1. Third Meeting of Officials Responsible for Penitentiary and Prison Policies Washington, 17-18 September 2012 Health in Detention and Prison Settings Dr Mark STEINBECK Medical Delegate, ICRC

2. ICRC mission statement The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of armed conflict and other situations of violence and to provide them with assistance.

3. ICRC and detention in 2011 1,869 places of detention in 75 countries and in 5 different international courts holding 540,828 detainees of whom 28,949 were individually visited by ICRC delegates and of whom 14,790 were registered and visited for the first time in 2011

4. ICRC and detention Monitoring visits Family links Family visits Physical assistance to detainees Physical assistance to authorities Technical and structural assistance to authorities Therapeutic feeding Medical care

7. Declaration of Alma-Ata, 1978 International Conference on Primary Health Care "The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world- wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector."

8. Moscow Declaration 2003 International Meeting on Prisons and Health WHO / Russian Federation "Delegates noted that penitentiary health must be an integral part of the public health system of any country. In this connection, it is necessary for both prison health and public health to bear equal responsibility for health in prisons."

9. Recommendation C(f) Second Meeting of Officials Responsible for Penitentiary and Prison Policies in OAS Member States August, 2008 "Steps should be taken to promote the recognition and protection of the health needs of persons deprived of liberty, defined as the enjoyment of the highest possible level of physical, mental, and societal well-being in a manner consistent with community standards of care. This includes, among other things, timely medical attention in all various specialties, emergency care, and confidentiality in the handling of the patient's medical records and information."

10. Principal Actors Detention Authorities (MOJ; MOI; MOD) They are responsible for the health of the detainees: curative and preventative – including healthcare services and food Detainees – Inmates / Prisoners They are also responsible for their health: hygiene; exercise Minister of Health Is responsible for the service quality inside the places of detention, directly or indirectly

11. But it's not just the prison … Prison health cannot be addressed in isolation from the health of the general population as there is a constant interaction between the prison and the surrounding community, be it through the guards, the administration, the health professionals, visitors and the constant admission and release of prisoners. Prison walls may keep the prisoners inside the prison but community health and prison health freely intermingle. Therefore, prison health must be seen and treated as part of public health.

12. Main physical problems 1)Overcrowding 2)Insufficient food and nutrition 3)Bad hygiene condition – Infectious diseases 4)Life in prison: access to open air, living conditions, no major activities 5)Status of health of the prisoners before incarceration 6)Risk factors – drugs, violence, unsafe sex 7)Torture

16. Main systemic problems 1)Lack of resources 2)Motivation of the medical team 3)Difficulties in accessing the health services 4)Confidentiality and medical ethics 5)The link between the health services in the prison and outside the prison. 6)Which Ministry is in charge?

17. MOH because (1)Patients not prisoners (2) Integrated overview of health in the country (3) Medical ethics

18. Thank You www.icrc.org