January 21, 2015
In the
other cases, detainees who had heart disease, cancer, or other ailments
were either denied necessary medical treatment or release on medical
grounds, and in some cases were held in overcrowded conditions that
exacerbated their health problems.
This stemmed
from an August 18, 2013 incident in which 37 detainees died after
police fired a tear gas canister into a prison van in which they were
confined at Abu Zaabal Prison. A judge convicted four officers but, in
July, an appeals court ordered them retried. The next hearing will be
held on January 22.
In a message to Human Rights Watch smuggled out of Tora Prison in March
2014, one prisoner said teams of prosecutors regularly visited prisons
but refused to listen to prisoners’ complaints. “All they did was enter
each cell, take a quick glance, count beds, and note names in each
cell,” this prisoner said.
The authorities should investigate deaths in custody and prosecute
police officers and other officials suspected of negligence or abuse,
Human Rights Watch said. Egypt’s prosecutor general should release all
detainees held solely for exercising their constitutionally protected
rights to peaceful protest or political expression.
The prosecutor
should create a process to review pretrial detention practices, with a
presumption against pretrial detention in all cases, and ensure the
immediate release of all those who need medical care unavailable in
detention.
“The Egyptian authorities have appeared shockingly complacent in the
face of so many detainee deaths,” Whitson said. “They need to ensure
that all such deaths, as well as abuse allegations, are independently
investigated, and rapidly put in place and enforce effective safeguards
to protect everyone in state custody.”
DEATHS IN DETENTION
Despite the Abu Zaabal incident and some accounts of death in custody
that involved torture or physical abuse, a large number of the deaths
reviewed by Human Rights Watch in media and reports from nongovernmental
groups – in addition to the majority of the nine cases independently
verified – appear to be the result of inadequate medical care,
exacerbated by overcrowded conditions.
The United Nations Basic Principles for the Treatment of Prisoners,
adopted by the General Assembly in 1990, provide that prisoners “shall
have access to the health services available in the country without
discrimination on the grounds of their legal situation.”
The universal
right to “the enjoyment of the highest attainable standard of health,”
as recognized and described in various international treaties, including
the African Charter on Human and Peoples’ Rights, and the International
Covenant on Economic, Social and Cultural Rights, both ratified by
Egypt, also applies to prisoners.
Furthermore, under international standards, pretrial detention should
only be used when it is absolutely necessary to ensure the integrity of
the criminal proceedings and should take into consideration the
likelihood that the detainee will flee. A suspect’s health, and the
ability of the prison system to provide adequate care, should be a basic
consideration for pretrial detention.
Egypt’s Prisons Act of 1956 and Interior Ministry Decree 79 of 1961
mandate adequate care by prison doctors and a bed for each inmate,
including pre-trial detainees, to avoid overcrowding. But in the nine
cases verified by Human Rights Watch, the authorities routinely ignored
and violated these prescriptions.
They also did not remedy other
flaws the EIPR has identified in prison regulations, such as the fact
that prison wardens and other administrators hold approval power over
doctors’ recommendations for treatment or release.
DEATHS IN CUSTODY
Ahmed Ibrahim: Signs of a Beating
Ahmed Ibrahim, 23, died early in the morning of June 15, 2014, at a
police station in Cairo’s Matariya district. Ibrahim had been learning
how to install heating and air conditioning systems before he was given a
three-year prison sentence for theft in 2012. Prison authorities had
transferred him to the Matariya police station on June 14 to finalize
his early release. His father, Mohamed Ibrahim, told Human Rights Watch
that he last saw Ahmed alive when he took some food to the police
station for him that evening. His son, he said, was held in an
uncomfortably hot cell of about 4 by 4 meters that was so packed that
prisoners were forced to remain standing.
Mohamed Ibrahim told Human Rights Watch that he complained to the police
captain in charge of the station that the conditions were inhumane but
that the officer punched him and told him to find a doctor if he thought
so. Ibrahim spoke briefly to his son, who assured him that he would
survive until his expected release. At around 1 a.m., however, Ibrahim
received a mobile phone call from Ahmed, who said, “Dad, I’m dying,” the
father told Human Rights Watch.
Ibrahim called an ambulance, he said, but when he went to the station
the next morning, the police told him that Ahmed had died while being
taken by ambulance to a hospital only a short distance from the station.
At the morgue, Ibrahim saw blood on his son’s lips and bruising on his
face and head – injuries noted in a forensic medical report that also
found that Ibrahim’s lungs were swollen and had hemorrhaged.
Ibrahim told Human Rights Watch that he suspects police beat his son. He
said he had filed a complaint with the local prosecutor, who has not
filed charges. According to the December investigation by Al-Watan
newspaper, eight detainees died at the Matariya Police Station in 2014,
the most of any location in Cairo or Giza.
Dr. Tarek Mahmoud al-Ghandour: Refusal to Provide Life-Saving Care
Dr. Tarek Mahmoud al-Ghandour, a dermatology professor at Cairo’s Ain
Shams University and local leader of the Muslim Brotherhood, died on the
morning of November 12 in the intensive care unit of the National Liver
Institute at Monofiyya University, where he had been moved only hours
before.
His death from liver disease occurred following nearly a year of
detention during which prison authorities denied him access to necessary
medical care, according to al-Ghandour’s family and friends.
Police arrested al-Ghandour on December 18, 2013, at his home in Cairo’s
Nasr City neighborhood. Prosecutors charged him with several offenses
related to his membership in the Muslim Brotherhood and, in April, a
judge convicted him of participating in an illegal protest and sentenced
him to five years in prison, despite evidence that he had been at the
headquarters of the national Doctors Syndicate throughout the day of the
protest in question, his wife told Human Rights Watch.
Though al-Ghandour suffered from Hepatitis C, liver cirrhosis, and other
problems and needed a liver transplant from a donor that his family had
identified, the authorities kept him detained pending his appeal of his
five-year sentence and did not transfer him to a hospital where he
could receive the transplant.
According to the EIPR and witnesses
interviewed by Human Rights Watch, Egyptian prison hospitals are not
equipped for surgery, and authorities often put pressure on regular
hospitals to return admitted prisoners as quickly as possible, sometimes
preventing follow-up treatment or recovery time.
Al-Ghandour’s family informed the prosecutor about his medical condition
and requested his release for the liver transplant, and his wife wrote
similar appeals to the presidency and the quasi-governmental National
Council for Human Rights (NCHR).
On April 28, the office of the East Cairo General Prosecutor wrote to
prison authorities requesting that al-Ghandour undergo medical
examinations to see if he needed to have surgery and that further steps
be taken “in accordance with the law,” according to a letter provided by
al-Ghandour’s family.
On May 4, a prison doctor sent a medical report
to prison authorities recommending that al-Ghandour be transferred to
Ain Shams University Specialized Hospital to receive a liver transplant
and warning that his health would deteriorate if he was not. The report
was smuggled to al-Ghandour’s family, who provided it to Human Rights
Watch.
Eventually, prison administrators said they would investigate,
al-Ghandour’s family said, but by then they had moved al-Ghandour first
to one prison, then another. In late October, authorities moved him to
Shibin al-Kom Prison in the governorate of Monofiya because of its
proximity to the National Liver Institute.
The prison authorities
allowed him to have an operation in the Liver Institute necessitated by
his cirrhosis but insisted that he be immediately returned to prison
after surgery without allowing time for recovery. Al-Ghandour’s cousin,
also a dermatologist, told Human Rights Watch that he should have stayed
longer.
“I know that all hospitals in general don’t admit political prisoners
easily. They receive instructions not to admit them,” he told Human
Rights Watch. “The doctor at that time said it’s difficult for them to
admit political prisoners because it means a lot of problems for them
and the hospital.”
On November 9, nearly a year after his arrest, a prison medical
committee reviewed al-Ghandour’s case and asked for an ultrasound of his
cirrhosis, his wife said. Al-Ghandour received the ultrasound on
November 10. Early the next morning, he began to vomit blood.
Prison
authorities transferred him to the Monofiyya University Hospital, where
he was placed under police guard and for roughly three hours received
little treatment aside from a blood infusion, family members who saw him
there told Human Rights Watch. Al-Ghandour’s brother and cousin, who
arrived at the hospital from Cairo after the family received a call from
a doctor, said they found him conscious and that he told them, “I threw
up a bucket of blood.”
Police refused to transport al-Ghandour to the Liver Institute, so his
brother and cousin helped him make the roughly 10-minute walk. A manager
agreed to admit him, and doctors began giving him an endoscopy, but he
continued to bleed heavily, suffered cardiac arrest, and fell into a
coma. Doctors transferred him to the intensive care unit, where he died
the next morning.
Two days later, Hafez Abu Saada, a member of the NCHR, called on the
interior minister and prosecutor general to investigate al-Ghandour’s
death. Neither has announced an investigation.
Mahmoud Abd al-Rahman al-Mahdi: Repeated Heart Attacks
Mahmoud Abd al-Rahman al-Mahdi, 51, a government employee, died in
custody at Suez General Hospital on November 3 after being held for
months in an overcrowded prison cell and suffering apparent heart
attacks.
National Security officers arrested al-Mahdi, a supporter of the ousted
president, on January 19, 2014, at his office in Suez. Prosecutors
accused him of carrying firearms, inciting violence, and belonging to a
banned group – the Muslim Brotherhood.
They ordered him detained for 15
days pending investigation and repeatedly renewed the order until
August, when a judge acquitted him. The prosecutor appealed, and the
judge ordered al-Mahdi released on a 10,000-pound (US$1,400) bail.
However, National Security officers made new allegations that led
prosecutors to file new charges against him and keep him in pretrial
detention.
Authorities held al-Mahdi in Ataka Prison in Suez, in a cell with nearly
50 other inmates that was so small they had to sleep in shifts,
al-Mahdi’s daughter told Human Rights Watch. Al-Mahdi began suffering
chest pains and was transferred to Suez General Hospital three times,
his daughter said. The family arranged for a Health Ministry inspector
to visit al-Mahdi in prison, and the inspector recommended his immediate
transfer to a hospital, though the hospital declined to admit him. Many
doctors seem reluctant to admit those viewed as political prisoners
because they do not want to be legally responsible, al-Mahdi’s daughter
said.
“Actually, in the last period my father sometimes refused to go to
hospital when he felt sick because he thought it would be a lot of
useless effort,” she said.
One afternoon in late October, a few days before he died, al-Mahdi’s
pain became so severe that fellow prisoners began banging on the cell
bars to attract help, his daughter said, but it took 10 hours before
prison officials moved al-Mahdi to Suez General Hospital, where doctors
diagnosed high blood pressure and elevated blood sugar and said he was
probably having a heart attack.
They admitted al-Mahdi to the intensive
care unit for fewer than 12 hours and then transferred him to the
hospital’s prison ward, a facility that seemed to lack basic equipment,
including an oxygen mask, al-Mahdi’s daughter said.
On November 2, al-Mahdi suffered another bout of chest pain, and doctors
took him to the intensive care unit for an oxygen mask and
electrocardiogram. Though al-Mahdi said he was sick and could not
breathe, nurses and others told his daughter, doctors returned him to
the prisoner ward, where he died a few hours later.
Under the United Nations Standard Minimum Rules for the Treatment of
Prisoners, sick prisoners who require specialist treatment must be
transferred to specialized institutions or civil hospitals. The refusal
of a hospital to admit a sick prisoner does not relieve prison
authorities of their duty to provide the prisoner with adequate care,
such as transferring the prisoner to another hospital, Human Rights
Watch said.
Abu Bakr Ahmed Hanafi: Continued Detention Despite Terminal Illness
Abu Bakr Ahmed Hanafi, an accountant and Brotherhood leader in the Qena
governorate, died in Assiut Prison on November 13 after more than 10
months in detention. Police arrested him on January 1, 2014, at his
office in Qena governorate and charged him with involvement in a riot
that damaged Qena’s main train station in July 2013.
Prosecutors ordered him held, pending trial. In July, while at Qena
Prison, he began suffering stomach pain and vomiting, his wife told
Human Rights Watch. After several weeks, a prison doctor sent him to
Qena University Hospital for tests. A doctor there said his symptoms
were psychosomatic and ordered him returned to prison.
Prison authorities moved him to the prison hospital when he continued to
vomit and fed him intravenously because he could not eat, his wife
said. They then returned him to the university hospital, where doctors
diagnosed liver and pancreatic cancer, and estimated that he had only
three months to live, his brother, a prisoner in the same facility, told
Hanafi’s wife.
On September 7, prison authorities approved Hanafi’s transfer to Assiut
University Hospital for an MRI scan, but his transfer took 10 days. The
MRI confirmed the earlier tests, but doctors asked for a biopsy.
Meanwhile, Hanafi’s lawyer requested that Hanafi, likely suffering from a
terminal illness, be released for treatment.
At a September 20 court
session after trial began, the judge ordered further medical
examination. On October 26, rather than release Hanafi, he ordered him
transferred to a hospital.
Two days later, authorities sent him first to Qena University Hospital
and then to Assiut University Hospital, where the doctor kept him for 13
days in the prisoners’ ward, where he was under guard and almost always
handcuffed, his wife said. He underwent a biopsy, but because prison
officials confused his results with those of another prisoner, Hanafi
had to return for a second session. This delayed the release of the
biopsy results until the second week of November.
On November 12, doctors discharged Hanafi, prescribed medication, and
ordered him transferred to Qena University Hospital. But a prison
officer insisted on taking him first to Assiut Prison where, according
to Hanafi’s wife, the officer and the warden debated whether he should
still be held. Eventually, the warden ordered him held while awaiting
transfer to Qena.
On November 13, prison guards told Hanafi’s wife that she could not
visit him. The next day, they allowed Hanafi’s nephew to enter, and he
discovered that Hanafi had died. Hanafi’s brother, the prisoner, said
guards had found Hanafi dead in his cell and moved his body to an
ambulance. On his death certificate, they wrote that he had died in a
hospital.
Returning a critically ill prisoner like Hanafi to prison despite
doctors’ recommendations to send him to another hospital likely amounted
to inhuman and degrading treatment under international law.
Abd al-Rahman al-Razahi: Failure to Allow Care in Prison
Abd al-Rahman al-Razahi, a 43-year-old school employee and Muslim
Brotherhood leader from Assiut governorate, died on or shortly before
October 13, 2013, in Tora Prison in Cairo.
Police arrested al-Razahi on August 17, 2013, three days after security
forces brutally dispersed pro-Morsy sit-ins in the capital and killed
more than 800 people, mostly Muslim Brotherhood supporters. Prosecutors
accused al-Razahi of spying for the Palestinian movement Hamas and of
escaping during the 2011 revolution from Wadi al-Natroun Prison – where
many Muslim Brotherhood leaders had been held during the January 2011
uprising.
The authorities initially held him in solitary confinement in a high
security section of Tora Prison. When his wife saw him more than a month
after his arrest, al-Razahi had lost weight and was ill and vomiting,
she said. She said that Khairat al-Shater, a top Brotherhood leader
detained with al-Razahi, had asked the prison authorities to let a
doctor see al-Razahi but that the warden had refused, and she added that
prison guards sometimes threw away medicines taken to al-Razahi by his
brother.
As al-Razahi’s health deteriorated, his wife said, an
ophthalmologist sharing his cell asked the authorities to transfer
al-Razahi to a hospital. The authorities refused and only allowed the
ophthalmologist to order blood tests for al-Razahi. The tests did not
reveal anything abnormal, she said.
His wife told Human Rights Watch that she believed prosecutors would
release al-Razahi because they had no evidence that he had ever been a
prisoner in Wadi al-Natroun but that National Security officers provided
testimony to prevent his release.
On October 12, 2013, the
investigating judge ordered al-Razahi released without bail for health
reasons, and an ambulance arrived to transport him back to his home in
Assiut. But the prosecutor appealed the release order, and the judge
ordered al-Razahi held for another 45 days pending investigation, his
wife said.
On October 13, al-Razahi’s brother arrived at the prison for a visit and
found the facility in chaos. Guards told him that a prisoner had died
and ordered him to leave. Al-Razahi’s brother called the family’s
lawyers, who discovered that al-Razahi had died and that authorities had
already transferred his body to Cairo’s Zeinhom Morgue.
Al-Razahi’s
brother said that morgue workers told him that National Security
officers had instructed them not to confirm that the body was there.
When al-Razahi’s brother was finally allowed to take the body, morgue
officials asked him what he wanted written as the cause of death. He
responded that it did not matter, and they wrote “acute circulatory
failure.”
Al-Razahi’s wife told Human Rights Watch that Tora Prison officials had
never conducted medical tests on her husband, but the prison doctor told
her that he suspected he suffered from a stomach ulcer.
