Sana’a Central Prison’s medical state: Under the microscope [Archives:2008/1166/Health]

Amel Al-Ariqi
Sana'a Central Prison last year recorded eight deaths among its more than 2,200 inmates.

Although prison officials admit that the facility has one of the highest fatality rates, compared to previous years, they insist that its medical services have increased remarkably.

However, this view is the opposite of what was published last month by a former medical employee, a bone specialist who had worked at the prison for two months and now is calling on international organizations to investigate the facility's true medical state.

Dr. Ahmed Abdulaziz Numan, who is also head of Manar scientific establishment for health studies and research, says that ill prisoners at Sana'a Central Prison “are in desperate need of human attention.”

He harshly criticized the prison management in his blog article entitled, “To whom it may concern,” published in both Arabic and English at http://msehsr1.pbwiki.com, accusing the prison's medical staff of carelessness, negligence, misusing medicines, committing medical errors causing deaths and mistreating and discriminating against prisoners.

In response, prison management recently opened the prison gates to the Yemen Times in order to investigate the facility's true medical situation.

Located in the north of the capital city, Sana'a Central Prison consists of three residential sections for men, women and young men between ages 16 and 20.

A clinic sees and attempts to treat sick inmates. “There are various widespread diseases among the inmates. Skin diseases, kidney infections, kidney failure, liver diseases, hepatitis, diabetes, heart disease, rheumatism and even gum diseases – they're all there,” clinic director Dr. Mohammed Ma'aiad explains.

The clinic, at which two doctors, a surgeon, and three nurses a work, is a small building consisting of four rooms: one for receiving and diagnosing patients, the second contains an ultrasound and a heartscanning machine, the third is a dentistry office and the last is used for medicine storage.

The three doctors work according to a certain timetable in order to be able to follow up patients' cases.

“Some cases are transferred to hospitals, especially those requiring intensive medical care, such as surgery or tests that we can't perform in this clinic,” Ma'aiad explains.

The clinic's monthly budget is YR 270,000 (approximately $1,350) provided by the capital's Health Office and used to cover the expenses of medication and testing. In addition to this amount, the Military Hospital provides the prison medicines.

“We still need more aid, especially medicine,” Ma'aiad says, pointing to the difficulties of giving certain patients the medical care they need. “Liver patients, kidney failure patients and those who've had surgery need certain medical attention, besides special nutrition that prison management struggles to provide.”

More tests needed

There are 69 female inmates at the central prison, where nine children live with their mothers in the same section.

“When a female enters the prison, she's given a pregnancy test,” explains Najiba Naji, director of the facility's women's section.

Prison administration conducts no other tests, such as a fitness test or a general health examination. “We don't give a malaria test or any other tests unless the prisoner requests it, as they sometimes must pay for such tests,” explains the inmate Aisha, who has spent three years at the prison.

Prison director Mutaher Al-Shubi stresses the importance of periodic medical testing, which may help prison management follow up health cases instead of discovering them at the prison. He says he wrote to the Health Ministry many times for help in this regard, but got no response.

“Last year, when the Ministry of Health conducted random medical testing among the female prisoners, we discovered many hepatitis infections and three HIV carriers,” confirmed Naji, who is also nurse.

“We did the tests only when obvious serious symptoms like fever and coughs appeared. We either do the tests at the prison or send them outside,” she explains, adding, “We also need a gynecologist to follow up cases and examine patients.”

As prisoner Fatim observes, “The doctors here are good; however, medicines sometimes aren't available, so some of us who still receive financial support from our families can pay for medicine from outside pharmacies, while others must wait until the prison administration provides them the medicine.”

The prison's laboratory is supplied with one microscope, and a basic blood analysis machine.

Al-Shubi further notes that the prison clinic still needs medical equipment such as an X- ray machine to help determine prisoners' ages. According to Dr. Numan, young delinquents often are mixed in with prisoners of the wrong age and thus are mistreated by the other prisoners, which leads to the spread of skin diseases.

Qat and cigarettes are one's best friends behind bars

Most ill inmates – particularly men – become infected in prison due to practicing bad habits. “Most inmates have poor health and hygiene, insisting on smoking tobacco and chewing qat. Such practices cause numerous medical problems among prisoners,” Ma'aiad notes, referring to cigarettes and qat that prisoners receive from their visitors.

He adds, “They get the worse kind of qat, full of pesticides, which causes many diseases, particularly teeth and gum infections.”

However, smoking and chewing qat isn't monopolized just by the prison's male population; female inmates also are greedy due to their addictions to qat and smoking. “Eighty percent of our female residents are smokers and qat chewers,” says one security official who wished to remain anonymous.

Thus, women holding cigarettes in their fingers while chatting with each other is a very common sight at the prison.

“We prevent illegal substances from entering the prison, but qat and tobacco are legal, so we can't keep it from those who already have a strong addiction to cigarettes or qat. Only if we want to punish a prisoner do we prevent him or her from having qat or cigarettes,” he added.

Despite these unhealthy and hard-to-break habits among inmates, doctors continue examining and testing ill prisoners, prescribing medication and recommending those patients requiring extra attention outside of the prison's bars, according to Dr. Mohammed Nasser, who works at the clinic daily.

“During the first two weeks of June, we sent four patients for surgery at government or private hospitals: two were Caesarean sections for Somali inmates and two were appendectomies,” Al-Shubi noted.

Wounded inmates

Some inmates, particularly those who were involved in gangs, arrive at the prison with deep wounds, from which they may have to endure the consequences during their stay at the prison, according to Al-Shubi. Most injured prisoners are victims of gunfire or stabbing.

He explains, “It's really bad because these individuals have been charged and already have medical issues, so we as prison management must deal with their situations and provide extra medical attention, depending on our limited resources.”

Psychiatric ward

A sanatorium was established at the prison in the 1980s to receive homeless and unknown psychiatric patients from the streets and in parks who were disturbing citizens by committing aggressive acts against women, children and pedestrians and spreading fear and terror on the streets and in alleyways.

The facility also contained those prisoners who went mad inside the prison and were transferred to the sanatorium to serve out their sentences. However, in 2005, the sanatorium came under Health Ministry supervision and now only holds mentally ill prisoners.

“At the sanatorium, those who have committed illegal acts and claim a mental disorder may be examined under a specialist's observation to determine his mental state,” Al-Shubi explains, confirming that some 70 prisoners now are receiving psychological treatment at the facility.

Accusations and denials

Al-Shubi denies claims that prison management has ignored some prisoners' medical cases. “That's not true. All prisoners receive the same medical services, regardless of the crimes they've committed,” he stressed.

“I could be rich by taking bribes from these prisoners who can get medical reports stating that they are suffering critical health situation and then get a conditional release,” Al-Shubi continued, “However, I follow certain procedures whereby I ensure that prisoners receive real medical care and have no access to obtaining fake medical reports.

“For example, I sent a prisoner to an honest good doctor without telling the prisoner's relatives or revealing the date of the visit in order to ensure that I would receive an objective result,” he recounted.

Al-Shubi further emphasized the prison management's responsibility to ensure prisoners' safety while receiving medical care outside of the prison bars, explaining, “In many cases, convicted murderers need protection from their opponents. When I send them outside the prison for medical examination or surgery, management should pay more to the security members who guard these prisoners, so I prefer if we can perform simple treatment at our clinic rather than sending them out.”

The prison director denies most of what Numan asserted in his article, responding, “We don't hide anything.”

Food from inside and outside

Because nutrition is an important aspect in keeping prisoners healthy, the facility provides inmates three meals a day. However, most – if not all – strongly depend upon food supplies from their visitors, who come daily. “We have around 400 visits per day,” stated one security official wishing to remain anonymous.

“Seventy percent of prisoners' nutrition comes from such visits, which really covers their needs; otherwise, it would be difficult to meet all of the prisoners' food needs,” he added, smiling.

Why did eight inmates die?

Despite prison management's efforts to provide medical services, problems are possible, Al-Shubi confessed, adding that the deaths occurred at his prison not because of its limited or poor medical services, but due to the serious illnesses they suffered, such as heart attack, cirrhosis and geriatric diseases.

However, he does admit that one female nurse caused the death of a 2-year-old suffering burns by allowing his mother to give him an injection during the nurse's absence.

“I don't say that we're perfect; I'd say that we're doing our best. Whoever works may make mistakes, whereas those who never work never make any mistakes,” he concluded.
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