Advocacy

Providing offender healthcare in a wide variety of settings and countries has given us ample opportunity to advocate for our patients.

Our advocacy service has three arms - individual advocacy, group advocacy and public advocacy - and trades via Integridad: Heart for Detainees as the Gerry Serrano Centre. And in developing our advocacy programmes, we have been mindful of the wide variation in clients’ circumstances.

Individual advocacy

• We aim to model best practice towards each individual client who appears to be particularly vulnerable.

• With the client’s permission, we make spontaneous appeals to secure environment personnel regarding the conditions of his/her detention.

• Again with the client’s permission, we twin advocacy with healthcare and expertise by advocating for him/her within clinical letters and written reports about alleged torture & ill-treatment.

Group advocacy

• We teach our personnel about the needs of particularly vulnerable detainee groups.

• We aim to model best practice towards detainees who come from these particularly vulnerable groups.

• We empower our personnel with knowledge about international humanitarian law.

• We twin advocacy with training by teaching secure environment staff and detainee leaders about the needs of particularly vulnerable groups.

Public advocacy

• We raise awareness through online news articles about contemporaneous issues connected with offender healthcare and other aspects of advocating for detainees, ex-detainees and their dependents.

• We submit evidence to government enquiries about issues connected with offender healthcare.

• In carefully selected cases, such as the imminent execution of a particularly vulnerable detainee, we may publish online analysis and direct appeals to the powers that be.

circumstances

To parody one of literature’s greatest social critics, George Orwell...

All detainees are unequal…

Whether they are built-like-a-tank 6’6” men residing in a high income country’s most luxurious open prison or waspish 4’10’’ women in a low or middle income country’s deepest, darkest dungeon, detainees are - by their very definition - relatively disempowered compared to free citizens.

… but some are more unequal than others

Some incarcerated citizens though are especially vulnerable - like this inhabitant of a tiny police cell…

The sick

There are so many ways to die of illness behind bars. Take asthma, which is one of the world’s most common chronic illnesses though rarely thought of as fatal. Put a relatively mild asthmatic in a cramped, hot, humid space though and you have a dangerous situation. Even mild asthma can and does kill behind bars.

I [Jesus] was sick… and in prison…
and you visited me.
(Matthew 25:36, Bible)

The mentally ill

Mental illness is incredibly common behind bars. People suffering from mental illness need care, comforts, compassion and - whenever possible - companionship. Yet how many times have we found distressed, half starved, mentally ill detainees in dark, dank solitary confinement - placed there to punish them for the ‘crime’ of being mentally ill or in a misguided attempt to protect the other detainees’ sanity?

I was put in here, months ago, because I talk to myself.
(Patient with mild learning difficulty in pitch dark solitary cell)

The disabled

Disabled detainees come in all shapes and sizes - learning difficulty, autism, acquired brain injury, deafness, amputees, stroke patients and quadriplegics to name but a few. People with disabilities often need particular consideration, yet how often do detainees’ disabilities go unrecognised at best, are bullied as a cultural norm, and are penalised at worst?!

We have particular concern for detainees who have mental illness, autism or other disabilities. And so we employ Zoe, our very own Autism & Disabilities Advocate:-

I felt that they [the staff on her locked ward] overlooked my needs.
My emotional and physical boundaries were crossed repeatedly.
I suffered so much more than the neurotypical patients. I felt forgotten.
(Zoe, our Autism & Disabilities Advocate)

The Poorest

In many countries, poor detainees lack food. They go without other necessities such as toothbrushes, soap & clean drinking water. And they sit at the very bottom of their detention facility’s social ranking - resulting in things like lacking a sleeping space.

I look forward to your visits.
(Poorer detainee in police custody)

The minorities

Detainees who are ‘different’ face additional challenges. Those with minority ethnicity, sexuality, gender identity and/or religion are frequently harassed, marginalised and even attacked. And whether through institutional or informal culture, they often find themselves placed last in the line for anything positive on offer including healthcare.

I am grateful for your help.
Often I am the last to be helped.
(Homosexual prisoner)

The women

In many countries of the world, female detainees are especially vulnerable. They may arrive in detention pregnant. During incarceration some women do not maintain control over their own bodies: sexual harassment, coerced sex work, rape and pregnancy all occur. In certain countries, giving birth in chains still occurs. And maintaining menstrual hygiene behind bars can be particularly tricky in hotter parts of the world where communal cells are also the norm.

Thank you for the sanitary pads!
(Female recipients of our police detainee welfare programme)

The children

Children are so disrupted by their parents, especially their mothers, being detained. Often they have to go and stay some place other than their home - in a relative’s home, in a children’s home, or even on the streets. In some countries, they may accompany their parents to prison. Some are even born into imprisonment. And behind bars, children may face additional risks including abuse, exploitation, infection and lack of access to education.

My son was born here. He’s eight now. He’s never been outside the gates.
(Female detainee, speaking to one of our field researchers)

The Dying

End of life care can be a challenge at the best of times. But behind bars, in cramped conditions and with limited or even no formal healthcare, terminally ill detainees often face prolonged and uncontrolled suffering.

So many detainees die behind bars every year around the world. It is our privilege to try to advocate for a small number of them, petitioning for them to receive the palliative care we or other agencies may be able to offer.
(Dr Pickering, our CMO)

The CONDEMNED

And then there are those condemned to death. Dozens of nations still have the death penalty. Execution methods vary from the more ‘humane’ to the truly barbaric, and many wait years on ‘death rows’ whilst justice systems creak on. Particularly within processes are often flawed and open to manipulation by the wealthy and powerful, this is often the crowning injustice.

It’s awful. Waiting to die for years and years. When will they do it?
(Death row detainee, speaking to one of our expert witnesses)

Speak up for those who cannot speak for themselves, for the rights of all who are destitute. Speak up and judge fairly; defend the rights of the poor and needy. (Proverbs 31:8-9)