Alexei Navalny

One day

My 16th February 2024 started out as a pretty standard Friday, doing my job as a doctor within the UK’s prison system. Sadly, it ended in tragedy with the unexpected death of one of my detained patients. After leaving the prison, I sat in my car for a while, thinking and praying for my late patient’s family. And as I drove out of the prison car park, I noticed two parked up police vehicles…

Investigation

Of course, the police were there because - whether expected or unexpected, self-inflicted, accidental or murderous - all UK deaths in custody are subject to extensive investigation by multiple agencies:-

• the police

• the coronial system

• the health service

• and the Prisons and Probation Ombudsman.

In addition to all these measures, the Council of Europe’s Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), which is responsible for monitoring member states’ compliance with Article 3 of the European Convention on Human Rights, also takes a keen interest in deaths behind bars.

Two deaths

In the busyness of managing the immediate aftermath of my own detained patient’s death, I missed the breaking news about another custodial tragedy - that same day but thousands of miles away, in the frozen Artic Circle…

Prisoner Alexei Navalny, the fiercest and most enduring critic of President Putin, is dead.

Investigation?

• He died just one day after being well enough to laugh and joke with his judge.

• There is the usual confusion about the cause of his death and the location of his body,

• The Investigative Committee of the Russian Federation, whose agency executive is (according to Wikipedia) a certain President Putin, is on the case.

• And so it remains to be seen whether the United Nations has engaged in a spot of wishful thinking, in calling for his death to be rigorously investigated.

One judge

UK detainees are relatively blessed compared with those held in many other parts of the world. UK conditions of detention are regulated, monitored and - when found to fall short - investigated. Yes, I know full well that there are many problems behind my nation’s bars - and the CPT highlights these failings on a frequent basis. But compared with many places in the world, UK places of detention sit within a veritable Garden of Eden where the Rule of Law presides.

Yet viewed through the long lens of eternity, whether a free President in the Russian Federation or a detained person in the UK, one day every one of us will die and face judgement by the same Judge.

From His courtroom, He examines all the goings on in our world, with notable concern for detainees:-

The Lord looked down from His sanctuary on high, from heaven He viewed the earth, to hear the groans of the prisoners and release those condemned to death.
(Psalm 102:19-20)

And to those who ignore the visible suffering of others, yet alone those who cause it, He will say…

 Depart from me, you who are cursed, into the eternal fire… For I was hungry and you gave me nothing to eat… I was sick and in prison and you did not look after me…

Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.
(Matthew 25:41-45)

The author is one of our spokespeople
Their views do not necessarily represent those of Integritas Healthcare

Will nitrogen enter the death arena?

So once again, death penalty demonstrators are gathering outside a USA prison. This time though, things are a bit different: the execution agent is gaseous, and the condemned man is a repeat attender…

Who and why?

Kenneth Smith is one of two assassins-for-hire who in 1988 killed Elizabeth Sennett, the wife of a pastor who hoped her life insurance could ease his financial troubles. Shortly after the killing though, the pastor killed himself - rather than face earthly justice.

A long 22 years later, in 2010, Kenneth’s partner-in-crime received the stiffest penalty meted out by the US Justice System - execution. And Kenneth himself is sentenced to the same punishment, yet he’s still on death row - at least until later today, 25th January 2024, when he is scheduled to become the first person in the USA to be executed through nitrogen asphyxiation.

Why gas and why now?

But why are the authorities using nitrogen gas rather than lethal injection, and why have they waited until now - almost 36 years after the murder - to execute him? Well the answers to these two questions are linked…

The USA’s capital punishment appeal system is notoriously slow and convoluted. It’s common for condemned people to spend around 20 years on death row. Some argue that this long wait for almost certain death is itself a form of psychological torture. And it’s not uncommon for death row prisoners to die of illness rather than by the executioner’s hand.

In Kenneth’s case, it was 33 years between conviction and the authorities first taking him to the death chamber in November 2022. But things didn’t go to plan…

As is common to many botched executions, his would-be executioners lacked sufficient skill in venous access to get the necessary needles into him. After several hours of trying, his death warrant expired and so they had to abandon the execution and return him to death row, his home for the previous three decades.

And in the aftermath of that debacle the authorities promised not to try to use lethal injection on him in the future.

So that is why Kenneth has been rescheduled to die - at another time and in another way.

Why worry?

Right now, more than the usual amount of last minute legal appeals are going on. And this is due to at least two key factors…

Firstly, no-one can reasonably deny that surviving a botched execution is a traumatising experience. And Kenneth’s legal team is arguing that it’s cruel to do this to him all over again.

And crucially, the UN High Commissioner for Human Rights is alarmed at the prospect. Quoting an extract of their full statement:-

We have serious concerns that Smith’s execution in these circumstances could breach the prohibition on torture or other cruel, inhuman, or degrading treatment or punishment, as well as his right to effective remedies. These are rights set out in two International Human Rights treaties where the United States is bound by – the Covenant on Civil and Political Rights and the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment [CAT].

So, will the execution go ahead and - if so - will it go as ‘smoothly’ as the authorities hope? All eyes - and many hearts and prayers - are fixed on that death chamber right now. We’ll be updating you soon.

Dr Rachael Pickering is our Chief Medical Officer
Her views do not necessarily represent those of Integritas Healthcare

A Time of Love?

I am sure we all have somebody we wish we were better at loving. We find it easy to love when we receive love and kindness in return, but as soon as somebody wrongs us or does not thank us, we feel they no longer deserve our love.

It is even harder to love a stranger. In particular, a stranger who may have committed a terrible crime. I doubt that many of us have the 11 million prisoners of this world on our list of people we want to show love to this Christmas. And why would we?

There is darkness in the world and justice must be sought. But these prisoners could so easily be you or I, a mother or a father, a brother or a sister. We must not deny them their humanity and their right to be treated with compassion.

Martin Luther King famously said:

 “Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that” 

We aim to show love to some of the world’s detainees through medical care, pastoral care, feeding programmes and advocacy work. We urgently require your support to enable us to continue this work. Donations of any amount will be so gratefully received and will have a lasting impact on the work we are able to do.

Wherever you are, we hope you have a very happy Christmas, filled with hope, peace, joy and love.

Click here to donate.

A Time of Joy?

“Merry Christmas”, “Happy Christmas”, “Joy to the World!”  It is a time of year when we expect and hope to feel joyful. A time of laughter and fun as we meet with loved ones, exchange gifts and fill up on festive food.

There is much to be joyful about but it can often feel short-lived or leave us feeling deflated, as reality doesn’t always match up with our expectations.

But imagine how much harder it must be to feel joyful when in prison. You are away from your family, perhaps dealing with the guilt of past actions and kept in poor conditions, sometimes for many years or even a lifetime.

At Integritas, we believe that Jesus Christ and his offer of forgiveness and hope can bring joy to even the deepest, darkest prison cell on earth. It is a joy that does not depend on external circumstances.

Through our work, we hope to show every prisoner that regardless of their past, they matter and they have value. They do have a reason to be joyful.

If you would like to support us in this work, please click here to donate.

We hope that whatever circumstances you find yourself in this year, you too may know this joy this Christmas season.

A Time of Hope?

We all need something to give us hope. That might be the thought of a weekend lie-in to get you through the week, a successful career to provide a comfortable retirement or maybe the hope that there is a purpose and meaning to life, which you just haven’t found yet.

For many prisoners around the world there is nothing to give them any hope. They are locked away and forgotten by society. Integritas carries out a large proportion of its humanitarian and medical work within prisons and police stations in the Philippines.  A problem faced by prisoners worldwide is that of pre-trial detention and delayed sentencing. In the Philippines 75% of the prison population has not been sentenced. On average prisoners are detained for 9 months before they receive a sentence.  This leads to overcrowding of jails, making conditions even more unbearable. Prisoners may serve time in prison that far outweighs their crime. Individuals are subjected to terrible conditions with no hope of knowing when they will be released.

Integritas currently provides healthcare to detainees in the Philippines primarily by telemedicine clinics. Our team on the ground visits the prisons and co-ordinates video consultations between prisoners and our team of doctors. We are able to offer a glimmer of hope to these prisoners as we care for their medical needs and treat them with compassion and respect. This service relies on our team of both voluntary and paid staff. We also rely on funds to provide medical supplies to the prisoners, as many cannot afford to buy their own medication.

As we look ahead to Christmas, a time that offers a message of hope, we greatly require your support to continue our work. If you feel you could offer your time and skills then please get in touch. Financial donations of any amount would go a long way to provide medical care to those trapped in a hopeless system. Please join us in bringing hope this Christmas.

 Click here to donate

A Time of Plenty?

What do you think about at this time of year? Perhaps the long lists of gifts you need to buy, organising the family get together or just hunkering down and avoiding the madness.

For Christians, Christmas is when we celebrate the person of Jesus Christ coming into our world. He came and was willing to get stuck in with the painful mess of humanity. Jesus loved the unlovable. Regardless of somebody’s past He said I can help.

At Integritas, we are motivated by Jesus’ love and His example to treat our neighbour as ourselves.  We have a particular concern for the 11 million of our fellow human beings currently behind bars across the world. Many of these people are kept in terrible conditions, without adequate food or healthcare and do not know when they will next see their loved ones. Regardless of their past actions, we believe they deserve to be treated with dignity and respect.

Like many other charities, the pandemic has taken its toll on Integritas. We have lost many of our main sources of funding and this has directly impacted the work we are able to carry out. This festive season we are asking you to help us help those most in need across our world. Any donation will go a long way to provide healthcare to vulnerable men and women behind bars.

So perhaps this year, as it is for me, will be the first year you think about the world’s detainees, those forgotten and abandoned in unthinkable conditions. There is a great need and we can work together to show radical love to one another.

If you would like more details on partnering with Integritas please do get in touch. Any donation would be gratefully received and would make a huge impact on the work we are able to do.

Click here to donate.

Ecuadorian prison riot kills over 100 prisoners

On Tuesday 28th September a gang-related riot broke out in an Ecuadorian prison. Prisoners pulled firearms on each other and set off explosives in what has been called the worst gang-related violence in Ecuador’s history. It wasn’t until Wednesday 29th that officials claimed they had the prison under control again, however neighbours of the Guayas prison complex claim to have heard explosions and gunshots early Thursday morning . Ecuadorian authorities said a major operation took place on Thursday 30th to regain control using 900 officers and army soldiers at which point a death toll of 24 prisoners was reported, later rising to over 100 as police worked their way through the prison.

The attack broke out when prisoners from one wing of the prison crawled through a hole and gained access to another wing of the prison which held their rival gang members. Local media reported that the killings may have been ordered from outside the prison highlighting a power struggle between Mexican cartels currently under way in Ecuador.

If this violence had occurred outside of a prison it would not be forgotten, it would be headline news and would be classed as a tragedy. But this event did occur inside a prison, and it was not headline news.

One of the purposes of a prison is to rehabilitate people so that they can re-enter society when their sentence is finished. Events like these call into question whether some prison environments actually achieve their rehabilitative purpose.

To read the BBC article follow this link: https://www.bbc.co.uk/news/world-latin-america-58733202

The Ms Maxwell Series: Is it torture?

This week we finish our series pegged around the topic of torture, which made British news headlines in early Spring 2021 when Ghislaine Maxwell’s brother, Ian, spoke out against what he felt were torturous conditions in her New York jail. She is apparently being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations.

Previously: is sleep deprivation torture?

During this series we have asked ‘What is torture?’, ‘How small is too small?’ for a jail cell, and ‘What’s diet got to with it?’. And most recently we asked, ‘Is sleep deprivation torture?’ Over in Europe, a landmark case in the European Court of Human Rights (ECtHR) concluded that sleep deprivation, used as part of five techniques used in interrogation, amounted to inhuman and degrading treatment, but not torture. For Ghislaine over in the United States of America (USA) though, sleep deprivation as a consequence of suicide monitoring during the night could be an over-reaction and indeed counter-productive, unless that monitoring matched her level of risk. Whether sleep deprivation is inflicted for the purposes of interrogation, suicide surveillance or it is a result of other biopsychosocial factors from living in prison, it can have lasting health consequences that no human deserves.

Conclusions

Is it ill-treatment?

If Ghislaine is indeed being held in a 6x9ft (1.8x2.7m) cell with no natural light, under constant surveillance, and with terrible food and water rations as her brother reports, then could this amount to ill-treatment? According to the Nelson Mandela Rules (NMR), which the USA (as a member of the United Nations (UN) General Assembly) has to abide by, it could well be the case:-

• Has she been held for 22 hours a day, for more than 15 consecutive days as defined as solitary confinement, so breaching rules 44 and 45?

• Has her microwaved food lost its nutritional value to the extent that it is inadequate for health and strength, so breaching rule 22?

• Has there been insufficient attention to minimum floor space and lighting in her cell, so breaching rule 13?

If the answer to any of these question is an objective yes, then it may fairly be said that she has been subjected to cruel, inhuman or degrading treatment.

But is it torture?

Moving on from an objective yes to the above ill-treatment questions, then - as torture is a subset of ill-treatment - it may be that Ghislaine is being tortured. Let’s see…

We can’t use the European Convention on Human Rights (ECHR) or its more detailed Convention on the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), as she is not being held in Europe. Even if we could use these conventions, they do not actually define the torture that they ban. Instead, ECtHR judges sometimes rule on whether a particular case of alleged ill-treatment could be said to amount to torture.

We can’t utilise the UN’s Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) and monitoring by its mandated Subcommittee for the Prevention of Torture and Cruel, Inhuman or Degrading Treatment or Punishment (SPT) to inspect her jail and look for evidence of torture, as the USA is not signed up to OPCAT. And even if USA jails did qualify for SPT inspections, this monitoring body does not have publicly available standards by which to judge cell size, nutrition, lighting and sleeping conditions.

However, the USA is signed up to the UN’s more basic Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). And according to CAT, torture requires a particular action to have:-

• caused severe pain or suffering, whether physical or mental;

  and

• been intentionally inflicted for such purposes as:-

  • obtaining information or a confession from the victim or another person,

  • punishment for a suspected or actual deed committed by the victim or another person,

  • intimidation or coercion of the victim or another person,

  • or discrimination of any kind;

  and

• been inflicted by a public official or other person acting in an official capacity.

Pain or suffering arising only from, inherent in or incidental to lawful sanctions such as corporal or capital punishment is specifically excluded.

So, to consider whether Ghislaine’s conditions are torturous according to the letter (as opposed to the spirit) of the USA’s legal obligations under the international humanitarian law it has chosen to sign up to, we must establish affirmative answers to all of the following questions:-

1. Is it causing severe mental or physical pain or suffering?

   • Severity is a completely subjective concept. In healthcare, we use a scale from 0 (no pain) to 10 (agony) for people to rate their pain. The major downside to this though is that one person’s 10 is another person’s 5. So this severity stipulation within CAT is the major sticking point for our conclusion.

2. Is its purpose to get information or a confession, or else to punish, intimidate, coerce or discriminate?

   • It’s difficult for third parties like us to establish the exact purpose or purposes.

3. Is it not a lawful sanction of corporal or capital punishment?

   • This is easy to answer. Yes, it is most definitely not a lawful act of corporal punishment.

4. Is it authorised or conducted by a state official?

   • Again, this is fairly easy to answer. Yes, it will be being authorised by her state prison managers and it will be being carried out by state prison officials (eg guards and cooks), although it’s possible that some of the poor cooking is being done by fellow prisoners.

Letter of the law

So, the long and the short of it is that no, according to the letter of the law, Ghislaine is not being tortured.

Spirit of the law

But really, is it right that a certain action may be judged torturous in one country yet non-torturous in another? Why is it that nations including ‘leaders of the free world’ such as the USA may belong to Club UN without ratifying OPCAT? Even signing up to the more basic CAT is optional. After all, Council of Europe member states are obliged to sign up to the CPT on top of the ECHR.

And as an aside, considering that information obtained under duress is often inaccurate, it is surely concerning that the majority (the USA along with China and Russia) of the five permanent members of the UN Security Council (the UN body charged with maintaining international peace and security) are OPCAT signatories.

But let’s return to the fact that what is deemed torture in one state is deemed non-torturous in another. Where is the equivalence? Where is the justice? So many of the world’s 11 million prisoners eat terrible food and live 24/7 in cramped, dark cells - with the full knowledge of their country’s officials. Others are kept alone for months and years at a time. At the very least, this is discrimination against people who are deprived of their liberty. It is surely perverse that we need to argue about semantics in order to decide if these poor people are being tortured! Just how malnourished, lonely, cramped and light deprived does a human being have to be before the law will consider protecting him or her?!

A higher law

As we are a Christian faith-inspired NGO, we also look to an additional set of rules to guide our work - God’s Laws as set out in the Bible.

The Bible has much to say about how to live in just societies. In a nutshell, it rests on how we treat one another. In the New Testament, Jesus teaches his followers ‘The Golden Rule’ as well as ‘The Greatest Commandment’:-

“So whatever you wish that others would do to you, do also to them, for this is the Law and the Prophets.”

Matthew 7:12

Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbour as yourself.’ All the Law and the Prophets hang on these two commandments.”

Matthew 22: 36-40

Loving our neighbours - that is, others living within our culture - as ourselves is a wonderful principle, regardless of one’s faith. Let’s ask ourselves, ‘Would I wish to live day in, day out in a tiny, dark cell? Would I want to eat bland, unhealthy food for breakfast, lunch, and dinner? And would I want to live my life under constant scrutiny?’ If our answers are ‘No, No and No’ then consider: ‘How can I not speak up whilst this is happening to my neighbours?’

At Integritas Healthcare, we advocate for those who are tortured or otherwise ill-treated because we believe that every human being is made equal with innate worth and dignity. We are called to treat everyone with the kindness and compassion we ourselves would want. Taking inspiration from Matthew 25:37-39, whatever we do in the service of others, we do in love of our fellow man and in our love for God:-

“For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.”… “Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.”

A glimmer of hope

We end this series with some recent good news that provides a glimmer of hope for prisoners in solitary confinement in the USA.

From next year, the State of New York has agreed to ban solitary confinement exceeding 15 days, so as to ensure compliance with the Nelson Mandela Rules. This new law will include screening for suicide risk and the development of rehabilitation units for those who would otherwise have been sent to solitary confinement.

It may only be one law, but it could be the start of a nationwide change in how detainees are treated within the USA’s penal system. It is also the beginning of being able to hold certain USA detention centres accountable for any discrimination against vulnerable patient groups who are disproportionately sent to solitary confinement and who are generally more poorly treated within many of the world’s penal institutions. So watch this space!

If you have been moved by this series on torture and you’d like to support our anti-torture & ill-treatment work, we welcome donations towards the Gerry Serrano Centre.

The Ms Maxwell Series: what's diet got to do with it?

We return to our series pegged around the topic of torture, which made British news headlines in Spring 2021 when Ghislaine Maxwell’s brother, Ian, spoke out against what he felt were torturous conditions in her New York jail. She is apparently being continually observed in a 6x9ft (1.8x2.7m) cell with no natural light and terrible food & water rations…

Previously: How small is too small?

After exploring the question of ‘What is torture?’, we looked at how to decide ‘How small is too small?’ for a jail cell. Ghislaine is in the United States of America (USA), which is not subject to inspections by the UN’s torture inspection committee, which anyway lacks published standards on living space. However, if she was transferred to a European jail, the Council of Europe (CoE) would be able to apply its own torture inspection committee’s living space standards and declare her solitary 4.9m² cell too small. Whether or not such environmental ill-treatment would be deemed to amount to torture would however be a matter of deliberation for judges at the European Court of Human Rights (ECtHR).

So what about her diet?

In his interview Ian Maxwell raised concern about Ghislaine’s food and water:-

The water that is provided through the prison is brown, and the food that she is given is very highly microwaved and basically inedible.

The Nelson Mandela Rules, which are designed to maintain a prisoner’s human rights and dignity, include guidance on nutrition:-

Rule 22:-

1. Every prisoner shall be provided by the prison administration at the usual hours with food of nutritional value adequate for health and strength, of wholesome quality and well prepared and served.

So is this true of Ghislaine’s food?

Her food is described as ‘highly microwaved’. But what does this mean? Mostly microwaved as opposed to boiled or grilled? Or microwaved for too long a period of time? Rather than speculating further as to the meaning behind this ambiguity, let’s inspect known facts.

Microwaving does not necessarily deplete food of its nutritional value. In fact, it can preserve certain vitamins and minerals better than boiling, which causes nutrients to leak into the cooking water. The very nature of a microwave is that it requires only a short period of time to heat food. However, over-cooking even by microwave does start to affect a meal’s nutritional value.

Still, there’s poor food and poorer food. Prisoners around the world have very different meals. Many have to consume unrecognisable soups and stews that are barely sufficient to sustain life, and others have reduced or even completely absent food rations as punishment.

And what about her drinking water?

Rule 22 of the Nelson Mandela Rules also states:-

2. Drinking water shall be available to every prisoner whenever he or she needs it.

But how much water does a human require? The International Committee of the Red Cross’ handbook Water, sanitation, hygiene and habitat in prisons states:-

The strict physiological needs of a human individual may be covered by 3 to 5 litres of drinking water per day. This minimum requirement increases in accordance with the climate and the amount of physical exercise taken.

The minimum amount of drinking water that must be available inside the cells and dormitories is in the order of 2 litres per person per day if the detainees are locked in for periods of up to 16 hours, and 3 to 5 litres per person per day if they are locked in for more than 16 hours or if the climate is hot.

Ghislaine does has ready access to drinking water though it is apparently brown, which of course doesn’t look appetising and may affect its taste. Such discolouration may be due to the corrosion of plumbing leaching lead into the water. However, running the water briefly before use should flush the system. Moreover, in New York City the water is monitored carefully, from delivery from upstate reservoirs to street-side sampling stations, to ensure the the risk of lead poisoning remains low.

Such safeguards do not protect many of our globe’s 11 million prisoners. Little data exists on how many have access to clean drinking water, but it definitely is a problem. In Brazil, for example, Human Rights Watch found that in some prisons water is available for only half an hour in the morning and half an hour in the evening.

What about her access to natural light?

According to her brother, Ghislaine has ‘no natural light’ in her cell. If true, this is a contravention of the Nelson Mandela Rules:-

Rule 13: All accommodation provided for the use of prisoners and in particular all sleeping accommodation shall meet all requirements of health, due regard being paid to climatic conditions and particularly to cubic content of air, minimum floor space, lighting, heating and ventilation.

Rule 14: In all places where prisoners are required to live or work:

(a) The windows shall be large enough to enable the prisoners to read or work by natural light and shall be so constructed that they can allow the entrance of fresh air whether or not there is artificial ventilation;

Of course, there are greater and lesser degrees to which thousands of prisoners around the world are deprived of their right to natural light. Some, apparently like Ghislaine, are kept in cells lacking natural light but are allowed outside daily for exercise in the fresh air. This latter fact complies with another Nelson Mandela Rule:-

Rule 23:-

1. Every prisoner who is not employed in outdoor work shall have at least one hour of suitable exercise in the open air daily if the weather permits.

A prisoner, found in a dark solitary confinement block where we assessed his dental hygiene and general health

Many others though are kept without natural, or indeed any, light 24/7:-

It’s been my sad duty to visit solitary confinements in many countries across the world. And I can confirm that many regimes still subject human being to darkened solitude. If they weren’t mentally distressed upon entering such environments, then the environment itself soon rectifies this. Why is this still going on in the 21st century?!

(Dr Rachael Pickering,
one of our medical experts)

And what are the likely health consequences?

A diet lacking in fibre can cause constipation, which may be linked to bowel inflammation and even perforation.

A diet with inadequate intake of key vitamins and minerals, can lead to malnutrition. Vitamin deficiencies can cause lethargy, breathlessness, palpitations, reduced vision, gum disease, and muscle wasting to name a few. Vitamin D deficiency, which is caused by dietary deficiency and lack of access to sunlight, may cause various symptoms including bone and muscle pain, difficulty walking, muscle weakness, and increased risk of fractures. It may also impact mental wellbeing, being linked to depression and schizophrenia.

Even without associated vitamin D deficiency, lack of exposure to sunlight may contribute to low mood and fatigue, due to the brain’s reduced production of serotonin and increased production of melatonin.

So is Ghislaine Maxwell being tortured?

Next week we will reflect on the findings within this series and consider…

If these allegations are true, is Ghislaine being ill-treated?

And if so, is it ill-treatment which could be said to amount to torture?

Until next week…

Dr Esme MacKrill

PS If you’d like to support our anti-torture & ill-treatment work, we welcome donations towards the Gerry Serrano Centre.

#Choosetochallenge Period Poverty in Prisons

International Women’s Day 2021

Today is International Women’s Day, a day to celebrate the achievement of women globally and to raise awareness of difficulties that women continue to face. This year’s theme #choosetochallenge is a way for organisations and communities to unite in challenging gender inequality and discrimination of women worldwide.

Bangkok Rules

2020 marked ten years since the Bangkok Rules were established by the UN to ensure appropriate treatment of women prisoners and protection of their human rights. This includes women awaiting trial, those serving prison sentences and also those with sentences other than imprisonment. They also protect the rights of children who accompany their parents to prison. These 70 rules include guidance on gender-specific healthcare, rehabilitation and training, which supplements the Standard Minimum Rules for the Treatment of Prisoners, also known as the Nelson Mandela Rules.

Within the basic rules on personal hygiene, rule 5 states:

The accommodation of women prisoners shall have facilities and materials required to meet women’s specific hygiene needs, including sanitary towels provided free of charge and a regular supply of water to be made available for the personal care of children and women, in particular women involved in cooking and those who are pregnant, breastfeeding or menstruating.

In 2019 the UK announced it would provide free sanitary products to all female prisoners. However this is an unusual exception: around the world, it is so common for women prisoners to face difficulty accessing soap and water to keep themselves clean during their periods, let alone have the sanitary products they also need. And these challenges are on top of the stigma and shame attached to menstruation in many cultures.

Period Poverty

‘Period Poverty’ is the term used to describe the inability to access sanitary products and adequate hygiene measures due to the lack of financial resources. It also relates to a lack of education for boys and girls on menstruation and hygiene. Period poverty leads to many girls and women missing out on their education, and also prejudicial treatment in many communities.

In 2015 the UN General Assembly set out 17 sustainable development goals to make the world a better place by 2030, through addressing poverty, inequality and climate change. Within these goals, numbers five (gender equality) and six (clean water and sanitation) directly address period poverty:

Target 5.1: End all forms of discrimination against all women and girls everywhere.

Target 6.2: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.

These targets are important for all of us as we aim to end period poverty.

Period poverty in prison

A recent article by Prison Reform International highlighted how many female prisoners experience period poverty, especially in low and middle income countries (LMICs). All too often, women are dependent on visitors to bring them sanitary protection. Yet they are frequently reluctant to even ask their male relatives - and these relatives often do not think to consider their incarcerated relative's feminine hygiene needs. And during the COVID-19 pandemic, most prisons and other secure environments have drastically reduced - often completely stopped - visiting rights. Our own police custody welfare service in the Philippines has seen first hand evidence of just how much women detainees are struggling during lockdown. Mam Loy (pictured above), our Philippines Operations Manager, explains more:-

The cells are 8x7 foot and they usually hold about 20 detainees. They share one toilet separated by a thin wall from the rest of the cell. Those most recently incarcerated struggle the most to use the toilet, given the proximity to the other women.

Comparisons

It is hard for Europeans and other High Income Country readers to conceptualise this level of space restriction. 20 detainees in 8x7 feet equates to just less than 0.25 square metres per woman, which is 16 times more crowded than the minimum level of personal space permitted in the standards for European prisons set by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT).

The Solution

While not all governments can immediately adopt the Bangkok Rules, our own organisation - Integritas Healthcare - has been giving this matter serious consideration since the end of 2018. In 2019, a team of healthcare professionals set about educating a cohort of Filipina remand prisoners on the use of menstrual cups, giving out a cup to every woman who attended our seminars and wished to try one. The pandemic prevented our planned 2020 follow-up research from taking place. However, as soon as possible, we will be reactivating this research stream. If this research proves that menstrual cups are popular and feasible to use within Philippine detention settings, we aim to start issuing them as standard to any Filipina detainee within our care.

In the meantime, we are trying to help as many Filipina detainees as possible with conventional sanitary protection. If you'd like to help us do this, our #Coronacash appeal is in ever great need of funds. And we are happy to respect requests that donations be used purely for menstrual hygiene.

What can you do?

Creating awareness around period poverty is vitally important. Talking about it will start to break the walls of stigma attached to menstruation. Why not take to social media and use #choosetochallenge and #endperiodpoverty to start a conversation?

You could also share this article with friends and family and use the hyperlinks embedded to educate yourself further on period poverty in prison.

Closer to your own home, you could buy feminine hygiene products and donate them to your local food bank or women’s refuge.

And, once again, you could help us to help Filipina detainees in period poverty.

Whatever you do, take time this International Women’s Day to consider what you would #choosetochallenge to achieve gender equality and end discrimination.