If you say you’re sick, the warden just kicks you and says, “Even dead bodies must work.”
—Musa, Muduuma Prison, November 12, 2010
The prisoners at Muinaina Farm Prison have been forgotten by the Ugandan criminal justice system. Almost two thirds of the inmates on this rural hilltop have never been convicted of a crime. Some have not set foot in a courtroom in five years. Prisoners plead guilty just to know their date of release. Yet the backlog in the courts allows the prison authorities to profit from these forgotten prisoners because every day the prisoners at Muinaina go to work, farming the lands of the Uganda Prisons Service (UPS), producing the maize meal that feeds inmates at other prisons. Or they dig on the wardens’ personal farms, growing produce that the wardens sell for personal profit. Or they work for private farmers in the area, who pay the prison authorities. On the farms, they are brutally beaten for lagging behind.
They sleep on a cement floor, crowded together in hot cells. There is hardly any medical care available: HIV-positive prisoners are sent to work and are only sometimes excused when they are too weak to keep up; then they may be transferred to Kampala for treatment. Some prisoners cough, violently, night after night, their lungs possibly full of drug-resistant tuberculosis (TB), which is being spread to those around them. “Help us, we’ll die,” pleaded 10 of the prisoners in a note transmitted to Human Rights Watch.
In Uganda, prison conditions at a few, larger, regional prisons have improved in recent years because of the enactment of the new Prisons Act in 2006, partnerships with a few international donors on health, and the work of the Uganda Prisons Service. At these prisons, prisoners can usually access HIV testing and treatment and general healthcare. Overcrowding is less severe and clean water is usually available. But at many of the others, including Muinaina, the conditions and treatment rise to the level of cruel, inhuman or degrading treatment, and even torture.
Between November 2010 and March 2011, Human Rights Watch interviewed 164 prisoners and 30 prison officers at 16 prisons across Uganda, as part of a series of reports on health in prisons in Africa. Human Rights Watch found that poor conditions, forced and corrupt labor practices, routine violence at the hands of prison wardens, infectious disease, and inadequate medical care threaten the lives and health of the 50,000 inmates who pass through Uganda’s 223 prisons each year.
The conditions at some Ugandan prisons are improving but—particularly in rural, former locally administered prisons—are still far below international standards. Overcrowding is endemic, with prisons nationwide at 224 percent of capacity. Of the 16 prisons visited by Human Rights Watch, all but one was significantly over its official capacity, in one case rising to a staggering 3,200 percent of capacity. Prisoners often sleep on one shoulder, packed together so that they can only shift if an entire row agrees to roll at once.
Prison food is nutritionally deficient, leaving inmates vulnerable to infections and in some cases blind; sex is sometimes traded by the most vulnerable for additional food. Water is often unclean or unavailable. At some prisons, boiled water has become a commodity sold by inmates with kitchen privileges. Proper hygiene is difficult with limited government-provided soap, and lice and scabies are rampant. Mosquitoes and malaria are a constant threat, but the prison administration has only sprayed with insecticide at three prisons, and bed nets are forbidden for male inmates because of security fears.
A brutal compulsory labor system operates in rural prisons countrywide. Thousands of prisoners, convicts and remands, are forced to engage in hard labor—cultivating crops, clearing fields—day after day. Compulsory labor is often combined with extreme forms of punishment, such as beatings to punish slowness, and handcuffing, stoning, or burning prisoners who refuse to work. Few prisoners receive proper medical care for their injuries, and prisoners are regularly refused access to medical care because officers will not allow them to miss work. Prisoner productivity translates directly into profit for prison authorities, but prison authorities often do not account for the funds raised through prison labor.
In addition to abuses in the fields, prisoners are beaten and abused within the prison, allegedly as punishment. Inmates are also sometimes confined in isolation cells, often naked, handcuffed, and sometimes denied food; the cells are sometimes flooded with water up to ankle height. Some have had their hands or legs broken, or have become temporarily paralyzed as a result of beatings, and seldom receive medical care. Prisoners with mental disabilities are in some cases targeted for beatings, and even pregnant women are not spared.
The prevention and treatment of disease pose major problems in Uganda’s prisons. TB spreads quickly in the prisons’ dank, overcrowded, and poorly ventilated wards. TB prevalence in the prisons is believed to be at least twice that in the general population, which already is one of the world’s highest. While the prisons service has recently rolled out TB entry screening at 21 prisons, more than 200 still offer none. Prisoners routinely reported having coughed for long periods without having been tested for TB. TB treatment is only available in the prison medical system at Murchison Bay Hospital in Kampala, but even those inmates transferred for treatment may not stay long enough to be cured. TB patients are sometimes sent back to prisons where continued treatment is not possible in order to perform hard labor or ease prison congestion. The result may be drug resistance or death.
HIV prevalence in Ugandan prisons is estimated to be approximately 11 percent, almost twice national estimates. And although sexual activity among male inmates is acknowledged by prison authorities, condoms are universally prohibited because consensual sexual conduct between people of the same sex is a criminal offence. While just over half (55 percent) of the prisoners Human Rights Watch interviewed had been tested for HIV while in prison, rates were much lower at smaller, rural prisons. However, for those who are positive, treatment may be unavailable. Of Uganda’s 223 prisons, prison-based antiretroviral therapy (ART) is only available at Murchison Bay, and even there, ART is sometimes unavailable to those in need of it according to national protocols.
Under Ugandan law, people with mental disabilities should not be detained in prison. But a backlog of prisoners awaiting mental competency determinations, and still more who develop mental health problems once incarcerated, create a significant need for mental health services within the prison system. At upcountry facilities, mental healthcare is nonexistent; even at Murchison Bay, treatment consists only of medication prescribed by a visiting psychiatrist and dispensed by other inmates, with no attempt at psychotherapy or other forms of alternative mental healthcare. Inmates with mental disabilities at some prisons are simply isolated in punishment cells with no treatment.
The health needs of pregnant women are also largely unmet. Pregnant inmates receive little or no prenatal care. Pregnant and nursing women usually receive the same nutritionally deficient food as all other prisoners. And pregnant women are forced to perform hard labor and beaten just like other prisoners, leading to reported miscarriage or injury. Protections for women detainees under regional human rights standards are simply ignored.
The dangerously unhealthy conditions in many of Uganda’s prisons are in part a result of failures of the criminal justice system; prison officers’ inappropriate denials or delays in permitting access to medical treatment; and an under-resourced and inadequate healthcare system that has received limited support from the government and international donors.
Prison overcrowding is a direct result of extended pretrial detention and underuse of the non-custodial alternatives that are available, such as bail and community service. Fifty-six percent of the Ugandan prison population has never been convicted of any crime and is by law presumed innocent. However, remand prisoners often wait for years for their cases to be resolved and are forced into harsh labor conditions alongside convicts. While efforts have been made in recent years to address the case backlog, an insufficient number of judges, judges’ failure to grant bail in accordance with Ugandan law, and inadequate legal representation still conspire to create significant remand times, particularly for prisoners awaiting trial before the High Court. Corruption is reportedly rampant in the criminal justice system, from arrest through trial, so in some cases those remaining in prison are simply those unable to pay the necessary bribe. Children are also sometimes held in adult prisons instead of in juvenile detention facilities, contrary to Ugandan and international law.
Uganda has repeatedly committed itself to upholding the human rights of prisoners through its assumption of international and regional obligations. Under international human rights law, prisoners retain their human rights and fundamental freedoms, except for restrictions on rights necessitated by the fact of incarceration itself. Uganda has an obligation to ensure that its criminal justice and penitentiary standards comply with international and regional human rights standards, to ensure that detainees are treated with appropriate dignity and full respect of their human rights, and to prevent all forms of cruel, inhuman and degrading treatment. Uganda is also required to ensure adequate healthcare for prisoners, at a standard at least equivalent to that available to the general population, a commitment acknowledged by the Uganda Prisons Service. Yet medically unqualified prison officers routinely assess the health needs of prisoners and then deny their right to access care.
In Uganda, ill-health, hunger, and poor access to healthcare are not unique to prisoners. However, Uganda has an obligation to ensure basic minimum conditions and healthcare for detainees, to protect prisoners’ rights and public health. The Ugandan government has a binding and non-negotiable obligation not to expose people to torture and cruel, inhuman or degrading treatment, which it currently violates when sending them to prison.
Reform is critical: of prison oversight and management and of laws and practices that lead to extended pretrial detention. The Ugandan government and international donors need to prioritize prison funding, while ensuring that corrupt labor practices end. By building on the advice of its own medical staff and that of outside human rights monitors, the Uganda Prisons Service has the opportunity to continue to improve its protection of the rights and health of prisoners, by eliminating the abusive practices that lead to poor health.