not show any reinforcement of the medical units in terms of personnel and equipment, particularly respiratory equipment. It does not appear that guidance to health providers for COVID-19 and severe acute respiratory infections has been disseminated.

3.3 Conveyance and stay of detained patients in hospital. No increase in the number of medical personnel was reported, nor were escorts provided to transport patients with Covid-19 to civilian hospitals. No legal measures to ease the transfer and hospital stay appear to have been envisaged.

  1. Measures liable to infringe fundamental rights.

Several countries have taken, or are about to take, drastic measures to limit the prison population’s contact with the rest of the world. Some countries have decided to completely suspend family visits[13], others have imposed severe restrictions in this area. Some States have provided for compensatory measures, such as increased telephone[14] or video conferencing facilities[15].

Several UN experts[16] and the Council of Europe have urged States to avoid overreach of security measures in their response to the coronavirus outbreak. When it comes to prison, the NGO Penal Reform International has recalled the requirements of necessity and proportionality of measures limiting visiting rights in this context[17].

While limitations on contact with the outside world may be justified where they are proportionate to the risk and accompanied by adequate compensatory measures, it must be stressed that closing prisons on themselves increases the risk of ill-treatment, especially in crisis and panic situations. Limitations on visits and activities will inevitably lead to situations of great tension[18]. Prison administrations will face unprecedented pressure. If relief measures are not taken swiftly, particularly in terms of the number of detainees, they may find themselves facing situations that are very difficult to manage.

Furthermore, it is essential that NPMs retain their right of access to prisons and that detainees have the possibility of contacting them by telephone, under appropriate conditions of confidentiality.

 

  1. An indispensable intervention at the international level

The Signatories urge international governmental organizations to take full account of both the major health risk associated with the spread of COVID-19 in prisons and the inertia shown by States, and consequently to take measures to ensure that States act effectively and with full respect for the fundamental rights of detained persons.

5.1 Health measures of prevention, early detection and control of COVID-19. International organizations must act swiftly to get States to develop the required prevention and response plans. WHO must play its leading role in this area and provide support to authorities for preparation and response. However, the technical support approach is not enough, and WHO and the relevant United Nations and Council of Europe bodies must use all their influence to bring States to meet their international obligations to protect the life and health of detained persons.

5.2 Avoid the spread of COVID-19 by significantly reducing the prison population. Whatever measures may be taken by the prison authorities to adapt to life in detention, the configuration of the premises and the organization of the prisons do not allow for the implementation of preventive measures, and in particular of social distance. Unless there is a clear reduction in the number of detainees, the virus will spread rapidly within the facilities and the prison and medical services will be overwhelmed. The national authorities must take urgent measures to seriously reduce the number of prisoners. In this respect, Council of Europe bodies, and in particular the Committee of Ministers, the General Secretary, the Committee for the Prevention of Torture (CPT) and the Commissioner for Human Rights, which play an important role in guiding penal and prison policies, must rapidly adopt recommendations to bring states to take these decisive steps. States have at their disposal a wide range of measures that can produce rapid effects, from penal policy guidelines provided to prosecutors’ offices to exceptional measures of pardon and amnesty. It is essential that an impetus be given very quickly at European level to steer national policies in this way.

5.3 Monitor respect for fundamental rights. The mechanisms for monitoring respect for fundamental rights should take exceptional organisational measures in order to be able to fully play their role. First, the ECtHR should strengthen its capacity to deal with requests for interim measures under Rule 39. In ordinary times, these are already very often necessary in some countries, such as Russia or Ukraine, in order to obtain acts of care which are essential for the protection of life. It is likely that the number of well-founded requests will increase significantly. Moreover, for legal or practical reasons, prisoners’ access to their lawyer or to NGOs will become acute. The Court should adopt practical instructions adapting the formal requirements resulting from Article 47. The other relevant bodies of the Council of Europe and the United Nations should organise the monitoring of the measures taken by states to combat the pandemic.

A PDF version of the document

On 18.03.2020

First signatories :

European Prison Litigation Network – EPLN

Eurasian Network of People who use Drugs – ENPUD

Helsinki Foundation for Human Rights (Poland)

Altro Diritto (Italy)

PromoLex (Republic of Moldova)

Antigone (Italy)

Belgian Bar (French and German speakers bars) – Avocats.be (Belgium)

Kharkiv Human Rights Protection Group – KHPG (Ukraine)

Ukrainian Human Rights Institute (Ukraine)

Bulgarian Helsinki Committee (Bulgaria)

Public Verdict Foundation (Russia)

Russia Behind Bars (Russia)

Ban Public (France)

Observatoire International des Prisons – Section Française (France)

Prison Archive/Strafvollzugsarchiv e.V. (Germany)

Legal Basis (Russia)

Agora International Human Rights Group (Russia)

Zona Prava (Russia)

Association for Human Rights of Andalusia (Spain)

Iridia – Center for the Defense of Human Rights (Spain)

Centre de la protection internationale (France/Russia)

Siberia Without Torture (Russia)

Man and the Law (Russia)

Ural Human Rights Group (Russia)

Civil Activists (Russia)

Tatort Zukunft (Germany)

Kosova Rehabilitation Centre for Torture Victims – KRCT (Kosovo)

Avocats sans Frontières – ASF (Belgium)

La Ligue des Droits de l’Homme – Section belge (Belgium)

Alliance of Ukrainian Unity (Ukraine)

HPLGBT (Ukraine)

«New Life » (Russia)

«All-Ukrainian League «Lеgalife» (Ukraine)

Zahid Chance (Ukraine)

Initiative Group PULS (Moldova)

Citizen N. (Russia)

Forum PUD (Russia)

Ukrainian Helsinki Human Rights Union (Ukraine)

AFEW International (Netherlands) 

[1] WHO, Prison and Health, Genève, 2014
[2] The Lancet, HIV and related infections in prisoners, Sep 10, 2016 Volume 388Number 10049p1025-1128, e2-e3
[3] Prison population brief. See also CoE, White Paper on Prison Overcrowding, CM(2016)121-add3
[4] WHO Europe, Good practices in the prevention and care of tuberculosis and drug-resistant tuberculosis in correctional facilities (2018)
[5] For instance, a report by Public Health England (PHE) showed that the proportion of people in prison aged 50 or older has increased by 150 per cent between 2002 and 2017.
[6] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
[7] In France, the National Preventive Mechanism stated on 16 March that the safety of persons in remand detention centres was no longer guaranteed and that the administration will therefore fail in its obligation to protect the persons under its control if it does not take the necessary measures as a matter of urgency. It called for a reduction in the prison population by encouraging prison exits and limiting entries.
[8] In addition to visitations restrictions, the Irish Prison Service planned on a number of contingency measures to reduce the number of people in custody in a controlled manner.
[9] In Italy the lack of medical information and miscommunication resulted in panic and false myth.
[10] For instance, hydroalcoholic gel is prohibited for detainees.
[11] In Italy, according to the NGO l’Altro Diritto, ombudsmen have expressed high concerns for the lack of masks, gloves or sanitizer. In Belgium, the guidelines for the management of suspected or actual cases of contamination recall the shortage of means of protection (masks, disinfectant gel) and recommend their use only when necessary.
[12] In Moldova, the texts dated 12 March foresee the supply of equipment stocks (protective masks, multifunctional electronic thermometers, etc.), medicines, biodistructive preparations, etc.;
[13] Including Belgium, Spain, Italy, France, Russia, Ukraine, Moldova, Bulgaria
[14] Belgium has granted a 20 euro telephony credit to all detainees.
[15] On 8 and 9 March, the Italian authorities authorised wide access to video calls to offset the effects of the suspension of visits. However, these instructions were unevenly applied, contributing to the outbreak of trouble.
[16] COVID-19: States should not abuse emergency measures to suppress human rights – UN experts, GENEVA (16 March 2020)
[17] Penal Reform International, Coronavirus: Healthcare and human rights of people in prison, briefing paper, 16 March 2020.
[18] Riots or protests have been taking place in 27 prisons throughout Italy. In this context, 13 prisoners died on 7 March 2020.

How to help migrants?

According to UNAIDS (www.unaids.org)[1], Russia has the second highest number of labour migrants in the world after the USA. Rostov region is one of the areas where this number is constantly growing. One of the reasons is its geographical position – Rostov region has the biggest borderline with Ukraine. Due to this fact as well as certain developments related to the armed conflict in Donetsk and Lugansk regions, many migrants from Ukraine with different statuses are coming to Rostov region, in addition to the labour migrants from Central Asia.

Are there any special services for migrants in Rostov-on-Don? How is HIV prevention implemented among migrants? Where can migrants seek help without endangering themselves? AFEW International asked these questions to Vyacheslav Tsunik, President of Rostov-on-Don Regional NGO “KOVCHEG – AntiAIDS” and Manager of the Project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”.

Significant financial support to carry out surveys and provide services to migrants within this project was provided by AFEW International, which, in particular, facilitated coordination with the Central Asian organisations to provide effective support to migrants when they leave their countries of origin and come to Russia.

For reference

Labour migrants are one of the populations most vulnerable to HIV in the world, which is explained by a number of factors. The data of numerous studies show that people coming from the Central Asia have a very low knowledge of infectious diseases: HIV/AIDS, hepatitis B and C. The situation is further aggravated with the low social and economic status of the migrants from Central Asia and the neighbouring countries, lack of access to health services, low level of social support and high prevalence of depression caused by such people living away from their families. High isolation of this social group often leads to HIV transmission inside this community, in particular through contacts with female sex workers, who come from the same countries.

Vyacheslav, how accessible is health care for the labour migrants in Rostov-on-Don?

Health care is provided to the labour migrants who officially live in Russia, in particular in Rostov region, based on their insurance certificates, which they buy when registering their patents. Without certificates, people can access health care on a paid basis, while emergency care if a person’s life is under threat in cases of heart attacks, strokes, catastrophes or accidents is provided to everyone, even with no documents, free of charge and is covered by the state.

How well informed are labour migrants about the problem of HIV?

Surveys among the labour migrants showed that they are not well informed about HIV. In our opinion, the reason is lack of preventive information provided to them in educational institutions in their home countries and when they come to work in Russia.

Do migrants practice any risky behaviours?

In fact, the prevalence of risky behaviours among migrants is approximately the same as among all young people. If we talk about the migrants who come from Asia, e.g. from Tajikistan and Uzbekistan, they have less risky behaviour due to their national customs and traditions. They mostly socialize with their fellow countrymen and they also have respect to older people and certain traditions, which restrict their risky behaviours. As for people from Ukraine and Moldova, they are closer to us, Russians, in terms of their culture and so the situation among them is similar to ours. There are young people who practice high-risk behaviour in terms of HIV. Mainly, they represent key populations. Their share in the total number of migrants is not so big, but they exist and some of them are clients of our organisation. They are not ready to quit their behaviour models.

Are there any differences in the behaviours of HIV-positive and HIV-negative migrants?

There is really a difference in the behaviours of migrants with HIV and those who do not have HIV.

Migrants living with HIV are a closed group. They are not ready to talk about their disease with their family members or their countrymen. Usually, they seek help in HIV organisations only in life-threatening situations or sometimes when they need to stock up their ARVs if there is a danger of treatment interruption.

In Russia, if migrants test positive for HIV, they cannot access free antiretroviral (ARV) therapy as they are foreign citizens. How is this issue resolved?

The situation with supply of ARVs is regulated by relevant provisions. In Russia, government covers ARV therapy only for the citizens. That is why migrants are not able to access free treatment as they are not Russian citizens. However, our organisation has contacts with community organisations in a number of neighbouring countries. We can help people who come to us and assist them is getting support services and ARVs from the countries of their origin.

Currently you are implementing the project “HIV Prevention and HIV Services for Migrants in Rostov-on-Don”. Please tell us more about it.

The goal of our project is to slow down the transmission of HIV through raising the awareness of HIV among migrants and creating services aimed at HIV prevention in migrant populations.

What do we do? Firstly, we train peer consultants from among migrants. Secondly, we provide medical and social support to HIV-positive migrants, giving them access to health services. Thirdly, we have meetings and negotiations with the representatives of diasporas concerning implementation of the prevention tools among migrants in Rostov region and coordinate service provision with the NGOs in the countries of origin of those people who seek our help.

Our organisation, “KOVCHEG – AntiAIDS”, is a community-based organisation of people living with HIV, representatives of vulnerable populations, PLWH, sex workers, LGBT and migrants. For instance, with our current project we trained a peer consultant from the migrant community. This is a woman from Ukraine living with HIV. Another peer consultant that we have, who works with people who use drugs, is also a citizen of Ukraine. Besides, when we carried out a survey among migrants, we had a volunteer supporting us – Ravshan from Uzbekistan – who is a student of a university in Rostov region.

Within the project for migrants, we organized the process to deliver HIV services. In particular, we have rapid testing, pre- and post-test counselling, if necessary provision of ARVs from our reserve stock, medical assays and support in receiving consultations from infectious disease doctors, tests for immune status and viral load, prescription of medications and treatment monitoring. We also inform migrants about the existing legal opportunities to acquire Russian citizenship with HIV status and facilitate people with HIV in obtaining temporary residence permits and Russian citizenship.

How and where do you share information about the services available?

Migrants can access our informational leaflets in the places, which they visit, such as the migration departments, health institutions, which issue the required health certificates to them, pre-deportation detention centres, and higher educational institutions we cooperate with. We use QR codes, allowing migrants to download any information on their smartphones and use it when necessary. As a result, it brings clients to our consultants, who can provide them with any additional information needed.

Name one of your most important recent activities?

Recently, we appealed to the Public Monitoring Commission and asked it to help us access the migrants in pre-deportation detention centres. The Public Monitoring Commission sent an official request to the Ministry of Internal Affairs. We visited the detention centres, met with the migrants living with HIV who stayed there and agreed with the administration of such centres that we would have further access to such migrants living with HIV. We are planning to seek financial opportunities for people living with HIV to receive consultations from infectious disease doctors, get tested for their immune status and viral load and access ARVs for the period of their stay in such institutions. Besides, we are working on developing an appeal to the government officials about the need to provide this category of people with HIV treatment at the expense of the state.

[1]Migrant populations and HIV/AIDS: the development and implementation of programmes: theory, methodology and practice / UNAIDS, UNESCO.