An online programme aims to help doctors deal with the ethical dilemmas of caring for prisoners, writes Joe Armstrong.
A new free online human rights course for prison doctors and healthcare personnel has been launched in Geneva. The course is timely given alleged complicity of some doctors at Abu Ghraib prison, Baghdad, in failing to protect prisoners, according to human rights campaigners.
The Irish Penal Reform Trust believes the initiative may nudge the Irish Government towards meeting its obligation to ensure equivalence of care between prisoners and the general public.
The medical system at Abu Ghraib "collaborated with designing and implementing psychologically and coercive interrogations," according to a recent study in The Lancet. In one instance, a prisoner "collapsed and was apparently unconscious after a beating" and "medical staff revived the detainee and left, and the abuse continued".
It lists other alleged abuses by medical staff, including inserting an intravenous catheter into the corpse of a detainee who died under torture to create evidence that he was alive in the hospital. It alleges the falsification of death certificates citing the example of a detainee tied to the top of his cell door and gagged. His death certificate said he died of "natural causes during his sleep".
The Irish Government is obliged by international instruments such as the UN rules for the treatment of prisoners that detainees have an equivalence of care with the general population, says Rick Lines, executive director of the Irish Penal Reform Trust.
He believes serious consideration should be given to transferring the responsibility for the health of prisoners from the Department of Justice to the Department of Health.
Dr Hugh Gallagher, chairman of the Irish Prison Doctors Association, says: "Everybody other than the Department of Justice and the Department of Health" agrees prisoner healthcare should be the remit of the Department of Health.
He says there are "huge deficiencies in the healthcare system in prisons", citing poor facilities and equipment. Observing that a large proportion of the prison population are drug users, he says: "And there's not a single addiction counsellor working within the Irish prison system."
Indeed, the recent 10-week dispute involving prison doctors concerned what the Irish Medical Organisation (IMO) describes as the non-implementation of the 2001 report of the group to review the structure and organisation of prison healthcare services.
Moreover, Sean Love, director of Amnesty International's Irish section, noted at that time: "The Irish Minister for Justice did not want Amnesty International to investigate the issue of racism within the Irish penal system", which Love agrees has implications for prisoners' health.
The new human rights course for prison doctors and other interested parties is designed to support the human dignity and health of prisoners.
Developed by the Norwegian Medical Association, it aims to raise awareness of the responsibility to identify neglect, abuse and torture.
Ethical dilemmas faced by doctors include being asked to declare prisoners fit for punishment; examining shackled patients; not knowing to whom to report abuses; confidentiality of prisoners' medical records or their confidential health status; and coming under pressure not to refer prisoners to outside clinics.
Dr Delon Human, WMA secretary general, said at the launch last week: "Doctors working in prisons face problems that are different from those that doctors working with the ordinary population meet. In many countries, education of prison doctors is not a priority.
"Many of them do not even have access to international conventions and rules regulating healthcare services for prisoners. They encounter human rights violations, but do not know how to deal with them adequately."
According to the World Medical Association, four doctors have already completed the course and another 20 are currently undertaking it.
The course is accessible from www.wma.net or http://lupin-nma.net. Click on "Doctors working in prison".