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

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.