The COVID-19 pandemic now sweeping the world is known to be particularly highly contagious and transmissible affecting mostly those who live in overcrowded and unhygienic environments.
ALQST has often reported on the overcrowded and insanitary conditions in Saudi Arabia’s prisons, where torture and ill-treatment, drugs and crime are also rife. In 2017 we reported on the spread of TB, scabies and other communicable diseases resulting from these chronically poor conditions. The General Prisons Directorate carried out an investigation, but did not act with transparency and did not reveal the true situation.
ALQST received videos and footage of inmates having to share beds or sleep in corridors and on landings. In some prisons inmates have to wash themselves in hand basins, using jugs of water, because they lack proper bathrooms or shower facilities.
In light of the extreme risks posed by overcrowding to the health of prisoners, staff and visitors alike, and at this time of public health crisis as the highly infectious novel coronavirus spreads throughout the kingdom and the world, ALQST urges the Saudi authorities to take measures to combat the spread of highly infectious diseases including and not limited to COVID-19 virus.
ALQST calls on the Saudi authorities to respect and ensure the basic rights of all those held in prison or detention centres, namely the rights to life, safety and health. ALQST makes the following recommendations to achieve this:
Initial assessment of new prisoners on arrival
1 - Organisation: The prison must have a well equipped clinic. A nurse and doctor must be available to provide immediate health care when needed. 2 - Screening and physical examination: Upon arrival from the community the prisoner must be screened for infectious diseases, including COVID-19, and receive a full physical and mental assessment.
- Special care should be taken to identify prisoners with communicable diseases such as STDs, HIV/AIDS, Hepatitis B and C, TB, other communicable respiratory diseases such as COVID-19 and scabies.
- Special care should be given to inmates with chronic diseases such as COPD, asthma, HTN, epilepsy, auto-immune disease and ischemic heart disease etc.
- Special attention must be paid to prisoners with a history of drug abuse, alcohol abuse and behavioural issues such as aggression/violence, and prisoners with suicidal ideation or self-harming.
- Special attention must be paid in regards with placement of prisoners who suffer from mental illness and require on-going observation in order to protect prisoners and maintain a safe and healthy environment.
- Special attention must be paid to prisoners with dental diseases or requiring dental care.
- Special attention must be paid to female prisoners, including cervical cancer scans and addressing the needs of pregnant women.
3 - Vaccines and medical treatment must be provided as needed. 4 - The examining doctor should make recommendations to the prison management regarding the prisoner’s placement and health care needs, such as any medication or special diet.
- All medications must be controlled following the relevant guidelines.
5 - Prisoners should be provided with a leaflet giving information on their health care rights, the physical, dental and mental health care services and facilities available, and how to access these services.
Recommendations regarding prisoner transfer
1 - When a prisoner is to be transferred to another facility, an assessment must be made regarding their fitness to travel and the availability of care in the new facility to meet the prisoner’s health care needs.
- Special attention must be paid to prisoners with pending medical appointments or procedures and those with communicable diseases.
2 - The prisoner’s medical file must be transferred with him/her, and if there is a need for continuity of care this should be clearly communicated to the relevant facility. 3 - The prisoner’s medications, if any, must be transferred with him/her. 4 - It should be assessed whether there is a need for medical staff (a nurse/doctor) to accompany the prisoner during transfer.
Recommendations regarding health promotion
1 - Provide educational sessions for prisoners on how to prevent communicable diseases (hygiene, hand washing etc.). 2 - Provide dietary education for prisoners with coronary heart disease, stroke, diabetes etc. 3 - Implement a no-smoking policy in public areas and separate smokers from those who do not smoke. 4- Provide exercise equipment and encourage inmates to stay physically active
Recommendations to avoid overcrowding and unhealthy conditions
To minimize the risks posed by overcrowding, ALQST calls for the release of all prisoners of conscience and grant pardons to those imprisoned for minor offences and pose no threat to the public.
1 - ALQST advises the Saudi authorities to follow strict measures for the minimum standard for personal living space in prison establishments which is being followed in several other countries, which are as follows:
- 6m2 of living space for a single-occupancy cell and sanitary facility
- 4m2 of living space per prisoner in a multiple-occupancy cell and fully-partitioned sanitary facility.
- At least 2m between the walls of the cell.
- At least 2.5m between the floor and the ceiling of the cell
- A cell of 8 to 9m2 should hold no more than one prisoner, and a cell of 12m2 no more than two prisoners.
- Furniture should be maintained in a decent state and efforts should be made to keep living areas clean.
- Sufficient ventilation must be provided to ensure renewal of air.
- Heating and/or air conditioning must be available to provide a comfortable room temperature.
- Prisoners must at all times have access to toilet facilities that afford them individual privacy.
- Prisoners should be encouraged to participate in purposeful activities such as work, vocational training, education and recreation.
2 - Prisoners should be provided with clean clothes, towels and bed linen. 3 - Prisoners should be provided with hygiene products such as soap and toothbrush and toothpaste. 4- Female prisoners should have access to sanitary protection. 5- Adequate shower facilities and laundry services should be provided.
Recommendations for infection control
1 - Vaccination and immunisation
- Hepatitis B immunisation should be offered to all prisoners as a preventive measure.
- Hepatitis A vaccine should be offered to all prisoners as a preventative measure.
- Influenza vaccine should be recommended.
2 - Communicable disease control TB , COVID-19 and other respiratory infectious disease :
- Provide prisoners with screening facilities based on current public health advice by the WHO.
- Provide appropriate diagnostic and treatment facilities for prisoners considered at risk.
- Arrange appropriate aftercare/follow-up where required.
- Maintain hygiene and infection control procedures, such as isolating infected patients from inmates who are not infected, use of masks etc.
- Provide prisoners with an appropriate clinical assessment and treatment for HIV-related illnesses.
- Medical, psychological and social implications should be discussed with the prisoner.
- Provide screening, therapy and immunisation as per public health recommendations.
- Provide education concerning the risks of needle-sharing and effectively implement anti-drug policies to prevent the spread of hepatitis.