Writer: Daneeya Sheeraz
You are in an old prison cell packed to the brim with bodies. On one side, a grimy wall digs into you while from the other, sticky bodies are pressed into yours. Temperatures soar past forty degrees Celsius and the humidity is so intense, everyone is soaked in perspiration and every lung-full of air is heavy and saturated with water vapor. The smell is unbearable, the soulless eyes are unsettling, and the constant sound of coughing is painful. This is not an article for sympathy, but one for basic human rights.
Originally, I started this article wanting to investigate and research the link between access to medical care in Pakistan and crime. However, during my research, I came across a different perspective that captured my attention much more - the state of healthcare for prisoners in the country.
Pakistan’s flawed and frail justice system and police service are no secret. The crumbling foundations both are built on are clear to see. Victims and criminals, and even innocents who are wrongly bolted behind bars, are casualties of these decaying and corrupt systems.
The criminal justice system has four pillars: prosecution, judiciary, police, and prison. Ihsan Ghani Khan (former Inspector General of Police) says that out of these four elements, prisons are the most abandoned element and most of the focus is turned to bettering the police service.
No Room to Breathe
Pakistan has one of the world’s most overcrowded and densely packed prison systems. According to the World Prison Brief, as of August 2022, Pakistan’s total prison population was 87,712. This was a whopping 136.8% occupancy level, well above the 64 099 prisoners the national prison administration is built to sustain. Already, we can see that the prisons are severely overcrowded, a reflection of the country itself. In places, around 15 prisoners are sharing cells built for three people.
According to Saroop Ijaz (senior counsel for Human Rights Watch’s Asia division), most inmates in Pakistani prisons are yet to be proven guilty and bail laws must be reformed to prevent overcrowding. Many prisoners are innocent and have been forgotten in some dank corner of a jail cell. This contributes to prisons being jam-packed and violates human rights. Arrests and detentions are handed out for even minor offences, while those with power and wealth walk away free and strutting from charges of murder, violence, corruption, and abuse. Apparently, cash and influence act as a Get Out of Jail Free Card.
Meanwhile, for others who are not so fortunate, petty crimes mean jail time. Some homeless people living in intense poverty occasionally commit small crimes just so they can be arrested and put in a cell, as this gives them a roof over their head and free meals. A huge backlog of court cases means lengthy delays between hearings. The majority of inmates are yet to undergo trial, are currently undergoing very slow and tedious trials, or may never even be brought to trial. In the meantime, the accused are kept imprisoned. Laws that can be over a century old from the colonial period and are clearly outdated are still being implemented without reform. All this contributes to the overcrowding of cells.
The bulk of the prison population also stems from poverty: those who are unable to pay for bail, buy their way to freedom through bribery, or do not have the funds to hire a lawyer to defend them in court.
As can be expected, this overcrowding has significant effects on the health of prisoners. Lack of space and privacy can have detrimental effects on mental health. In crowded spaces, contagious diseases, infections, lice, fleas, and other issues spread uncontrollably. Moreover, crowded conditions cause frustration and anger to build up, resulting in fights breaking out that can cause injuries and casualties.
Healthcare for Inmates: A Nonexistent Mess
Pakistan is not known to have an exceptional healthcare system, quite the opposite, in fact. Pakistan spends just 2.8% of its GDP on health. This is well below WHO standards. The right to receive medical care is not a constitutionally protected right and many people do not have access to even basic primary care. So if the situation is this bad for the common civilian, how are we treating our criminals inmates?
To put things into perspective, we must look at some statistics. At each prison, medical care is to be the responsibility of a medical officer. As of November 2021, the country had 116 prisons. In these collectively, the number of posts for medical officers was 193, however, in 2020, 105 of these posts were unfilled. Only the provinces of Punjab and Balochistan had posts (106) for psychologists. 62 of these posts were vacant, while provinces Sindh and Khyber Pakhtunkhwa had none to begin with. How can we expect criminals to come out of prison as bettered people if we do not provide them with the support they need?
Even when jails have medical centers, they are insufficient and neglected. They lack the most basic medical equipment. One such example is a jail in Hairpur. For a prison population of 1,772, there is a hospital comprising just 40 beds. Moreover, essential items such as an ECG machine, oxygen cylinders, X-ray films, various diagnostic kits for ailments like hepatitis, and basic medication are all missing. Clinics and dispensaries are also understaffed and many do not have much-needed female physicians and medical staff.
Prisoners with chronic conditions such as diabetes and heart disease are not catered to. Their plight is ignored, medications are not given and visits to doctors are practically absent. A former prisoner in Karachi tells Human Rights Watch, “I have diabetes and a heart condition, and I had to beg and plead with the superintendent’s staff to get a tablet of a painkiller. I am a poor man and had no money or connections.” An orthopedic surgeon was called to examine prisoners in the above-mentioned Haripur jail. It was found that a majority of them had developed osteoporosis due to long-term confinement and lack of physical activity.
Negligence by prison authorities and lack of care mean that casualties occur. Oftentimes, these are people who are not yet convicted and are still undergoing trial. In December of 2021, six prisoner deaths occurred in a Lahore jail just twelve days after they were taken into custody due to the lack of heating, warm clothing, and proper healthcare, coupled with the harsh winter conditions. In January 2022, a 35-year-old woman undergoing imprisonment while being on trial experienced kidney and abdominal pain. While the court ordered that she receive medical attention, delays by jail authorities caused her to die in custody. Bilal, aged 46, spent four years in a Punjab prison. Due to a medical condition, he has to avoid consuming foods with a high-fat content. Hence, while in prison, he made repeated requests to not be given the standard food, which, according to him, would be “floating in oil”. However, authorities ignored his pleas and said “this is not a hotel”. A 39-year-old prisoner, also jailed in Punjab, complained that he has had diabetes since he was a child. However, when he requested insulin, prison staff made fun of him and said the only condition he has is “being fat”. Eventually, he had to obtain a supply of much-needed insulin via bribery. There is no doubt that hundreds, if not thousands, of other such cases exist in Pakistan’s prisons, where obtaining medical attention means having to beg for it, and even then being unsuccessful is not uncommon.
Food and Sanitation
Problems in prisons pertaining to food, water, and sanitation arise from insufficient financial budgets. Prisons do not have the monetary resources needed to provide for the inmates. One reason for this is corruption: money flows to places that are not its intended destination. As a result, many have to have meals delivered from their own homes. This can be burdensome for inmates’ families as, often, their primary breadwinner is in jail. So while income is not flowing in, it is steadily flowing out. Prisoners are wards of the state - the state is required to fulfill their needs.
When prisons do provide food, it is low quality. Shumail Ahmed spent 2 years in a Lahore Jail. According to him, the prison menu claimed meals for inmates consisted of vegetables and chicken. However, in reality, they were given watered-down daal with a single roti. This is insufficient nutrition that can result in weight loss, malnutrition, deficiencies, and other conditions.
Tap water in Pakistan is not drinkable. To be able to consume it, water filtration systems have to be installed as it is not clean and groundwater has a high arsenic content. According to an inmate, if any such water filtration system existed, they were never privy to it and most of the people around him had water-related stomach problems.
Generally, prisoners are responsible for keeping their own cells clean. However, Prison Rules state that outbreaks of contagious diseases mean that cells must be sanitized and whitewashed. In overcrowded cells, it is unrealistic to expect detainees to be able to keep them clean. Frequently, this responsibility also falls upon the weakest, youngest, or smallest, and despite their efforts, cells are dirty and unsanitary most of the time. Pests like lice, fleas, rats, and geckos are also common inhabitants of cells.
The Nightmares of Female Prisoners
According to Human Rights Watch, female inmates are the most at-risk. The abuse and discrimination faced by Pakistani women in society rears its ugly head behind bars too. A patriarchal society means that they are often abandoned by family, have financial problems, and experience a lack of independence. They also experience discrimination in the criminal justice system and have difficulties accessing healthcare and basic necessities. Officials regularly choose to ignore laws made for women prisoners. Moreover, two-thirds of female inmates are still undergoing trial and have been detained without being convicted.
Most of the time, women’s children, particularly young ones, accompany them in prison. Even though the legal age limit for children being in prisons with their mothers is 5 years, children aged up to 9 or 10 are no strangers to the cell. This means they grow up in a jail cell and experience the same discrimination that their mothers do. One prisoner claimed that during her six years of jail time, she was provided with no support or medical care for her disabled child, despite her requests for it. Moreover, the congested and unsanitary environment of prisons leaves these children at risk of disease.
Women in Pakistani prisoners often fall victim to abuse, sexual violence, and rape at the hands of male prison staff. Another issue that befalls female inmates is the difficulty faced by them to access menstrual products. A female police officer states that part of the reason for this is the view that menstrual hygiene products are not necessities, but luxuries. Unsanitary conditions further put menstruating individuals at greater risk of infection. A female inmate, aged 41, speaks to HRW, “I got my periods on my first day in prison. I had heavy bleeding and stomach cramps. The sanitary pads available were not clean and I had to beg for them to allow my family to bring me sanitary pads. My husband had to pay a prison staff member to be allowed to give me pads and medicines. It was the most humiliating experience of my life.” Female inmates also find it difficult to ask for the products and medications they require, as menstruation is a taboo topic, with shame orbiting it.
Childbirth and pregnancy in prison are other issues that are faced by these women. Limited access to medical attention can increase the risk of complications, and midwives often do not have any proper qualifications.
“First, Do No Harm”
Am I defending criminals? The simple answer? No. Not at all. I believe that every criminal should receive the penalty that they deserve. If you know me, you know how I feel about those who inflict violence and harm others’ safety and well-being. In short, very strongly. I know severe punishment, consequences, and/or rehabilitation are necessary for many cases, and Pakistan has a sky-high crime rate. This country is an absolute hub for crimes and brutality. And if I view this topic from a more emotional lens as many people do, I understand that seeing those who inflict the highest acts of evil upon others getting their bodies patched up by doctors whose time, education and skills may be better used elsewhere, can be unbearable.
However, we cannot pretend that every person in Pakistan’s prisons is guilty. And we cannot pretend that every petty criminal deserves the strongest punishments we have to offer. We also cannot pretend that disgusting, inhumane conditions lead to changed people who go back out into society with the purest of intentions. Oftentimes, torturous prison environments can have an effect opposite to that which is intended: people are released as even more hardened criminals. Prisons themselves are also teeming with violence and crime. We can also not pretend that every criminal in the country who deserves to be behind bars is, in fact, behind them. Many roam free, living lives of luxury and opulence, with access to the best doctors whenever needed.
Not allowing access to appropriate healthcare is a serious human rights violation no matter how heinous the crimes committed by a person may be. It is the duty of a criminal to bear their punishment as ordered by a court after a fair trial, not to endure just about any suffering that happens to come their way.
When doctors take the Hippocratic Oath, part of this is to vow to do their best for all patients without judgment. To “do no harm”. Hence, if it is an obligation upon every doctor to give each patient the best treatment they can, no matter the circumstances, then it is an obligation upon those responsible for prisoners to allow access to appropriate healthcare when required.
Sources & Works Cited:
“Pakistan”, World Prison Brief: https://www.prisonstudies.org/country/pakistan
“HRW Report on Pakistan’s Overcrowded Prisons Highlights Abuses”, Al Jazeera: https://www.aljazeera.com/news/2023/3/30/hrw-report-on-pakistans-overcrowded-prisons-highlights-abuses
‘A Nightmare for Everyone’ The Health Crisis in Pakistan’s Prisons”, Human Rights Watch: https://www.hrw.org/report/2023/03/29/nightmare-everyone/health-crisis-pakistans-prisons
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