NEW YORK: Pakistani authorities have systematically deprived prisoners of adequate health care, leaving thousands at risk of disease and death, Human Rights Watch (HRW) said in a report released today. Outdated and discriminatory bail laws have led to severe overcrowding in Pakistani prisons, with most prisoners yet to be tried or convicted.
The 55-page report, “A Nightmare for Everyone: The Health Care Crisis in Pakistan’s Prisons,” documents widespread deficiencies in prison health care in Pakistan and the consequences for a total prison population of more than 88,000 people. Pakistan has one of the world’s most overcrowded prison systems, with cells designed for a maximum of 3 people holding up to 15. Severe overcrowding has compounded existing health care deficiencies, leaving inmates vulnerable to communicable diseases and unable to get medicines and treatment for even basic health needs, as well as emergencies.
“Pakistan’s prison system is in need of urgent, systemic reform,” said Patricia Gossman, associate Asia director at Human Rights Watch. “Successive governments have acknowledged the problem and done nothing to address the most critical needs to overhaul bail laws, allocate adequate resources, and curb corruption in the system.”
HRW interviewed 54 people, including former inmates in Sindh, Punjab, and Islamabad, among them women and juveniles, lawyers for detainees and convicted prisoners, prison health officials, and advocacy organizations working on prisoner rights.
The principal cause of overcrowding is the dysfunctional criminal justice system itself, Human Rights Watch found. Most inmates in Pakistani prisons are under trial and have yet to be convicted. The majority facing criminal trials are poor and lack access to legal aid. A lack of sentencing guidelines and the courts’ aversion to alternative noncustodial sentences even for minor offenses significantly contributes to overcrowding.
The crisis in prison health care reflects deeper failures in access to health care across Pakistan, exacerbated most recently by an economic crisis. Poor health care intersects with a range of other rights abuses against prisoners, including torture and mistreatment, and is a key symptom of a broken judicial system. Corruption among prison officials and impunity for abusive conduct contribute to serious human rights abuses.
Rich and influential inmates sometimes serve out their sentences outside prison in private hospitals, while poorer prisoners pay bribes just to get pain relief medication. Colonial-era laws enable the government and other powerful people to interfere in police and prison operations, sometimes directing officials to grant favors to allies and harass opponents.
Poor infrastructure and corruption have left Pakistani prison healthcare services vastly overstretched. Most prison hospitals lack adequate budgets for medical staff, essential equipment, and sufficient ambulances. Almost all prisoners interviewed described unhealthy and inadequate food, dirty water, and unhygienic conditions. Prisoners said that often their only option for drinking water was from the tap, which is generally unfit for drinking in Pakistan due to its high arsenic content.
Human Rights Watch found that women prisoners are among the most at-risk inmates. Patriarchal societal attitudes, lack of independent financial resources, and abandonment by families contribute to additional hardships for women prisoners. Women in the criminal justice system routinely experience prejudice, discrimination, and abuse, and for these reasons face greater difficulties accessing health care.
Prisoners with disabilities are at great risk of abuse, discrimination, and mistreatment. Despite the high prevalence of psychosocial disabilities – mental health conditions – among inmates, Pakistani prisons don’t provide access to even basic mental health support. The prison system lacks mental health professionals, and prison authorities tend to view any report of a mental health condition with suspicion. Psychological assessments for new prisoners are either perfunctory or not done at all.
Pakistani governments at the federal and provincial levels should urgently adopt measures to bring health care in its jails and prisons in line with international standards, such as the Nelson Mandela Rules. Successive governments’ failure to allocate adequate resources and to monitor and efficiently utilize them has contributed significantly to the dilapidated state of the prison system. The Sindh province is the only province in the country that has enacted prison rules in line with international standards, but the rules are not enforced well.
In addition to addressing access to health care, and ensuring sanitary living conditions and adequate food, the most important reforms include changing bail laws, expediting the trial process, and prioritizing noncustodial sentences to reduce overcrowding.
The United Nations Human Rights Committee has stated that governments have a “heightened duty of care to take any necessary measures to protect the lives of individuals deprived of their liberty.” This is because when detaining people, the government “assume[s] responsibility to care for their life.”
“Pakistan needs urgent and comprehensive prison reform, with a particular focus on the rights of women, children, and other at-risk prisoners,” Gossman said. “Basic health care is a fundamental right, including for prisoners.”
The following are select quotes shared by HRW as part of interviews conducted for their report “A Nightmare for Everyone: The Health Care Crisis in Pakistan’s Prisons”:
Aslam, 54, who spent three years in a prison in Lahore, from 2017-2020:
Muhammad Aqeel, a Lahore based lawyer:
A prisoner who spent 35 days in a Punjab prison in 2019:
Shafiq, 33, who was in a prison in Lahore for four weeks in 2021:
A 37 old woman, who spent three years in a prison in Lahore, Punjab after being convicted for a drug trafficking offense between 2016-19:
Setting bail beyond the reach of prisoners can result in extended detention. One lawyer based in Karachi described what happened to one his clients, a rickshaw driver who had been falsely implicated in a criminal case of assault:
The 55-page report, “A Nightmare for Everyone: The Health Care Crisis in Pakistan’s Prisons,” documents widespread deficiencies in prison health care in Pakistan and the consequences for a total prison population of more than 88,000 people. Pakistan has one of the world’s most overcrowded prison systems, with cells designed for a maximum of 3 people holding up to 15. Severe overcrowding has compounded existing health care deficiencies, leaving inmates vulnerable to communicable diseases and unable to get medicines and treatment for even basic health needs, as well as emergencies.
“Pakistan’s prison system is in need of urgent, systemic reform,” said Patricia Gossman, associate Asia director at Human Rights Watch. “Successive governments have acknowledged the problem and done nothing to address the most critical needs to overhaul bail laws, allocate adequate resources, and curb corruption in the system.”
HRW interviewed 54 people, including former inmates in Sindh, Punjab, and Islamabad, among them women and juveniles, lawyers for detainees and convicted prisoners, prison health officials, and advocacy organizations working on prisoner rights.
The principal cause of overcrowding is the dysfunctional criminal justice system itself, Human Rights Watch found. Most inmates in Pakistani prisons are under trial and have yet to be convicted. The majority facing criminal trials are poor and lack access to legal aid. A lack of sentencing guidelines and the courts’ aversion to alternative noncustodial sentences even for minor offenses significantly contributes to overcrowding.
The crisis in prison health care reflects deeper failures in access to health care across Pakistan, exacerbated most recently by an economic crisis. Poor health care intersects with a range of other rights abuses against prisoners, including torture and mistreatment, and is a key symptom of a broken judicial system. Corruption among prison officials and impunity for abusive conduct contribute to serious human rights abuses.
Rich and influential inmates sometimes serve out their sentences outside prison in private hospitals, while poorer prisoners pay bribes just to get pain relief medication. Colonial-era laws enable the government and other powerful people to interfere in police and prison operations, sometimes directing officials to grant favors to allies and harass opponents.
Poor infrastructure and corruption have left Pakistani prison healthcare services vastly overstretched. Most prison hospitals lack adequate budgets for medical staff, essential equipment, and sufficient ambulances. Almost all prisoners interviewed described unhealthy and inadequate food, dirty water, and unhygienic conditions. Prisoners said that often their only option for drinking water was from the tap, which is generally unfit for drinking in Pakistan due to its high arsenic content.
Human Rights Watch found that women prisoners are among the most at-risk inmates. Patriarchal societal attitudes, lack of independent financial resources, and abandonment by families contribute to additional hardships for women prisoners. Women in the criminal justice system routinely experience prejudice, discrimination, and abuse, and for these reasons face greater difficulties accessing health care.
Prisoners with disabilities are at great risk of abuse, discrimination, and mistreatment. Despite the high prevalence of psychosocial disabilities – mental health conditions – among inmates, Pakistani prisons don’t provide access to even basic mental health support. The prison system lacks mental health professionals, and prison authorities tend to view any report of a mental health condition with suspicion. Psychological assessments for new prisoners are either perfunctory or not done at all.
Pakistani governments at the federal and provincial levels should urgently adopt measures to bring health care in its jails and prisons in line with international standards, such as the Nelson Mandela Rules. Successive governments’ failure to allocate adequate resources and to monitor and efficiently utilize them has contributed significantly to the dilapidated state of the prison system. The Sindh province is the only province in the country that has enacted prison rules in line with international standards, but the rules are not enforced well.
In addition to addressing access to health care, and ensuring sanitary living conditions and adequate food, the most important reforms include changing bail laws, expediting the trial process, and prioritizing noncustodial sentences to reduce overcrowding.
The United Nations Human Rights Committee has stated that governments have a “heightened duty of care to take any necessary measures to protect the lives of individuals deprived of their liberty.” This is because when detaining people, the government “assume[s] responsibility to care for their life.”
“Pakistan needs urgent and comprehensive prison reform, with a particular focus on the rights of women, children, and other at-risk prisoners,” Gossman said. “Basic health care is a fundamental right, including for prisoners.”
The following are select quotes shared by HRW as part of interviews conducted for their report “A Nightmare for Everyone: The Health Care Crisis in Pakistan’s Prisons”:
Aslam, 54, who spent three years in a prison in Lahore, from 2017-2020:
Almost from the beginning of my imprisonment, I had pains, swelling and stiffness in my body. My complaints were either ignored and jail staff would ask me to “man up” and “suck it up,” or on certain occasions I was given a pain killer.
I could hardly stand up in the morning and kept pleading for an MRI or an ultrasound, but my requests were ignored. It was only when I was finally released that I was diagnosed with arthritis.
Muhammad Aqeel, a Lahore based lawyer:
Corruption in the prison system is almost entirely legalized and has created an incentive structure to continue the corruption. One example is creating the cycle of scarcity and then forcing prisoners to buy food items at inflated prices.
A prisoner who spent 35 days in a Punjab prison in 2019:
I was there in summer (June and July) and we had one fan, which only worked half the time due to power outages. In the Lahore heat, with the perspiration and sweat of seven people in a tiny room, it was like being baked alive. I was dizzy and sometimes delirious due to the heat. I collapsed and was unconscious three times and was given water, asked to take a shower and “not be dramatic.” I lost six kilograms in one month, permanently lost my hair and had bags under my eyes making me almost unrecognizable by the time I was released.
The police said that they had mistakenly arrested me and had no evidence. But the experience has scarred me for life. Two people in my cell had been in prison for over seven years awaiting the results of their appeal, I can’t imagine them ever recovering from this hellish experience even if they are released.
Shafiq, 33, who was in a prison in Lahore for four weeks in 2021:
The room was so clogged at night that it was almost impossible to get up and go to the bathroom without stepping on people’s heads and the only option was to wait till morning.
A 37 old woman, who spent three years in a prison in Lahore, Punjab after being convicted for a drug trafficking offense between 2016-19:
Throughout my stay in prison, I suffered from acute migraines and hormonal issues causing pains and irregular menstruation cycles. I was not allowed to meet a specialist even once and was only given a painkiller. It is extremely difficult for us to speak about menstruation to a male prison official due to social taboos and embarrassment.
Women prisoners are treated the worst because in Pakistan they are abandoned by their families, and no one comes to visit them and hence the prison authorities know that no one is willing to pay any (bribe) money for their better treatment.
Setting bail beyond the reach of prisoners can result in extended detention. One lawyer based in Karachi described what happened to one his clients, a rickshaw driver who had been falsely implicated in a criminal case of assault:
My client was a rickshaw driver who had been falsely implicated in a criminal case of assault. It took one year for him to be granted bail and the legal process by then had completely wiped out his meager financial resources. The judge set his bail at PKR 500,000 [about US$ 2,320]. His monthly income before going to prison was PKR 20,000 [about $93].
By the time the bail was granted he was already in debt and the family had no money or assets. He remained in prison for one month for nonpayment of bail bonds. Finally, his brother-in-law pledged his house as surety to bail him out.