Egypt: Abused and denied heath care, prisoners’ lives at risk

Prison officials in Egypt are subjecting prisoners of conscience and others held for political reasons to torture, cruel and inhuman conditions of detention and are deliberately denying them health care to punish dissent, Amnesty International said in a new damning report today highlighting how prison authorities’ callousness has led or contributed to deaths in custody and irreparable harm to prisoners’ health.

The report, “What do I care if you die?” Negligence and denial of heath care in the Egyptian prisons released on the 10th anniversary of the start of Egypt’s 2011 uprising, paints a grim picture of the human rights crisis in Egyptian prisons, which president Abdel Fattah al-Sisi’s government has packed with brave men and women who were at the forefront of the struggle for social and political justice. It also shows how prison authorities have failed to protect prisoners from the COVID-19 pandemic and regularly discriminate against prisoners from socio-economically disadvantaged backgrounds.

“Prison officials show utter disregard for the lives and wellbeing of prisoners crammed into the country’s overcrowded prisons and largely ignore their health needs. They leave it to the prisoners’ families to provide them with medication, food and cash to buy basics like soap and inflict additional suffering by denying them adequate medical treatment or timely transfer to hospitals,” said Philip Luther, Amnesty International’s Middle East and North Africa Research and Advocacy Director.

“The authorities go further in intentionally depriving men and women detained solely for exercising their human rights and others held for political reasons like health care, adequate food, and family visits. It is deplorable that the Egyptian authorities are seeking to intimidate and torment human rights defenders, politicians, activists and other actual or perceived opponents by denying them health care. When the denial causes severe pain or suffering and is a deliberate act for the purpose of punishment, it constitutes torture.”

The report documents the detention experiences of 67 individuals, held in three women’s prisons and 13 men’s prisons in seven governorates. Ten of them died in custody and two shortly after their release in 2019 and 2020.

Amnesty International communicated its findings to the Egyptian authorities in December 2020 but received no response.

Cruel and inhuman conditions of detention

Authorities subjected prisoners in the 16 researched prisons to cruel and inhuman conditions of detention, threatening their right to health.

Former detainees described being cooped up in unventilated, overcrowded cells with substandard sanitation, and guards denying them adequate bedding and clothes, sufficient food, items for personal hygiene including sanitary towels and access to fresh air and exercise. Scores are cruelly barred from family visits.

“There is evidence that prison authorities, in some cases citing instructions from the National Security Agency (NSA), target certain prisoners to punish them for their perceived opposition to or criticism of the government,” Philip Luther said.

Reprisals included being held in prolonged and indefinite solitary confinement in abusive conditions for more than 22-23 hours a day; being denied family visits for periods of up to four years and being deprived of receiving any food packages or other necessities from relatives.

Medical negligence and denial of health care

Amnesty International’s research revealed the prison officials routinely fail to provide prisoners adequate healthcare – either through neglect or deliberate denial.

Prison infirmaries are generally unsanitary and lack equipment and qualified health professionals, with prison doctors, only giving painkillers regardless of symptoms and even verbally abusing prisoners, including by accusing them of “terrorism” and “moral delinquency”. Two female former detainees said that prison medical staff sexually abused and harassed them.

Former detainees also said there was no clear mechanism to seek medical help including in cases of emergencies, and that they were completely at the mercy of guards and other prison officials, who frequently ignored their pleas. 

Virtually no mental health services are provided in prison, while access to external assistance was only made available for a few prisoners who had attempted suicide.

Prison authorities frequently refuse to transport detainees with political profiles needing urgent medical care to outside hospitals with relevant specialist capacity and withhold medication from them, even when costs could have been borne by families. 

Security officials continued to deny prisoner of conscience Zyad el-Elaimy, a former parliamentarian and one of the leading figures in 25 January 2011 protests from regularly receiving the constant care he needs for his underlying medical conditions.

Sixty-nine-year-old Abdelmoniem Aboulfotoh, a former presidential candidate and founder of Misr Al-Qawia opposition party, has been arbitrarily detained since February 2018 in solitary confinement and suffers from diabetes, high blood pressure and an enlarged prostate, yet the prison authorities have repeatedly denied his requests for transfer for treatment outside the prison, and severely delayed access to doctors inside prison. Prosecutors have dismissed his complaints.

“It is shocking that all 67 individuals, whose cases are documented in this report, were denied adequate health care in prison or transfer to hospitals with specialist capacity, at least once during their detention, thereby causing a significant deterioration in their health.” Philip Luther said.

“This gross dereliction of duty by the prison authorities is carried out with the knowledge and sometimes complicity of prosecutors in the absence of any independent oversight.”

Deaths in Custody

Amnesty International investigated 12 deaths in custody or shortly after release and is aware of 37 other cases in 2020, where the organization was unable to obtain consent from families for fear of reprisals. Egyptian human rights groups estimate that hundreds have died in custody since 2013 amid the authorities’ refusal to disclose figures or carry out effective, thorough, impartial and independent investigations into such deaths.

Horrid prison conditions, including in prolonged solitary confinement, coupled with the deliberate denial of adequate health care may have contributed or led to multiple deaths in 2019 and 2020. Lives were also cut short by inadequate or delayed treatment in cases of emergency.

Shady Habash, a 24-year-old filmmaker, died on 2 May 2020 after prison staff at Tora Investigations Prison failed to urgently transfer him to an outside hospital, despite knowing he was suffering from alcohol poisoning.

Mass arbitrary detention and overcrowding

The Egyptian authorities refuse to disclose the numbers of prisoners in the country. Estimates put the number at 114,000, over double the prison capacity of 55,000 indicated by President Abdalfatah al-Sisi in December 2020.

The number of prisoners mushroomed after the ouster of late former President Mohamed Morsi in July 2013, leading to severe overcrowding. In the 16 examined prisons, hundreds of detainees are crammed into overcrowded cells with an estimated average 1.1m² floor space available per prisoner, much less than the 3.4m² minimum recommended by experts.

The authorities continue to ignore calls to reduce the prison population amid COVID-19 outbreaks, endangering more lives. In fact, 4,000 fewer people were released in 2020 than in 2019 through presidential pardons and conditional releases.

Poor response to COVID-19 in prison

In the face of the COVID-19 pandemic, prison administrations have failed to regularly distribute sanitary products, trace and screen new arrivals, or test and isolate those suspected of infection.

Longstanding issues, such as a lack of clean water, poor ventilation and overcrowding, have made physical distancing and preventative hygienic measures impossible to implement.

Detainees with COVID-19 symptoms were not systematically tested. In some prisons, they were quarantined in small and dark cells used for solitary confinement without access to adequate treatment. In other prisons, they were left in their cells, endangering others.

No oversight

Prisons authorities operate with little to no independent oversight. Prosecutors have the authority to carry out unannounced visits to places of detention, but rarely do so and generally ignore prisoners’ complaints.

Detainees have initiated hunger strikes, which have been met with threats and beatings. Families who have protested in public have been arrested. Human rights defenders and lawyers have faced threats and imprisonment.

“The authorities must urgently reduce overcrowding including by immediately releasing all those detained arbitrarily and consider releasing prisoners at higher risk from COVID-19 complications due to their age or underlying medical conditions. They must provide all individuals in their custody with adequate health care, including COVID-19 vaccination, without discrimination. Egyptian authorities must allow independent experts unfettered access to prisons and work with them on addressing the abysmal conditions of detention and access to healthcare in prisons, before more lives are tragically lost.” said Philip Luther.