Human Rights Watch Report: Overcrowded Prisons in Pakistan Deny Healthcare to Inmates

Outdated and discriminatory bail laws from the Colonial era, and rampant neglect by the state authorities in Pakistan have not only resulted in overcrowding in Pakistani jails and prisons, but have also deprived prisoners of basic or emergency health care, with thousands in jails at risk of disease and death, highlighted a report by the Human Rights Watch released on Wednesday.

The 55-page report, “A Nightmare for Everyone: The Health Care Crisis in Pakistan’s Prisons,” documents widespread deficiencies in the prison system, focusing on lack of health care and examining the consequences for a prison population of more than 88,000.

Six to 15 inmates squeezed in a prison cell for three

Pakistan has one of the world’s most overcrowded prison systems. Prison cells that have been originally designed for a maximum of three people actually hold up to 15, says the report. As of 2022, many of the country’s 91 jails and prisons were 100 percent over capacity.

In some prisons between six and 15 prisoners may occupy a single prison cell built to hold a maximum of three prisoners.

Jalal was 19-years-old when he was arrested in connection with a case of theft and sent to prison in Lahore in 2019. He remained in prison for 35 days in a cell with six other people. He said:

“I was there in summer [June and July] and we had one fan which only worked half the time due to power outages. In the Lahore heat, with the perspiration and sweat of seven people in a tiny room, it was like being baked alive. I was dizzy and sometimes delirious due to the heat. I collapsed and was unconscious three times and was given water, asked to take a shower and “not be dramatic. I lost six kilograms in one month, permanently lost my hair and had bags under eyes making me almost unrecognizable by the time I was released.”

Shafiq, 33, who was in a prison in Lahore for four weeks in 2021, said, “The room was so clogged at night that it was almost impossible to get up and go to the bathroom without stepping on people’s heads and the only option was to wait till morning.”

This severe overcrowding has resulted unhygienic conditions, inadequate and poor-quality food, and lack of access to medicines and treatment. More so, it has compounded existing health care deficiencies, leaving inmates vulnerable to communicable diseases –such as the deadly outbreak of COVID-19 in 2020. The floods that struck Pakistan in mid-2022 have also damaged many prison facilities, especially in Sindh, and left prison populations even more isolated and vulnerable to water-borne disease.

Besides lack of basic health care facilities, there are other rights violations against prisoners, including torture and mistreatment – a key symptom of a broken criminal justice system; corruption among prison officials and guards, and impunity for abusive conduct.

The prison health care crisis reflects the failures in health care across Pakistan, and is worsened by the recent economic crisis.

While the rich and influential inmates sometimes serve out their sentences outside prison in private hospitals, poorer prisoners must pay bribes only for pain relief medication. Colonial-era laws enable the government and other powerful people to interfere in police and prison operations, sometimes directing officials to grant favors to allies and harass opponents.

Patricia Gossman, associate director of Human Rights Watch Asia said that the prison system in Pakistan needed urgent reform. “Successive governments have acknowledged the problem and done nothing to address the most critical needs to overhaul bail laws, allocate adequate resources, and curb corruption in the system,” she said.

A lack of sentencing guidelines and the courts’ aversion to alternative noncustodial sentences even for minor offenses significantly contributes to overcrowding. Most inmates are under trial, and the majority facing criminal trials are poor and lack access to legal aid.

Stories from Within
Several former inmates in Sindh, Punjab, and Islamabad, were interviewed for the report, including women and juveniles. Others who were interviewed include lawyers for detainees and convicted prisoners, prison health officials, and advocacy organizations working on prisoner rights.

Aslam, 54, who was in Lahore prison from 2017 to 2020 says, “Almost from the beginning of my imprisonment, I had pains, swelling and stiffness in my body. My complaints were either ignored and jail staff would ask me to “man up” and “suck it up,” or on certain occasions I was given a painkiller. I could hardly stand up in the morning and kept pleading for an MRI or an ultrasound, but my requests were ignored.” Only when he was finally released was he diagnosed with arthritis.

A 37 old woman, who spent three years in a prison in Lahore, Punjab after being convicted for a drug trafficking offense between 2016-19 highlights how women were treated.

“Throughout my stay in prison, I suffered from acute migraines and hormonal issues causing pains and irregular menstruation cycles,” she said. “I was not allowed to meet a specialist even once and was only given a painkiller. It is extremely difficult for us to speak about menstruation to a male prison official due to social taboos and embarrassment. Women prisoners are treated the worst because in Pakistan they are abandoned by their families, and no one comes to visit them and hence the prison authorities know that no one is willing to pay any (bribe) money for their better treatment.”

Women and Girls

HRW spoke to nine women who had been imprisoned. Women in Pakistani prisons face mistreatment and abuse on a massive scale, reflecting discrimination and their vulnerability.

In 2020, Pakistan’s Human Rights Ministry issued a report, ‘Plight of Women in Pakistan’s Prisons, and submitted it to the prime minister. It documented poor conditions and barriers to adequate medical care faced by women prisoners. It found that of the 1,121 women in prison as of mid-2020, 66 percent had not been convicted of any offense and were detained prior to trial or while awaiting their trial’s conclusion. More than 300 women were detained in facilities outside the districts where they lived, making family visits nearly impossible. The prisoners included 46 women over the age of 60 and 10 girls under 18. Currently, only 24 female health workers are available to provide full-time care to women and girls in prisons across the country.

Children who accompany their mothers in prison faced additional risks. As of September 2020, 134 women had children with them in prison, some as old as 9 and 10, despite the legal limit of 5 years. Altogether at least 195 children were housed in prisons.

Lawyers and rights activists said that women prisoners are especially vulnerable to being abused by male prison guards, including sexual assault, rape, and being pressured to engage in sex in exchange for food or favors. An Islamabad based lawyer said, “The stigma attached to women being in prison is very high and often leads to women prisoners being abandoned by their families. This increases their vulnerability further and enables and encourages abusive behavior, including sexual violence. Women arrested for sex work form a significant group of the detainees and are most at risk of sexual violence and abuse.”

One woman said she felt like ‘a piece of meat on display’, the way she was touched and groped by the prison officials.

Other issues faced by women in particular were menstrual hygiene issues, lack of access to sanitary napkins, soap and clean water, lack of women in supervisory and senior positions in the prison administration.

‘Mental health patients told to pray’

In its findings, HRW noted that prisoners with mental and physical disabilities are at particular risk of abuse, discrimination, and mistreatment. A lack of awareness about mental health in Pakistani society has resulted in the abuse of those with psychosocial disabilities (mental health conditions), and prisoners who ask for mental health support are often mocked and denied services.

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.

A prisoner who had spent four months in a Lahore prison in 2018 said that he had depression and was thinking of ending his life. He said that when he requested professional help, an official told him, “Everyone here is depressed. Even I am depressed. You should start praying.”

The report said that the governments at federal and provincial levels should urgently focus on the prison health care system and bring it in line with international standards, such as the Nelson Mandela Rules.

However successive governments have only failed to allocate adequate resources and utilize them efficiently. 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, the HRW report noted.

In addition to addressing access to health care, 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.

Recommendations

The reasons for the abysmal and rights-violating conditions in Pakistani jails and prisons are multifaceted and fixing the problems will require broad structural changes, the HRW report stated. Even so, the federal and provincial government can adopt measures that can begin to bring significant changes in prison conditions and in particular improve prisoners’ access to health facilities.

The HRW report recommended that the government must prioritize to reduce overcrowding by enforcing laws and early release; bringing the bail law in line with international standards; implementing sentencing guidelines for judges to allow bail unless there are reasonable grounds to believe the prisoner would abscond or commit further offenses; reforming the sentencing structure for non-violent petty crimes and first-time offenders to include non-custodial alternatives; implementing a mechanism of free and adequate legal aid to prisoners who cannot afford private legal representation and finally ensuring that prisoners in pre-trial detention are tried as expeditiously as possible, and never detained longer than necessary.

The report called for increasing the number of prison medical professionals.
All prison rules must be in line with international standards such as the Nelson Mandela Rules and the Bangkok Rules and address the specific challenges faced by women and children, including menstrual and reproductive health.

Most importantly, the government must ratify the UNCAT (Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment) and install a mechanism to carry out unannounced inspections at all detention facilities. An independent, and transparent mechanism must hold those prison officials responsible who fail to uphold prisoners’ rights and maintain required standards in prison administration.