30 May 2024

Joint Submission to the Special Rapporteur’s Report on Harm Reduction (Prisons)

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This joint submission to the Special Rapporteur on the Right to Health provides valuable input for preparing the Special Rapporteur's report on harm reduction for sustainable peace and development. It highlights the main challenges faced by people deprived of liberty during the Russian invasion of Ukraine and barriers to access essential medicines in prisons. t is co-signed by Harm Reduction International (HRI), European Prison Litigation Network (EPLN), and UnMode.

Full scale Russian invasions and prisons

After the full-scale Russian invasion of Ukraine in February 2022, people deprived of liberty have been disproportionately impacted by the war. Despite attacks on essential infrastructure, at least 11 prisons were not evacuated, and people deprived of liberty endured numerous human rights violations, including extrajudicial killings, ill-treatment, and torture. They also experienced the disruption of essential services, including medical care and harm reduction.

Following the Russian occupation of the Kherson Region, local organisations confirmed that around 2,0002 people detained in prisons in Kherson and Mykolaiv Regions of Ukraine had been illegally transferred by Russian forces to Russian territory in November 2022, in breach of international human rights and humanitarian law. All people transferred had been convicted by Ukrainian courts before the invasion, and information collected by local actors shows that the transportation of people deprived of liberty was made via occupied Crimea to prisons in Russia. Local organisations, activists and families tirelessly worked to trace the location of people transferred to Russia, finding out that most of them were ultimately transferred to correctional facilities in Krasnodar and Volgograd Regions, including medical prison facility in Volgograd (LIU-23). An unknown number of people were sent to correctional colonies in Vladimir and Sverdlovsk regions. Evidence also shows that some individuals were transferred to Rostov Region, where they were sent to a Prison tuberculosis hospital and a medical prison facility (LIU-20).

According to local organisations, all people transferred were ill-treated or tortured during their transportation to Russian territory. This degrading treatment was replicated upon detention in Russian prisons, where people were also segregated from the rest of the prison population, and deprived of contacts with the outside world and had no access to safe water, sanitation, or medical care. This is compounded by the general poor prison conditions in Russia, with reports indicating widespread ill-treatment and a high rate of transmission of infectious diseases, such as tuberculosis and HIV; with one third of all deaths in prisons being associated with HIV. In addition to that, from June 2022, around 100 prisoners in the occupied Kherson Region were deprived of the opioid substitution therapy which they have received before the occupation and which is prohibited in the Russian Federation.

While some transferred individuals were released from Russian correctional facilities after serving their sentences, they were immediately re-detained under immigration powers, imposed administrative deportation and sent to immigration detention centres. While the location and conditions of many of those who were placed in immigration detention could be traced, and many of them were able to leave Russia, the location and conditions of some of them remain unknown due to the lack of official communication channels and censorship. None of the immigration centres to which civilian prisoners from Kherson were transferred have adequate medical units, medicaments, and qualified medical specialists. As documented by Unmode and other organisations, Ukrainian prisoners living with HIV find themselves in the most vulnerable position, as the detainees in the immigration detention centres are not provided with the necessary anti-retroviral therapy.8 According to Unmode, an exception is that of Volgorad, where everyone who needed it received treatment for both HIV and tuberculosis.

Deprivation of liberty and access to essential medicines

Although over 30 countries have removed criminal sanctions for drug possession for personal use, punitive responses to drug policy remain a key contributing factor to prison overcrowding, with drug offences accounting for 22% of the global prison population. An estimated one third to half of people in prison have a history of drug use. People continue using drugs while incarcerated, often resorting to harmful drug use patterns, and it is in prison that many develop a problematic relationship with drugs.

Punitive drug policies and limited access to quality harm reduction services in prisons negatively impact on the health of people deprived of liberty and on/which could result in deaths in custody. Prisons are high-risk environments for the transmission of diseases due to a combination of factors including overcrowding, limited access to clean water and inadequate sanitary conditions, lack of healthcare and access to good-quality food, and mistreatment of people in detention. Additionally, the over-representation of vulnerable groups, such as people who use drugs, who are more likely to suffer from poor health, means many people in prison are at higher risk of becoming seriously ill if contracting a disease.

While harm reduction may be somehow available in some prisons, people in detention experience various barriers to accessing services due to, among others, stigmatisation and discrimination from prison staff and peers, which is compounded by poor prison conditions. In Asia, where only five countries provide Opioid Agonist Therapy (OAT) in at least one prison on their territory, punitive approaches to drugs have translated to poor detention conditions, which restrict the already limited access to basic harm reduction services. In Eastern and South Africa, while all countries provide HIV testing and treatment inside at least one prison, civil society has documented widespread barriers to access, particularly for women who use drugs, including humiliating and punitive treatment by prison staff, and availability of services in a limited number of facilities.

While OAT is available in most European and Eurasia regions, it is still insufficiently accessible. In Albania, Latvia, Montenegro and Serbia, people cannot start OAT while in prison, and it is only available if people were on OAT before being incarcerated. Research in Moldova in 2021 revealed that insufficient prison and medical staff is a barrier to accessing services, which is compounded by the lack of knowledge about harm reduction by existing staff. Methadone is considered a drug for prison staff.18 Lack of confidentiality and anonymity when trying to access the services, including needle and syringe programs (NSP) and OAT, is reported as a barrier by the prison population. In Romania, the National HIV/AIDS Strategy for the Surveillance, Control and Prevention of HIV/AIDS infection cases (2022-2030) recognises people who inject drugs and persons deprived of liberty as priority groups with access to free condoms, substitution treatments, and needle exchange programs. However, Asociatia Romana Anti-SIDA (ARAS) found that services are not evenly distributed or not implemented at all. Condoms are available for visits only in some prisons, and in other cases, people must go to the doctor’s office to access to the contraceptive, with the person accessing the service having to reveal they are having sexual relations in the penitentiary. ARAS also confirmed that despite NSPs being legally regulated, there is no program being implemented in prisons.

Conclusion and recommendations

Specific obligations for protecting the health of people deprived of their liberty derive from their inherent dignity and value as human beings, as well as their rights to life, to health and to be free from torture and ill-treatment. The increased degree of vulnerability caused by incarceration puts a heightened duty of care on the part of the State to protect their lives, and their physical and mental health. These rights are non-derogable and must be protected without exceptions, including in times of war or humanitarian crisis.

Additionally, following the principle of equivalence of care, international obligations bind States to provide at least the same standard that is available in the broader community including the provision of adequate health services that are closely linked to the general health service, continuity of care as people move between prisons and the broader community, including for infectious diseases and drug dependence provision of essential medicines, including methadone and buprenorphine and underlying determinants of health such as fresh air, clean water and adequate sanitation, nondiscrimination, and active and informed participation in decisions affecting their health.

In line with these international standards, and with the information provided through this submission we encourage the Special Rapporteur to recommend Member States to:

  • Decriminalise drug use and apply health and human rights centred community-based responses to drug use to reduce prison populations and promote the right to health;
  • Recognise harm reduction as an essential element of the right to health and incorporate it into prison health programmes and policies;
  • Ensure that good quality harm reduction services are available, accessible on a voluntary basis for all people in detention;
  • Eliminate all legal and policy barriers and stigmatising and discriminatory practices that limit the access to essential medicines and treatment for people deprived of liberty.
  • To actively protect the rights to life and the right to health of people deprived of liberty, including in times of war or humanitarian crisis;
  • In times of war and humanitarian crisis, prisons should be considered critical infrastructure that must be protected under humanitarian law;
  • People deprived of liberty must be prioritise when addressing health emergencies, war and humanitarian crisis and ensure the continuity of harm reduction on a voluntary basis for all people in detention;
  • People deprived of liberty cannot be transferred to other correctional facility outside the territorial jurisdiction without legal grounds and a fair trial. In case of war or humanitarian crisis, Member States must be held accountable of any human rights violation committed against people deprived of liberty.

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