“A Nightmare for Everyone” The Health Crisis in Pakistan’s Prisons

health by, inter alia, refraining from denying or limiting equal access for all persons, including prisoners or detainees, minorities, asylum seekers and illegal immigrants, to preventive, curative and palliative health services.”[177] Under the UN Code of Conduct for Law Enforcement Officials, police need to “ensure the full protection of the health of persons in their custody and, in particular, shall take immediate action to secure medical attention whenever required.”[178] Pakistani law provides that if an inmate becomes injured or ill, a prison physician needs to provide medical treatment. If required, however, and only
when the superintendent considers it necessary, the inmate may receive medical treatment from outside physicians or be admitted to an outside hospital.[179] Relevant sections of the United Nations Standard Minimum Rules for Treatment of Prisoners (Nelson Mandela Rules) define minimum standards regarding water, sanitation, food, and health care.[180] The right to clean drinking water is protected by article 11 of the ICESCR,[181] as well as the Mandela Rules.[182] The 1978 Pakistan Prisons Rules mandate that there must be clean drinking water pitchers available in each cell.[183] The Mandela Rules provide that governments need to ensure that “at every institution there shall be available the services of at least one qualified medical officer who should have some knowledge of psychiatry. The medical services should be organized in close relationship to the general health administration of the community or nation.”[184] Under international standards, Pakistan is obligated to provide specialist care for prisoners requiring it or transfer them to civil hospitals. The Mandela Rules state: “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.”[185] IX. Recommendations
To Pakistan’s Federal and Provincial Governments
Address overcrowding in Pakistani prisons by:
enforcing existing laws and early release;
reforming the bail law to bring it in line with international standards of presumption of innocence and liberty of the individual;
implementing sentencing guidelines for judges to allow bail unless there are reasonable grounds to believe the detainee would abscond or commit further offenses;
reforming the sentencing structure for non-violent petty crimes and first-time offenders to include non-custodial alternatives;
decriminalizing sex work;
creating a mechanism of free and adequate legal aid for criminal suspects who do not have the resources to engage private legal representation; and
ensuring that suspects in pre-trial detention are tried as expeditiously as possible, but never detained longer than necessary.
Prison staff
Ensure the independence of the provincial prisons’ departments by removing them from the supervision of the provincial home ministries.
Improve the standards of academic, physical, and psychological tests conducted to recruit prison officers and increase compensation.
Encourage and facilitate greater admission of women into the prison training academies.
Improve the standards of instruction at prison academies for officers of junior ranks by providing high quality instructors and resources to trainees.
Build dedicated prison training institutions in each province with curriculums based on international standards.
Health standards and medical care
Ensure all prisoners have adequate supply and free access to essential hygiene and sanitation items including soap, shampoo, sanitary pads, and uninterrupted access to clean drinking water.
Ensure that prison menus are revisited in consultation with provincial health departments and medical experts to bring food service in line with international nutritional guidelines.
Ensure that all prisons in Pakistan have adequate medical facilities, including medical officers, psychologists, sufficiently stocked hospital pharmacy and a prison hospital with all necessary equipment for primary and secondary care.
Ensure that all prison medical officers receive specialized training in correctional medicine.
Prisoners with disabilities
End the arbitrary detention of individuals on mental health grounds and ensure ongoing training of prison healthcare staff to respond to the needs of prisoners with mental health disabilities.
Ensure that prisoners with mental health disabilities are not segregated from other prisoners and receive adequate support services for their disability. They should never be segregated or diverted to alternative systems such as psychiatric hospitals.
Systematically screen prisoners for all types of disabilities upon entry into prison and provide appropriate support and accommodations.
Improve mental health services in prisons by providing sufficient qualified mental health professionals, adequate resources, services are gender-sensitive, based on free and informed consent, and the quality of care meets community standards.
Establish public safety commissions at the district and provincial level on the lines of Police Order 2002 with the power to visit prisons and examine prison conditions.
Establish an efficient, independent, and transparent mechanism to hold prison officials accountable for failure to uphold prisoners’ rights and to maintain required standards in prison administration.
Reform the Pakistan Prison Rules to bring them in line with international standards including the Nelson Mandela Rules and the Bangkok Rules.
Empower public safety commissions to do unannounced inspections to examine the food being served in prisons.
Ratify the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and establish a mechanism to carry out unannounced inspections of all detention facilities.
To Federal and Provincial Legislatures
Enact legislation that specifically defines torture as a criminal offense in the Penal Code and carries appropriate penalties.
Amend the Qanun-e-Shahadat Order 1984 to make inadmissible any evidence obtained on the basis of a police interrogation that involved the use of torture or other cruel, inhuman or degrading treatment or punishment.
To Foreign Governments and Donors
Raise whenever appropriate with the Pakistani government at the highest levels, concerns about police abuses, including mistreatment in custody. Urge the government to ensure that the police treat all individuals in accordance with international human rights standards.
Offer to include, in areas where there is a genuine and demonstrated commitment to reform, specialized police and prison staff training.
Provide increased support for Pakistani civil society organizations engaged in effective human rights monitoring and delivery of assistance to victims of police and prison staff abuse.
This report was written by Saroop Ijaz, senior counsel to the Asia division at Human Rights Watch. Patricia Gossman, associate Asia director at Human Rights Watch, edited the report. James Ross, legal and policy director, provided legal review, and Tom Porteous, deputy program director, provided program review. Skye Wheeler, emergencies researcher for the Women’s Rights Division; Bede Sheppard, deputy director of the Children’s Rights Division; and Kriti Sharma, senior researcher in the Disability Rights Division, provided additional reviews. Audrey Gregg, associate for the Asia Division, provided editorial and production assistance. Additional production support was provided by Travis Carr, publications officer. The report was prepared for publication by Fitzroy Hepkins, administrative manager.

Human Rights Watch wishes to thank those who agreed to be interviewed for this report in Pakistan, and the Legal Aid Society, Human Rights Commission of Pakistan, and Justice Project Pakistan for their assistance with our research.