1. PRETRIAL DETENTION & HEALTH UNINTENDED CONSEQUENCES – DEADLY RESULTS Denise Tomasini-Joshi

2. Summary  What is PTD  Why Focus on PTD  The Global Impact of PTD  Legal Standards  Health Consequences in PTD  Case Examples  The Global Campaign for Pretrial Justice  Recomendations

3. WHY FOCUS ON THE PRETRIAL PHASE?  Decision to detain someone before he/she is found guilty of a crime is one of the most draconian a State or individual can make  Decision: made in an instant  Loses freedom – can also lose family, home, education, community ties; and ACCESS to HEALTH SERVICES

4. A GLOBAL PROBLEM Number of people in pretrial detention Length of time spent in pretrial detention Percentage of all detainees who are in the pretrial stage Number: over three million people on any given day and over ten million people per year in pretrial detention Length: EU 167 days Nigeria 3.7 years

5. No. of persons in pretrial detention as % of all prisoners, 2010

7. A GLOBAL PROBLEM Percentage of all detainees who are in the pretrial stage Mali 88.7% Liberia 85% Bolivia 78.7% Niger 76% Paraguay 71.2% Bangladesh 69% India 67% © PAS Uganda

8. IMPACT ON THE STATE

9. HUMAN RIGHTS STANDARDS for PRETRIAL DETENTION  All persons have right to “highest attainable standard” of health goods and services  ICCPR: Persons in PTD should be held separately from convicted prisoners  Standard Minimum Rules: all rights of prisoners plus:  Allowed to wear own clothes, or prison-supplied clothing different from that of prisoners  Offered opportunity to work, but not required.  Right to all health services prisoners have, and should be allowed to be visited by own doctor.  Echo ICCPR: separate housing from convicted prisoners.

10. Main Health Risks in PTD  Treatment interruption  Withdrawal  Physical abuse  Exposure to poor conditions/disease

11. Treatment Interruption  A person gets arrested:  Lack of meds  Meds confiscated  Lack of access to medical professionals  Lack of contact to the outside world

12. Withdrawal  A person gets arrested:  Forced to go through withdrawal  Absence of drugs creates withdrawal  Lack of medications  Lack of awareness / interest / medical attention

13. Physical Abuse  The period before trial is the likely to lead to torture  Confessions  Extortion  Power  Vulnerable populations can be targeted by other inmates

14. Exposure to poor conditions/disease  Overcrowding  Lack of food/water/  Inadequate facilities  Designed as temporary  Arrestees usually from underserved communities  HIV prevalence higher in prisons and PTD than in the wider population

15. ‘DEATH SENTENCE’ IN HAITI’S PRISONS Health Through Walls David was18 years old and HIV positive when he was arrested and charged with theft in Haiti. He spent the next two years in pretrial detention, awaiting a court hearing. He was held, often without food, in an overcrowded cell where he had to fight for space to lie down. Eventually, he contracted drug-resistant tuberculosis from a fellow inmate. At age 20 he died in prison. He had never been convicted. In fact, he had never seen a judge, or even been to court.

16. Aleksanyan v. Russia (2008)  On 6 April 2006 he was arrested and remanded in custody  His health has progressively deteriorated. His eyesight worsened to the extent that he was effectively blind. In September 2006 he was diagnosed as HIV+.  2 key issues: length and rationale for pretrial detention and the treatment he received - including access to drugs and transfer to hospital with adequate services.  Court found violations of Articles 3 (inhuman or degrading treatment) causing suffering beyond that inevitably associated with a prison sentence and Article 5 (right to liberty and security) prolonged the applicant's detention on grounds which could not be regarded as "relevant" and "sufficient”.

17. SPECIFIC HEALTH PROBLEMS HIV/AIDS  We know what works – and what does not work:WHO/UNODC/UNAIDS Evidence for Action Papers: Interventions to Address HIV in Prisons: www.who.int/hiv/topics/idu/prisons/en/  HIV education programs  Prevention of sexual transmission  Needle & syringe program  OST and other forms of drug treatment  HIV treatment, care & support BUT: little, if anything, is done in pretrial settings

19. For further details: dtomasini@justiceinitiative.org Research and documentation (linking papers) Pilot innovative practices and methodologies, to identify effective, low-cost solutions. Build a forum for sharing knowledge among practitioners, researchers and policymakers – across communities. Foster sustained investment by governments & donors.

20. RECOMMENDATIONS  Research and data collection specifically related to ptd  Collaboration between health and legal professionals  Consideration re bail applications  Screening programmes, health checks and health care – from the entry point to the criminal justice system  Monitoring tools that address the specificities of ptd  Global Advocacy