July 14, 2011

II. Findings

The engagement of a prisoner in doing work as a principle would be ok, but it has to be closely supervised so that it is not abused.... There seems to be an insensitivity when it comes to the mobilization of labor. If a prisoner is on TB treatment, ARVs—you send him to where there are no services? … If they are on TB treatment, and you take them to a farm, you create drug resistance.
—Prison medical authority, Uganda Prisons Service, November 18, 2010

Prison Conditions

Overcrowding

Overcrowding in Ugandan prisons is endemic and by 2019, the UPS projects the prison population will more than double.[36] Contrary to international and Ugandan law requirements that accused people and convicted prisoners be held separately,[37] at every prison visited, all categories of prisoners (convict, remand, and debtor[38]) were mixed.[39]

Although international standards establish basic requirements with respect to prisoners’ accommodations, including with regard to ventilation, floor space, bedding, and room temperature,[40] 15 of the 16 prisons visited by Human Rights Watch were significantly over their official capacity. Fort Portal Women’s Prison was slightly undercapacity; Muduuma Prison, by contrast, was filled to a staggering 3,200 percent of capacity.[41] Prisoners reported wards routinely sleeping twice or three times their design capacity, and prison officers confirmed that congestion is a major problem.[42] At Luzira Upper, in one ward 124 prisoners packed into a space eight meters square.[43]

Prisoners complained about suffering each night in this limited sleeping space and described being “squeezed like iron sheets,”[44] “like chickens,”[45] or arranged nightly by a designated inmate “like logs,” “firewood,”[46] or “sacks of beans.”[47] Most often, prisoners told Human Rights Watch they were forced to sleep in lines, on one side, so packed together that if one turned to his other side, his entire row was forced to do so.[48] Occasionally, also, prisoners reported being forced to sleep in turns,[49] or seated or standing.[50]

Many prisoners said that they slept without any mattress; prisoners frequently reported being given one blanket to lie on and cover themselves. Sometimes two inmates shared a single blanket or mat. Occasionally, prisoners said they were not allowed to have a mattress, lest the ward become so crowded that its inhabitants would not fit in the room.[51]

Such tightly packed wards allow for little ventilation in contravention of international standards.[52] Inmates repeatedly complained of the heat in the congested cells: “We sweat from the bones.”[53] William said, “When your neighbor sweats, all the sweat will be on you.”[54]

At a few prisons, prisoners are forced to stay in their crowded cells day and night. Ugandan law provides that each prisoner have at least one hour of exercise in the open daily.[55] But at Masaka Ssaza and Butuntumura Prisons, the majority of prisoners spent all day and night locked in the overpacked cells because of security concerns about the prison’s perimeter[56] and were permitted outside for only 20 minutes a day.[57]

Food and Nutrition

Deprivation of food in prison constitutes an inhuman condition of detention in violation of the International Covenant on Civil and Political Rights.[58] International standards require that prisoners be supplied with “food of nutritional value adequate for health and strength, of wholesome quality and well prepared and served.”[59] Under Ugandan law, prisoners are entitled to nutritious food “adequate for health and strength.”[60]

At every prison visited, prisoners reported being given posho (maize meal) and beans once or twice daily, sometimes accompanied by a small portion of porridge for breakfast. Despite a recommended dietary scale including nuts, meat, vegetables, and sugar,[61] prisoners receive only maize meal, beans, and salt.[62] Greens grown by prisoners supplement the rations seasonally at some prisons. However, at others, prisoners reported that the officers confiscated all or a portion of the vegetables grown by prisoners.[63] Mark, at Muinaina Farm Prison, concluded: “We eat greens, but like a goat tied on a rope, the eating is controlled.”[64]

Most prisoners said that the government-provided food was not enough. Prisoners doing hard labor in particular considered food portions insufficient.[65] Julius, at Kitalya Farm Prison, said, “We are eating crumbs. However much energy we use, it is not enough.”[66] Medical personnel and a nutritional assessment conducted by the UPS agreed: “it is not enough for doing hard work.”[67]

Indeed, death records provided by UPS prison authorities to Human Rights Watch indicated that at least one prisoner died in 2010 from malnutrition.[68] The adequacy of the diet in terms of micro-nutrients was also a concern. The prison medical authority noted that:

There is a deficiency in terms of micronutrients, including A and C. Vitamin A is important in the immune system and eyes; vitamin C is important in cellular regeneration when recovering from diseases. These are important because we’re having a population of prisoners vulnerable to infections, and their capacity to recover from and fight off infections is grossly compromised. We see the cases of malnutrition….Especially the long-termers—they develop blindness, and infections like TB.[69]

The lack of adequate nutrition is particularly problematic for pregnant women prisoners and women with small children in prison. Under Ugandan law, “[a] female prisoner, pregnant prisoner or nursing mother may be provided special facilities needed for their conditions.”[70] Some women occasionally reported receiving supplemental milk or eggs during their pregnancy. [71] However, pregnant women typically do not receive extra food rations; they eat exactly the same diet as other prisoners.[72] At Jinja Women’s Prison, those pregnant women who had been exempted from hard labor ate an even less nutritious diet than their non-pregnant colleagues because they did not grow greens which they could eat.[73] Harriet, a new mother at Masaka Main, concluded: “The food we eat doesn’t generate breast milk.... I’m breastfeeding but it’s not enough.”[74] If prisoners choose not to breastfeed, or are unable to breastfeed, they do not consistently have access to formula or safe water with which to prepare it.[75] Despite international standards calling for special provisions for children incarcerated with their parents,[76] and Ugandan law requiring children imprisoned with their mothers to be supplied with “necessities of life,”[77] food is not generally provided for these young children.

Uganda’s own auditor general concluded that the UPS, given its budget and the food grown on farm prisons, would have the capacity to feed prisoners a sufficient diet, but that due to under-declaration and lax oversight of farm production by prison OCs, prisoners’ diets remain inadequate.[78] “[D]ishonest business practices like delivering less quantities of food items,” lack of prioritization (and reallocation of budgeted resources) for food, and the practice of taking prisoners to work on private instead of prison farms led to inadequate food for prisoners.[79]

Water, Sanitation, and Hygiene

There is no permanent water here. The kind of water we use is from the ponds we dig.… When you’re in the gardens, some people who are thirsty, if they come across stagnant water, kneel down and drink it. They drink it without the permission of the warden. But if you’re found drinking like a cow, they beat you.
—Martin, Bubukwanga Prison, November 16, 2010

Prisoners frequently told Human Rights Watch that water was insufficient in quantity and that they were constantly thirsty: “Sometimes we get water, sometimes we don’t. There are times we spend a day without drinking.”[80] At Kitalya Farm Prison, prisoners reported that each received approximately one liter of drinking water a day,[81] but it was not enough after a day of hard labor in the sun.[82] Officers in charge confirmed difficulties in supplying their prisons with sufficient quantity of water.[83]

At Bubukwanga Prison, inmates told Human Rights Watch that water did not consistently run from the tap, and they were forced to drink “stagnant water in the roads,”[84] full of small insects,[85] and green or brown in color.[86] At Muinaina, researchers observed the drinking water to be a cloudy olive green color. The OC at Muinaina described the water as “dirty white” and admitted, “It’s not clean.”[87] Indeed, at some prisons, boiled water has become a commodity sold in the cells by inmates with kitchen privileges, in exchange for soap, sugar, or money to those who can afford it.[88]

Under international standards, prisoners must be provided with adequate bathing installations for general hygiene,[89] yet bathing facilities at many Ugandan prisons fall far short of this standard. At Masafu, five prisoners share one basin of water to bathe each day.[90] At Muduuma, prisoners reported that no bathing water at all was provided.[91]

International standards specify that sanitary facilities shall “enable every prisoner to comply with the needs of nature when necessary and in a clean and decent manner.”[92] Despite efforts to overhaul sewage systems at a few prisons in recent years, prisoners at some prisons reported inadequate toilet facilities including the use of buckets.[93] “The most inhuman thing here is the bucket system” that inmates use at night, the OC at Masafu said.[94] At Muduuma, prisoners complained that they were sometimes refused permission to use the existing toilet facilities because they were located outside of the prison’s perimeter, and received beatings for making the request.[95]

International standards also require that prisoners shall be provided with toilet articles necessary for health and cleanliness[96] and separate and sufficient bedding that is “clean when issued, kept in good order and changed often enough to ensure its cleanliness.”[97] Ugandan law makes provision for prisoners to receive toiletries.[98] Yet, across prisons visited, prisoners and prison officers frequently reported an inadequate supply of such basic necessities. Prison officers admitted that, to give prisoners soap on a regular basis, part of the funding had to come from the proceeds of prisoner labor on private farms.[99]

Physical Abuse

Hard Labor

Thousands of prisoners are forced to engage in hard labor. They cultivate crops, clear fields, or fetch firewood and water. Prisoners, convicted or on remand, work often in oppressive conditions, in heat or rain, sometimes intentionally denied food, water, or bathroom breaks.[100] They are beaten as punishment for being slow or to instill fear upon arrival at prison, handcuffed, stoned, or burned if they refuse to work. Vulnerable prisoners, including children, the sick, elderly, and pregnant women are also beaten and forced to work.[101]

International legal standards place important constraints on how prison labor may be used. Under the United Nations (UN) Standard Minimum Rules for the Treatment of Prisoners, adopted by the United Nations as guidance, prison labor must not be of an afflictive but rather of a vocational nature, and prisoners should be allowed to choose the type of work they wish to perform.[102] The work must not be driven by financial profit motives.[103] No prisoner, whether remand or convict, should be forced to work for private entities, such as private landowners.[104] When working for the government, only convicts and not remands may work, and they must be medically assessed to see if they are fit and healthy for work,[105] they must be treated and remunerated fairly on terms close to what free workers receive, they should be male and between the ages of 18 and 45, and may not work more than 60 days a year.[106] Currently, Ugandan prisons do not comply with any of these international standards.

The practice of compulsory labor is longstanding in Ugandan prisons. In 2003 the government of Uganda wrote in its report to the UN Human Rights Committee that the “illegal and exploitative” practice of hiring prisoner labor to private individuals is a “common feature.” Enforced hard labor of non-convicts was at the time “rampant and therefore tantamount to painful punishment without conviction.”[107] In April 2011 according to the government-owned New Vision newspaper, the Uganda Prisons Service announced a new policy to the parliamentary public accounts committee that all prisoners would be paid 100 to 500 Uganda shillings ($0.04 to $0.21) per day for labor.[108] At time of writing, it was unclear to what extent this new policy had been put into practice.

While according to international standards, the safety and health protections in place for non-prison labor are supposed to be in place for prisoners,[109] prisoners in Uganda face greater risk of injury compared to free laborers because of abusive practices, including being made to work closely together or being beaten so that they will walk quickly through rough terrain without shoes, “like a herd of cattle.”[110] Prisoners spend long hours each day doing forced labor,[111] resulting for many in chest pain, ulcers, and fatigue.[112]

Many prisoners said they had to work while actively ill or injured, particularly if they suffered from illnesses that were not immediately visible. Prisoners often said that “there was no time to go to the hospital” because they were forced to work in the fields and were denied permission to miss work in order to receive care.[113] One prisoner, echoing an expression heard many times by researchers, said that prison authorities “were telling us we didn’t come to a hospital, we came to a prison and should work.”[114]The health consequences of prisoners’ hard labor may be severe: One prisoner died in Mubuku Prison while working in the field in November 2010. The exact cause of his death is unclear, but witnesses who saw the incident recounted that he was beaten and his numerous expressions of thirst and requests for water went ignored by prison authorities.[115]

Abuse in the Fields by Wardens and Other Inmates

They [the wardens] took the sick to work. They would take me to dig. They used to start the digging at 6am, and dig at high speed—but when the sun would rise up and the heat raise, I started feeling dizzy and in most cases I would fall down. I was beaten by the katikkiros [prisoners with disciplinary authority], claiming I was faking illness, until one time when this happened to me, the katikkiros beat me, but the wardens stopped them because I couldn’t move, and they ordered I should be taken back to the prison. I lost consciousness, only to wake up to see I was in the ward.
—Henry, a remand prisoner from Muinaina Farm Prison, interviewed at Murchison Bay Prison, November 20, 2010

At the 11 prisons visited by Human Rights Watch where prisoners were engaged in compulsory labor, prisoners reported routine, brutal beatings in the fields.

Prisoners said they were beaten by both prison officials and other prisoners with disciplinary authority, most commonly with sticks or canes. Beatings occurred for a range of reasons: if prisoners lagged behind others in their work, if they said they were sick, if they made errors in their work, if they straightened up to stretch their backs.[116] At Kitalya Farm Prison, Human Rights Watch researchers observed a prisoner with disciplinary authority hitting prisoners with a stick as they unloaded maize from a truck.[117]

Prisoners at Muduuma and Kitalya Prisons said new arrivals were beaten in order to preemptively instill fear, as work in open fields heightened the opportunity to escape.[118] Some were beaten together in groups as large as 25, each with legs and hands tied behind his back with rope.[119] Wardens and other prisoners then beat them with sticks, batons, or slashers, metal rods with a blade used typically for cutting grass.[120]

At some prisons, prisoners reported unique and especially brutal punishments. Four prisoners from Muinaina Farm Prison independently confirmed that prisoners who worked slowly had dried grass or banana leaves placed on top of them and set afire.[121] One was himself a victim while the remaining three said they observed this practice in at least two incidents in 2009. One from Muinaina Prison said he was forced to sit on an anthill to suffer ant bites.[122] Remand prisoners at Muinaina once refused to go to work in the fields after a new OC initiated a policy of making all prisoners, whether remand or convict, work. They were handcuffed to a tree all day, every day, until they succumbed.[123] Female prisoners from Jinja Women’s Prison recounted working in waist-deep water to cultivate rice for the wardens, as leeches attached to them.[124] The wardens, themselves unwilling to get wet, threw stones at prisoners to punish them.[125]

Despite the prohibition in Ugandan law that “[a] prison officer shall not employ a prisoner in the punishment of a fellow prisoner,”[126] and prohibitions in international standards on prisoners being employed in any disciplinary capacity,[127] some prisoners are given authority to punish other prisoners. One prisoner who was promoted through the ranks said that the prison authorities told him, “Don’t go back to the hoe. Now you have a stick.” He described an intricate hierarchical system in which he oversaw other prisoners, who themselves oversaw squads of 20 prisoners, called a “bicycle.” He said, “I can even beat commanders and say, ‘Your bicycle is not moving.’” If he beat a commander, the commander was then required to beat all 20 prisoners in his bicycle.[128]

The Economic Incentives behind Prison Labor

The money they are receiving for us, where do they put it?
—Ali, a former inmate at a farm prison, interviewed at Murchison Bay Prison, November 20, 2010

Testimony of forced hard labor and abuses was most frequent at farm prisons, or former LAP prisons in rural agricultural communities. Prisoners at those prisons said that they were hired out to work on land for private farmers and on land owned or rented by prison authorities. Because their productivity translated directly into profit for prison authorities, who sold the food harvested from their land or were paid per job by private landowners, they forced prisoners to work for long hours, with little rest, even despite illness or injury.

Prison OCs told Human Rights Watch that they needed the income produced by prison labor to meet the operating costs of the prisons.[129] Four OCs said that they received only 150,000 Uganda shillings (approximately $63) or less per month in addition to in-kind supplies from the prison administration in Kampala, leading to a shortfall which they met by contracting out prison labor.[130] As one OC said, “From the working arrangement, we use the money [the prison receives for private work], if it wasn’t there, then we wouldn’t be surviving, we wouldn’t be running the institution. Because of that, we buy milk for the kids, we buy fuel and repair the vehicle, we put a latrine in the female section.”[131] Another OC explained that, “Labor is not part of their sentence. Labor is just an activity that we subject them to for us to be able to keep them and rehabilitate them somehow.”[132]

OCs said that the prison administration knew of and indeed encouraged the practice of contracting out prison labor, as it was a display of initiative by OCs to ensure that their prisons were well run. One OC reported:

There is a language of initiative in the prisons. But they need to define the limits. The regional command had already told the commissioner, no prison in the region will be using a bucket toilet. He said to us, we should put water-borne toilets in the ward at your cost, don’t ask for any money. By December, all prisons in the Eastern region will be using water-borne toilets. But it is an uphill task….I talked to an engineer, and that will take 12 million shillings [approximately US$5,100].[133]

Prison authorities are not required to account fully to the prison administration in Kampala for the earnings from contracting out prisoner labor, potentially fueling corruption. One OC said that a senior colleague, also in the UPS, had told him when he was promoted, “Eat on the job, but don’t eat the job,” which he took to mean that it would be acceptable to personally gain from prison labor as long as he ensured that the prison could operate.[134] An OC of a farm prison informed Human Rights Watch that he intentionally underreported the amount of food his prisoners produced.[135] Uganda’s auditor general has criticized the “laxity in supervision and accountability for the food grown on the prison farms.”[136]

Generally, three models of prison labor exist. In the first, prisoners work on official farm prisons, farming government-owned land.[137] The produce from this activity is intended to go to Kampala for distribution to prisons nationwide. However, sometimes prison officers keep behind a portion of it to meet prison operating expenses. One OC said:

We declare estimates to Kampala [UPS headquarters]. If we expected 100 bags [of produce], we declare 80. You can’t complain to the boss all the time, or else he will call you a failure. You have to take your initiative. The resources we get from the central government are small, minute. Maybe the government should inject in more funds. The 20 bags sold off don’t make it into the books. The auditors don’t understand.[138]

Second, prisoners are contracted out to private farms at rates ranging from 2,500 to 3,500 Uganda shillings (roughly $1.00 to $1.50) per head per day, significantly lower than what free workers would earn, approximately 7,000 to 10,000 Uganda shillings ($3.00 to $4.25) a day.[139] Private farmers hire prisoners to work on their own land and pay the prison OC directly for the labor. Prison staff takes bookings for prison labor by phone or in person, and payment must be made in advance.[140] Injuries sustained by prisoners while working on private land are the responsibility of the prison and not the private farmer.[141] Private farmers must pay for transportation of the prisoners and may rent additional equipment such as hoes from the prison. They are responsible for providing some food for the prisoners and may also pay the accompanying wardens tips ranging from 5,000 to 15,000 Uganda shillings ($2.00 to $6.25) per day per warden to ensure that prisoners’ productivity is high.[142]

According to prison authorities, hiring labor out to private landowners can be done by the OC “for improvement of administration of his Prison.” It “can only be done as a form of employment in which the inmates will have to earn a statutory fee.”[143] Only prisoners who have been convicted of petty offences are permitted to work on private land.[144] Currently, Ugandan prisons violate their own policy.[145]

Media reports have speculated that wide-ranging police sweeps of people in slum areas of Kampala have been driven by the prison authorities’ desires to have free manpower to contract out to private landowners.[146] Prisoners at Muduuma Prison told Human Rights Watch that police engaged in large-scale street sweeps, accusing them of being “rogue and vagabond,” a vaguely defined crime akin to loitering, releasing those who could pay and taking the remainder for hard labor.[147]

In the third model, prisoners cultivate directly for prison OCs and wardens, who sell the produce at a profit. Officially, prison officers can have prisoners work on officers’ own “small gardens…usually once a week on Saturdays.”[148] One OC stated that he personally earned approximately 1,000,000 Uganda shillings ($425) per season and estimated his wardens each made 500,000 to 600,000 Uganda shillings ($200 to $250) per season, the equivalent of two to three months’ wages, by selling the produce that prisoners cultivated on their land.[149] Prisoners with prior experience in agricultural trade placed estimates of the OC’s stock to be several times the amount he reported to Human Rights Watch.[150] Inmates at the same prison, where remand times were on average five years, believed that their prolonged pretrial detention was in part due to the desire of prison wardens to profit from their labor for a considerable period of time. Human Rights Watch observed storage at the prison of the OC’s private maize and rice stock, which he said he planned to sell.[151] Inmates not only cultivated but also processed the maize from the OC’s private stock, and some prisoners observed private sellers paying the OC within prison grounds.[152] When the prisoners raised the issue of their hard labor with the regional prisons commander, they received no assurances that any of these practices would stop.[153]

Wardens and OCs also benefited personally from prisoners in smaller ways by forcing them to clean their houses or do their laundry, allegedly stealing church-donated goods or food given as payment for labor, and in one instance, having them build the OC a new house.[154]

Prison authorities wrote to Human Rights Watch, saying, “Where prisoners are forced to work without pay, that’s abuse. In my tours, I am yet to meet this. The Officer in Charge of the Prison must keep an inventory of these activities that will have to be checked by the Prisons Inspectorate and the Regional Prisons Commanders.”[155] However, at Kitalya Farm Prison, where Human Rights Watch had to go to the fields to retrieve prisoners from their work for interviews, each of the prisoners interviewed reported that only prisoners with disciplinary authority are ever paid for their work; all others receive nothing.[156] Indeed, the vast majority of prisoners Human Rights Watch interviewed who did hard labor reported being forced to work without pay. At some prisons, prisoners were paid nominal amounts of money, around 200 to 500 Uganda shillings per day ($0.09 to $0.21), or received small amounts of food, soap, or cigarettes as payment, but in most instances, prisoners received nothing.[157]

Punishment

Ugandan law lays out disciplinary procedures for prisons.[158] And some of the punishments currently inflicted are in line with Ugandan and international law: Prisoners may lose the possibility of early release,[159] be given additional cleaning or field work,[160] or denied visitors.[161] For serious unlawful offences committed in prison, a prisoner can be criminally charged, prosecuted, and convicted with an additional sentence.[162] Yet, at almost every prison Human Rights Watch visited, prisoners overwhelmingly reported beatings and the use of isolation cells flooded with water while the prisoner was forced to be naked, beaten, and given limited food as the primary punishments.[163]

Beatings

They hit me so hard, I was crying blood.
—Edmund, Muinaina Farm Prison, March 4, 2011, describing a beating by prison wardens and other inmates
 

Severe beatings—in the fields as described above but also in the prisons themselves—conducted as punishment either by the wardens or by inmates with disciplinary authority, were reported by prisoners at nearly all prisons visited by Human Rights Watch. Overall, 41 percent of the prisoners interviewed by Human Rights Watch said that they had been beaten; 87 percent of prisoners at farm prisons had experienced a beating.

Corporal punishment is forbidden in Ugandan prisons[164] and international law forbids cruel, inhuman or degrading treatment and torture.[165] Prison officers told Human Rights Watch that they knew corporal punishment was banned and frequently contended that it had been abolished in practice.[166] Yet prison medical staff acknowledged that they had observed injuries inflicted by prison wardens: A health worker at Murchison Bay Hospital reported that most of the injury cases he sees are inflicted either by police or prison staff,[167] and the prison medical authority admitted that he had heard of “instances” where “this has cropped up.”[168] Additional human rights monitors have noted the frequent, continuing, use of beatings, despite its official abolition.[169]

An assistant commissioner of prisons is charged exclusively “to monitor human rights abuses in prisons.” According to prison authorities, four OCs have been removed from their positions due to infractions, and an additional two OCs and two junior officers are currently facing criminal charges for assault of inmates.[170]

At every prison visited but one,[171] prisoners reported that caning still takes place; at most, it is the primary form of punishment. At Bubukwanga Prison, researchers touring the prison were confronted with a prostrate inmate, writhing on the floor and moaning in pain. He said: “I’ve been beaten by the OC, he hit me. He left me very badly off. He said I had stolen, and he beat me with a big cane. He beat me this morning.”[172] He showed researchers the marks the beating had left on his body. Other prisoners confirmed that they had seen the OC beat him that morning, for allegedly stealing some sugar from another inmate.[173]

At some prisons—in particular Luzira Upper, Fort Portal Men’s, and Muinaina Farm—prisoners reported marked decrease in frequency and severity of caning in recent years.However, inmates across facilities still consistently reported routine beatings by wardens: At one prison, several prisoners described being held by each arm and leg as they were beaten on the buttocks and back of the head with a stick.[174] According to one inmate, the OC said, “This is the stubborn part,” as he beat prisoners’ heads.[175] Prisoners reported receiving beatings of varying severity, from five strokes to “so many times I could not count.”[176] The instruments include batons, canes, sticks, whips, electric cable, and wire.

Despite prohibitions in Ugandan law and international standards on prisoners being employed in any disciplinary capacity, prisoners with disciplinary authority also mete out punishments within the prison.[177] At some prisons, prisoners reported having been beaten by prisoners with disciplinary authority in the wards on the orders of wardens or as they watched and tacitly approved.[178]

Several prisoners with mental health problems reported being targeted for beatings by inmates with disciplinary authority because of their mental disabilities.[179] As Ali, one inmate in the “mental health” cell at Murchison Bay, observed, “The cleaner [an inmate with disciplinary authority] will say, ‘Stay in the wards,’ and if you go out—you are beaten. But these people [with mental disabilities] don’t see things in the normal sense. They are punishing people for being mentally sick.”[180]

Table 2: Prisoners Reporting Beatings, Health Problems as a Result of Beatings, and Medical Care for Their Injuries

The health effects of beatings may be severe. Prisoners described how beatings in some instances caused loss of consciousness, or partial loss of hearing,[181] while others sustained broken legs as a consequence.[182] One prisoner described how he had been beaten so badly by a warden that he was unable to walk for a month.[183] Another prisoner recalled an incident he had witnessed at a farm prison:

They caned him, and he fell sick. The whole buttocks was rotten. In the ward where I was sleeping, you feel like dying; he lay on the floor crying. This boy received no treatment. But the smell was too much. After some time, we went to the OC’s office, and said, “We are not going anywhere. We need our colleague to get treatment.” The OC reached the door [of the ward], and smelled the stench, and saw the flies. He said the man should get treatment. But even after treatment, he still could not sit. He was totally rotten.[184]

Injuries from beatings at Kitalya Farm Prison were so common that one inmate said, “there was a time from May to October last year when the nurses here were no longer treating us for malaria, they were just treating us for wounds on our buttocks from beating.”[185] But treatment for these injuries is for many an unattainable luxury: only 15 percent of prisoners who told Human Rights Watch they had suffered a health problem as a result of a beating had received treatment, and none of those at former LAPs had received treatment. Matthew, a prisoner at Masafu, experienced a beating so severe that his hand was broken, but the prison warden who beat him would not allow him to go to the hospital.[186]

 

Isolation Cells

Under Ugandan law, an OC may order a prisoner confined to a separate cell for a period not exceeding 14 days on disciplinary grounds.[187] The law explicitly states that “[s]tripping a prisoner naked, pouring water in a cell of a prisoner, depriving him or her of food and administering corporal punishment and torture is prohibited.”[188]

Yet, at 9 of the 16 prisons visited,[189] Human Rights Watch researchers found that isolation cells were used for punishment, sometimes in conjunction with each of the aggravating factors specifically prohibited by law. Prison officers confirmed the use of isolation cells, but denied the additional deprivations.[190] At four prisons, Human Rights Watch researchers were able to tour the cells used for prisoners’ isolation and found them to be bare cement structures, with a bucket for a toilet, with sizes ranging from one meter by one meter to four meters by five meters. At Luzira Upper Prison, “never forget me” and “broken hands” had been etched into the wall of one of the cells. Prisoners said that isolation can range from a few hours to two weeks, as specified by law, but also noted that it could last in some cases from months to a year[191] depending on the prison and offence.

Despite the explicit legal prohibition, at many prisons a prisoner held in an isolation cell would likely also face a combination of handcuffing, reduced food, water poured on the ground to ankle depth,being stripped naked, and beatings. No toilets are typically available in the cell, so prisoners use a bucket or even a paper bag for their excrement. Esther described the conditions:

They completely undress you, and pour water in there….It’s very cold in there because of the water. I have been there. In the cell, there is something that retains the water and there are so many mosquitoes breeding. The water is very cold, and your body reacts badly. One woman was taken there on her period—she was undressed, and she spent time in blood mixed with water.[192]

Being confined in an isolation cell, compounded with the abuses described above, has a serious effect on inmates’ physical and mental health. Inmates were described as “sick,”[193] “not well,”[194] “swollen,”[195] “yellow and with a rash on their body,”[196] with “burns,”[197] “moving in a zigzag,”[198] or “weak and can’t walk,” [199] after they had been put in isolation and subjected to other abuses including beatings. One prisoner at Luzira Upper said that he had seen three people die there since 2005 as a result of beatings or mistreatment prior to or during incarceration in the isolation cells,[200] but the deaths could not be independently verified. Another prisoner reported one inmate who had been confined to an isolation cell for two months began cutting himself with a razor blade.[201] “When they will take you to the cells, that’s when people change,” concluded Abdul.[202]

The most fundamental protection for prisoners in international and Ugandan[203] law is the absolute prohibition on torture and cruel, inhuman or degrading treatment. There is little doubt that the use of these cells to inflict punishment constitutes prohibited inhuman and degrading treatment. Extended use of these cells when combined with other punishments, such as handcuffing, being stripped naked, food restrictions, and being made to stand ankle-deep in water, constitutes a form of torture.[204]

Prisoners may also be confined in isolation cells (typically without being stripped or forced to stand in water) not strictly as punishment, but as a result of officers’ inability to appropriately handle and offer treatment for their mental health problems. At Jinja Main Prison, researchers found one prisoner with what a warden described as “mental problems” occupying an isolation cell, who informed researchers that he had “not been receiving medicine” and that he had not been seen by a medical professional or offered any treatment.[205] “We have an isolation cell for psychiatric cases or for those who have failed to be disciplined,” admitted the deputy OC at Jinja Main. But, he contended, “We base it on the medical staff to give us the right information.”[206] Tumwesigye described a fellow prisoner at Jinja Main, “not a very stable man,” confined in an isolation cell for a full year.[207]

Prevention and Treatment of Disease

All people have a right to the highest attainable standard of health,[208] and under international law, states have an obligation to ensure medical care for prisoners at least equivalent to that available to the general population.[209] States also have an obligation to meet a certain minimum adequate standard of prison health conditions and care to individuals in detention, regardless of a state’s level of development.[210] The Human Rights Committee, the monitoring body of the International Covenant on Civil and Political Rights, has determined that danger to a detainee’s health and life as a result of the spread of contagious disease and inadequate care constitutes a violation of that treaty.[211]

Under Ugandan law, prisoners are also entitled to “have access to the health services available in the country without discrimination.”[212] The UPS acknowledges its legal responsibility to ensure healthcare services equivalent to those available in the general population.[213] Yet, the prison medical authority admitted that equivalence does not currently exist.[214] HIV and TB, which occur at high rates in the prisons, pose particular challenges. Incomplete and delayed reporting of health conditions from prisons hinders the development of appropriately tailored interventions for these and other health conditions.[215]

Tuberculosis

For TB, the rate is almost two, three, five times the rate in the general community, depending on which region you look at…. The prisoners enter, it makes them worse, it makes those who haven’t come in with diseases acquire them. If we inappropriately handle them—causing drug resistance, as for TB—we act as a petri dish, then they just give it back to the community.
—Prison medical authority, Uganda Prisons Service, November 18, 2010

Transmission

The conditions in Ugandan prisons—combining overcrowding, frequent housing together of the sick and healthy, poor ventilation, and lack of natural light—facilitate the transmission of tuberculosis.[216] “If one prisoner has Tuberculosis (TB) in a room filled with 50 inmates, at the end of a day, everyone will be infected,” the commissioner general of prisons has said, according to media reports.[217]

TB prevalence, already high in Uganda’s general population, is significantly higher in the prison population. Uganda is ranked 16th of the World Health Organization’s 22 high-burden countries for TB worldwide[218] and in 2010 had a prevalence rate of 330 cases per 100,000 members of the population.[219] In 2008, the UPS and UN Office on Drugs and Crime (UNODC) estimated that Ugandan prison TB prevalence was 654 cases per 100,000, almost double national population prevalence.[220]

The Prisons Service acknowledges that TB education programs thus far have been limited.[221] However, the risk of contracting TB through the coughing of their fellow inmates was not lost on many of the prisoners. As Johnson, a prisoner at Bubukwanga who had coughed for the entire five months since he had been detained, said, “I am sure I could be infecting other people. You see, here we sleep in one room—sometimes 70 people, or 80. If you are sick, definitely you will infect others. If they are also sick, they will infect you.”[222]

Testing

We worry a lot when people are coughing that we might catch the disease. No one has ever checked us for TB here. Normally when the nurse comes and people complain about the cough, he says, “I don’t have the gadgets to test you.” He gives you some tablets and says, “Let’s see what will happen next.”
— Owen, Kitalya Farm Prison, February 28, 2011

Regular TB screening is a well-established cornerstone of prison health. Since 1993 the WHO has explicitly recognized the need for “vigorous efforts” to detect TB cases through entry and regular screenings in prisons.[223] On Human Rights Watch’s visits to Ugandan prisons, screening for TB was taking place only at a few of the reception centers located near larger towns.[224] The prison medical authority reported that entry screening had recently been scaled up to 21 prisons from three original pilot sites,[225] and he has plans to scale up entry screening for TB further.[226] But he admitted: “We are wondering why we stayed too long to do that. The findings are shocking.”[227] Outside the major reception centers, TB screening for prisoners upon entry is not taking place.

Twenty-eight percent of male prisoners and seven percent of female prisoners interviewed by Human Rights Watch said that they had been tested for TB during the period of their incarceration. Twenty-two percent overall, the percentage of prisoners tested for TB varied between categories of prison and fell to only 11 percent at former LAPs.

Just over one-third (36 percent) of prisoners interviewed said that they had coughed for longer than two weeks since incarceration, but nearly three quarters of these prisoners had not been tested for TB (28 percent had been tested). Some of those prisoners who had been tested had never received the result.[228]

Table 3: Prisoners Interviewed Reporting Cough Longer than Two Weeks Tested for TB

Case detection rates for TB in the UPS are unknown,[229] but it is widely acknowledged that infectious TB patients are not being identified. The director of the national TB program speculated: “TB missed? It must be big. Transmission in prisons may be 10 times higher than in the general population. When you miss one, it is catastrophic.”[230]

Preliminary results from a recent national drug resistance survey suggest that between one and two percent of TB cases are multi-drug resistant (MDR-TB).[231] In the prisons, testing for drug resistance exists only at Murchison Bay Hospital; the prison medical authority acknowledged that drug-resistant cases undoubtedly exist but are not detected.[232]

 

Treatment

Uganda has been making progress in treating TB in the general population, though significant gaps exist.[233] Among the prison medical facilities, only Murchison Bay Hospital is accredited to manage TB.[234] Elsewhere, the prison medical authority envisions that TB suspects will be transferred to regional prison health units, which will establish contact with nearby public health facilities or, where there is no regional unit, will be referred to the public health system. But as the prison medical authority admitted, “It could be possible there are those not on treatment.”[235]

Inconsistent or incomplete adherence to the eight-month treatment course risks creating drug resistance. Saul was told by medical personnel at the public hospital to stop taking his TB medication after two and a half months but was still coughing at the time of his interview.[236] Prison authorities reported that at least three prisoners died of TB in 2010.[237] Prisoners and prison officers at some prisons reported that there were no medications for TB available at the prisons or at nearby health centers for prisoners with TB.[238] As Gilbert at Kitalya Farm Prison noted, “The nurses tell us there is no medicine, but there are quite a number of them [prisoners] who do cough. I worry about it because those who are suffering from TB, they are here. They are not isolated, and they receive no treatment.”[239]

The development of drug resistance because of transfer to a farm prison, or upon release, is a major concern of prison health officials.[240] The prison medical authority has noted that inappropriate referrals to upcountry prison centers for hard labor of patients on TB treatment risk creating drug-resistant TB.[241] While Ugandan law provides for prisoners under medical treatment to be linked to medical or social services upon discharge,[242] and prison medical officers reported trying to make efforts to link discharged TB patients to appropriate services, they noted that those released from court and others were still released before finishing their course of treatment without being linked to services near their homes.[243]

HIV/AIDS

When I told the prison officer I was HIV-positive, he said, “Fight on, complete the sentence, go home, and get treatment.” It meant he can’t do anything for me. There were wardens I informed. They said prison has nothing to offer me.
—Robert, Masafu Prison, March 8, 2011

In 2009 Uganda had an adult HIV prevalence rate of 6.5 percent.[244] Prevalence in Uganda’s prisons is even higher: a 2008 study found a general prevalence of HIV among prisoners of 11 percent.[245] Yet human rights monitors have continuously found that prisoners have limited access to HIV testing and treatment.[246]

Transmission

Sexual activity occurs in Ugandan prisons. Male prisoners at Murchison Bay, Luzira Upper, Masaka Main, Muinaina Farm, and Kitalya Farm Prison, all larger prisons with longer-term inmates, repeatedly told researchers that they had heard of, witnessed, or participated in sexual relations and same-sex relationships between inmates, particularly involving prisoners in authority positions. Prison wardens and officials confirmed that sexual activity takes place.[247]

Most frequently, prisoners reported that lack of food and other basic necessities led inmates to trade sex for those items.[248] Gilbert concluded: “The cause is the conditions. Some people will receive visitors and be able to have something. They use the power of their resources to entice others with doughnuts or sugar.”[249] As Mukasa, at Luzira Upper, described, “These are the things that happen in a closed environment. There is some homosexuality…. As a young man, they give you tea, and you can end up giving in. They say, ‘You are now a woman,’ once they get you.”[250]

Prisoners also said that rarely they had heard of instances in which individuals were forced into sexual activity.[251] Given the heavy stigma attached to same-sex sexual relations in Uganda, according to Joshua, “Most of them negotiate. It’s very difficult for someone to force. They will catch you and punish you.”[252] Yet sexual coercion does occur. As one prisoner described, “Sometimes, when you are sleeping together in the night, you will feel someone touching you. Sometimes people are forced in the corridors during the day, but at night, if someone touches you, you shout.”[253]

In addition to being subjected to caning or confinement in isolation cells as punishment, prisoners found to be engaging in sexual conduct with others, whether discrete consensual acts or longer-term relationships, are subjected to sexual humiliation in some prisons. According to Jacob:

Sometimes when people are caught having sexual intercourse, they are put out in the field and made to walk around naked. The chiefs in the wards help to identify them. If you are caught red-handed, you are taken to the prison wardens. To try to control the activities, they have undressed those who are caught, and have made them walk around the [area surrounding the prison], to make them ashamed.[254]

International organizations—including WHO, UNODC, and the Joint United Nations Programme on HIV/AIDS (UNAIDS)—all recommend that condoms be provided to prisoners.[255] Homosexual sex is illegal in Uganda.[256] Its criminalization, itself a human rights violation, has the added result of creating stigma and fueling transmission of HIV, particularly as it leads prison authorities to deny condoms to inmates. UPS concludes that “notwithstanding the existence of incontrovertible evidence of MSM [men who have sex with men], the distribution of condoms to prisoners in custody is not possible….Exploring the possibility of introducing condoms within the existing legal regime will continue to be our priority.”[257] According to the prison medical authority, “I know our interventions are not as effective as we wish them to be—we are legally bound.”[258]

Testing

HIV testing has increased in some prisons in recent years, and overall, 55 percent of prisoners interviewed who did not already know they were HIV-positive when they entered prison reported having been tested for HIV during their incarceration. A prisoner entrusted with medical authority at Luzira Upper claimed that all new entrants are now offered HIV counseling and testing.[259] HIV testing at other prisons is offered in partnership with  nongovernmental organizations.[260] Some prisoners also reported receiving diagnostic HIV testing at health centers when allowed to go out to receive healthcare.[261] More rural prisons, however, still lack completely both HIV screening upon entry and diagnostic testing for those who fall ill. At former LAP prisons, only 17 percent of the prisoners interviewed by Human Rights Watch had been tested for HIV during their incarceration. The prisons service acknowledges limited capacity for HIV testing because of inadequate staff, lab infrastructure, and lack of motivation among counselors.[262]

Table 4: Prisoners Interviewed Tested for HIV While Incarcerated, % (n)

Researchers heard reports that at those prisons conducting HIV testing, some prisoners were subject to mandatory testing, as opposed to the voluntary testing required by international best practice.[263] Enid, at Luzira Women’s, said, “Whether, you want it or not, you’re tested here.”[264]

Treatment

I’m positive. All the wardens are aware. Even the OC is aware. I’m not getting medicine. I used to get medicine. I left my medicine out there [outside of prison]. The warden beat me so much, I even fear asking to go to the hospital. Since my arrest up to now, I’ve not been taking my medicine.
- Matthew, Masafu Prison, March 8, 2011

Uganda has in recent years scaled up treatment, though significant challenges remain.[265] Estimates as to the number of prisoners receiving HIV treatment vary significantly.[266]

In 2011 prison-based ART services were only provided at Murchison Bay Hospital to residents of the Luzira/Murchison Bay Prison complex in Kampala. HIV-positive prisoners at other prisons were intended to access services at outside community clinics[267] or to be referred to a regional health facility (where they would access services at public facilities) or to Murchison Bay. The prison medical authority highlighted the HIV treatment gaps: “Upcountry, we don’t have any prison health unit accredited for ARVs. If you are positive and on antiretroviral drugs [when you come into prison], you would be in trouble. There is no mechanism for you to get these supplies….We have those who are positive. But no counselors, no access to public health facilities. What do we do?”[268]

Table 5: HIV Treatment by Prison Type for Prisoners Interviewed

Among prisoners interviewed, 18 (11 percent) self-identified as HIV-positive. Of these, 22 percent were receiving no treatment of any kind, and 50 percent were not receiving ART. The OC at Muduuma Prison confirmed that the prison held HIV-positive prisoners, but they received no ART, as it was not available at the nearby public facility.[269] An HIV-positive prisoner at Muduuma reported:

We, the sick ones, remain in the wards, and the OC comes to inspect. The only thing she does is to say not to go to work….With the OC, I’ve raised the matter [of my HIV-positive status and lack of medication] twice, but she doesn’t come inside the ward, only peeps inside and says, “How are you?”[270]

Prisoners reported deaths of HIV-positive fellow prisoners as a result of inconsistent or denied treatment.[271] Prison authorities indicated that at least three prisoners died of HIV/AIDS in 2010.[272] However Human Rights Watch was unable to verify claims of inmate deaths as a result of denials or lack of medication.

Rural prisons did not always immediately transfer HIV-positive prisoners to Murchison Bay. At Kitalya Farm Prison, seven HIV-positive inmates were receiving only Septrin while awaiting transfer on the day Human Rights Watch visited, but transfer was not immediate. Human Rights Watch researchers saw at Kitalya referral forms of prisoners who had been waiting for over a month to go to Murchison Bay. [273] At Muinaina, the OC reported that HIV-patients “in the early stages” received Septrin and continued to work, while “when it gets complicated, that’s when we have to take them to Murchison Bay,” but acknowledged: “CD4 testing, it’s difficult to monitor.” [274] While some HIV-positive prisoners were transferred to Murchison Bay, they were sometimes returned to their farm prisons, where treatment remained unavailable.

Even at Murchison Bay Hospital, medical staff reported that due to inconsistency in the drug supply[275] (ARVs come from the national medical stores), they are currently only starting patients with a CD4 count less than 250 cells/mm3 on ART, rather than following the national and international standard of less than 350 cells/mm3.[276] The chief physician explained that if national guidelines were followed, “so many would require it, it is not sustainable.”[277]

A high level of adherence is crucial for the success of ART.[278] Lack of adherence can lead to the development of drug resistance, illness, or death. But while many prisoners reported receiving their HIV medications regularly, five HIV-positive prisoners interviewed said they had missed doses. Reasons included drug stock-outs,[279] lack of food,[280] being prevented from going outside to access community-based care,[281] or transfer between prisons.[282] At times, prisoners share drugs to cover the shortfall.[283]

Gerard, an HIV-Positive Patient Sent from a Rural Prison to Murchison Bay Prison Hospital

I came in when I knew I was HIV-positive. I had swellings on my elbows and legs, and then I also feel paralyzed once in a while. By the time I was arrested, I was using Septrin, and I didn’t get it. I spent three weeks at Sentema [Prison], and there was no medicine.... They wanted me to go and dig—I told them I was sick… they did not believe me. I showed them my swollen fingers—they said, “We shall step on those fingers so they heal.” I insisted, so they left me. The following day, the swelling continued, and they realized—it was after two weeks when they took us to a clinic outside the prison—they didn’t check me, but they asked me which type of medicine I used. I said Septrin, and they gave me a few tablets. But the following day, there was no medicine.

When I stopped taking my medicine, that’s when I felt weak, and my body started shutting down completely. I think they looked at me and thought I was useless at their shambas [fields]; the kind of sickness I had would not allow me to go and work. They decided to get rid of me. The OC at Sentema saw me and I could not walk any more. He said I should be transferred to Murchison Bay, and on that very day I was brought here.

When I arrived here, on that very day I was taken to the hospital, and they admitted me. They gave me some tablets—Septrin—they gave me Septrin that very day. The following day, they checked me: They took my blood sample, told me I was HIV-positive, and checked my CD4 count. They said it was very low, 180. They said they were going to put me on a different medicine, but I had to wait, and they kept treating me. This month, they put me on ARVs—it was after two months since they checked me, I don’t know why it was so long. In the beginning, I did not feel very good, but now I’m getting better.

I used to move on crutches…but now I can walk on my own, and the body is no longer so weak.

I have had difficulty taking my medicine because of lack of food. The problem you get is when you take the medicine, you feel it in your stomach. You would love to eat, but you have to wait. It becomes problematic. Sometimes, I don’t take it because of that. Sometimes, I force myself to because I have no option—I want my life.[284]

Water- and Insect-Borne Diseases

Malaria

Together with HIV and TB, malaria is one of the leading causes of morbidity and mortality in Uganda’s general population.[285] While national health guidelines call for malaria prevention through use of methods including insecticide-treated nets and indoor residual spraying,[286] such measures have not been adopted in prisons. In the prisons, bed nets are not allowed for male inmates because prison authorities fear they could be used as ropes or nooses,[287] and even among female inmates interviewed by Human Rights Watch, only 29 percent said they had slept under a mosquito net on the preceding night.

Indoor spraying for mosquitoes has only been conducted by the prison administration at three prisons, with help from the International Committee of the Red Cross (ICRC),[288] though even at one of the ICRC’s sites, on the day of Human Rights Watch’s visit, researchers were informed that “the mosquitoes are there because the spray is out of stock.”[289] Prison officers elsewhere expressed a desire to spray for mosquitoes but had not done so because they had not received spray.[290] At some prisons, prison officers had attempted to put screens in the windows, though prisoners sometimes pierced these to relieve the heat in the congested wards.[291] The prison medical authority said that the UPS had allocated 100 million Uganda shillings (approximately $40,000) for FY 2010/2011 to fumigate and was “working out a mechanism,” but distribution of spray had not taken place.[292]

Prevalence is unmeasured but likely very high.[293] Prison officers reported that malaria is common among prisoners[294] and indeed is the most common ailment they observe.[295] “When I came here, half the population was sick with malaria,” one prison OC observed.[296] Between the four-year period of FY 2005/06 to 2008/09, Uganda’s auditor general calculated that 11 percent of deaths reported in Uganda’s prisons were caused by malaria.[297] As with TB, HIV-infected individuals are particularly vulnerable to malaria.[298]

However, treatment is frequently unavailable[299] and capacity hampered by drug stock outs.[300] Reported George, at Mutufu, “There are many who are suffering from malaria. If you don’t have money [to buy your own medicine], you just sleep in the ward and just keep there. The OC will tell you, ‘If you don’t have money, you will die.’ You will not get the medicine.”[301]

Hygiene- and Sanitation-Related Illness

Poor water and sanitation also lead to the spread of disease.[302] Prisoners reported and statistics confirmed that they had seen cholera outbreaks and frequent diarrhea.[303] The UPS has determined that “diarrhea diseases are a major cause of morbidity and mortality among prisoners” as a result of the continued use of the bucket system at the majority of prisons.[304]

Skin diseases are also common. Throughout the prisons, proper hygiene with limited government-provided soap is difficult, and lice and scabies are rampant.[305] Human Rights Watch regularly observed prisoners with significant skin problems, scratching throughout interviews. Jonathan at Masaka Ssaza Prison said, “There are so many lice…they say that the lice are the security guards of the prison.”[306] Prison medical officials accept that skin diseases are common.[307] At Masaka Main Prison alone, which has a population of 630, a medical officer reported seeing between 100 and 150 cases of skin infections a month.[308] However, prisoners frequently reported skin diseases that had gone untreated.[309]

Non-Communicable Health Conditions

Women’s Health

In addition to experiencing the problems accessing care faced by all inmates, women have a distinct set of healthcare needs and challenges in detention.[310] Women detainees benefit from special legal protections. Uganda became a party to the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (also known as the Maputo Protocol) in July 2010.[311] This provides that women in detention should be held in an environment “suitable to their condition” and ensures their right to be treated with dignity.[312] International standards dictate that women in detention should receive “special accommodation for all necessary prenatal and postnatal care and treatment.”[313] Yet as a minority in prison settings, women often receive little attention.[314]

Female prisoners who were pregnant or had given birth in prison reported that prenatal care was frequently unavailable or inadequate. Christine, six months pregnant at Fort Portal Women’s Prison, reported that she had asked daily to see a doctor for the pain she was experiencing and blood in her urine but had been refused.[315] Lydia, six months pregnant, had received no prenatal care for the month and a half she had been in prison.[316] Women at Luzira Women’s receive prenatal services at the staff clinic, the only prison-based facility offering delivery services (Murchison Bay Hospital is all-male);[317] but even there, female prisoners claimed that care was inadequate.[318] Postnatal care is minimal: Grace said she was forced to return to the prison two hours after giving birth at a hospital.[319] For women who are not pregnant, gynecological care is unheard of.

HIV testing for pregnant women suffered from numerous problems. Pregnant women reported “mandatory” testing in some instances.[320] In others, testing was either not offered[321] or the results were not shared with the woman who had been tested.[322] Prevention of mother-to-child transmission of HIV is available only through prison health services from the Murchison Bay staff clinic; or “if the situation allows, she can access the public health facility.”[323] The WHO protocol for PMTCT notes that even among HIV-infected pregnant women who do not require ART for their own healthcare, “ARV prophylaxis should be started from as early as 14 weeks gestation.”[324] Yet some HIV-positive pregnant inmates described treatment in violation of WHO guidelines. Hellene, a 16 year-old who was six months pregnant, reported: “After the [HIV] testing, they told me I was positive.… I have no ARVs. They give me panadol, Septrin.…PMTCT? They have never discussed with me.”[325]

Pregnant inmates—nearly all of whom said that they were forced to work in the fields—also have their health particularly impacted by hard labor conditions and abusive punishments.[326] At Fort Portal Women’s Prison, two female inmates separately described an incident in which a fellow inmate had a miscarriage at eight months pregnant, a result they believed of her forced hard labor and denial of healthcare.[327] Overall, 30 percent of female inmates interviewed by Human Rights Watch said they had been beaten, including eight pregnant inmates.[328] Hellene, the 16 year-old remandee at Butuntumura Prison who was six months pregnant, described being beaten in the stomach by a warden while digging, necessitating a trip to the hospital.[329] Mary, at Jinja Women’s Prison, reported being beaten and kicked while seven months pregnant, also leading to a hospital visit.[330]

Mental Health

Before coming in [to prison]...I was taken to Butabika dispensary mental health center, some time long ago. I was given a dosage, I was admitted. The doctors were coming to see me. [Now] no one is taking me back. At Butabika, very much good for my body, the drugs.... My spirit tells me to move to Butabika. I should walk to Butabika. That hospital is different from this one here. My spirit is telling me to go.
—Mutebi, Muduuma Prison, November 12, 2010

Ugandan criminal law exempts anyone with “any disease affecting his or her mind incapable of understanding what he or she is doing or of knowing that he or she ought not to do the act or make the omission” from criminal liability.[331] Courts may order accused people to undergo psychiatric assessments to ascertain competency to stand trial,[332] but there is a backlog of prisoners awaiting these determinations.[333] The prison medical authority admitted, “We are mindful we are flouting existing regulations of not having the mentally sick.”[334]

Human Rights Watch found that inmates who could not answer basic questions about their charges, length of incarceration, or age were undergoing criminal prosecution with no legal representation.[335] Additionally researchers found 11 inmates detained indefinitely awaiting action from the Minister of Justice following a ruling of not guilty by reason of insanity.[336]

Nationally, UPS estimates that five percent of prisoners have “mental problems” upon entry.[337] Prisoners and prison officers described that inmates also develop mental health problems following entry into prison.[338] UPS attributes the high burden of mental health problems in prison to a combination of “the association between substance abuse and criminality” and the “high psychological and emotional stress” associated with incarceration.[339] The president of the Uganda Medical Association, a psychiatrist who has previously provided mental health services at Murchison Bay, noted that mental health problems are very prevalent in the prisons, particularly anxiety and depression, as a result of mistreatment upon arrest and the “mental torture” of long remand periods.[340] Prison statistics indicated at least two deaths by suicide in 2010.[341]

At upcountry facilities, mental healthcare is almost nonexistent and, if it exists, is dispensed by the prison OC, a position with no medical training.[342] Prisoners repeatedly described receiving no or inadequate mental healthcare themselves or for their fellow prisoners. “Many get lost. Forget about upcountry, there’s nothing going on up there [in rural facilities],” concluded the president of the medical association.[343]

Prison officers outside of the major regional centers or Kampala by policy are supposed to send serious cases of mental health problems to regional units or Murchison Bay for treatment or analysis of competence to stand trial.[344] Over 140 prisoners at the Luzira prison complex are diagnosed with some form of mental health problem, including those with schizophrenia and severe mental disabilities who “have stayed for years in prison.”[345] But even at Murchison Bay and at regional centers, mental health services were grossly inadequate.[346] Treatment based entirely on provision of medication, without any psychotherapy or alternative mental healthcare, was inferior to that available at the public mental facility, Butabika.[347]

 

[36] J.O.R. Byabashaija, “Unclogging Prison Congestion! Whose Responsibility?” presented at the Donor Annual Review, Kampala, undated, http://www.jlos.go.ug/uploads/Unclogging%20Prisons%20Congestion!%20Whose%20Responsibility%20A%20paper%20by%20the%20Commissioner%20General%20of%20Prisons.pdf (accessed April 13, 2011).

[37] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, entered into force March 23, 1976, acceded to by Uganda on June 21, 1995, art. 10; United Nations (UN) Standard Minimum Rules for the Treatment of Prisoners (Standard Minimum Rules), adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, held at Geneva in 1955, and approved by the Economic and Social Council by its resolution 663 C (XXIV) of July 31, 1957, and 2076 (LXII) of May 13, 1977, paras. 9-11; United Nations (UN) Human Rights Committee, General Comment 21, Article 10, Humane Treatment of Persons Deprived of Liberty (Forty-fourth session, 1992), Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, UN Doc. HRI/GEN/1/Rev.7 (1994), paras. 9 and 13. See also Prisons Act of 2006, sec. 64(1).

[38] In March 2010, the UPS housed 169 debtors. UPS, “Summary of UPS Prisoners Statistical Returns.” This practice is directly contrary to international law. ICCPR, art. 11.

[39] However, female and male prisoners were separated.

[40] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 9-19. These standards, although non-binding, have been recognized as the minimum standards acceptable to the international community through adoption by the General Assembly.

[41] In March 2010: Luzira Upper was at 366 percent of approved capacity; Luzira Women’s at 357 percent; Murchison Bay at 128 percent; Butuntumura at 893 percent; Muduuma at 3,200 percent; Kitalya at 104 percent; Masaka Main at 333 percent; Masaka Ssaza at 1,611 percent; Muinaina at 269 percent; Jinja Main at 247 percent; Jinja Women’s at 133 percent; Fort Portal Men’s at 213 percent; Fort Portal Women’s at 86 percent; Bubukwanga at 1,343 percent; Masafu at 490 percent; Mutufu at 785 percent. It should be noted that while researchers did seek to visit some prisons on the basis of their overcrowding, researchers did not visit prisons in the Northern region of the country, which in March 2010 was the single most crowded region. UPS, “Summary of UPS Prisoners Statistical Returns.”

[42] Human Rights Watch interviews with OC, Masaka Ssaza Prison, November 22, 2010; doctor, Murchison Bay Hospital, November 10, 2010; OC, Masaka Main Prison, November 23, 2010; deputy OC, Jinja Main Prison, March 1, 2011; OC, Jinja Main Prison, March 1, 2011.

[43] Human Rights Watch facility tour with prison warden, Luzira Upper Prison, November 9, 2010. Diversity exists, however, between the sleeping arrangements at different prisons, and even within prisons. At Murchison Bay, Fort Portal Men’s and Women’s, Jinja Women’s, and Masafu Prisons, prisoners did not consistently complain about sleeping arrangements. At some prisons, some senior inmates or those with resources are given significantly more sleeping space.

[44] Human Rights Watch interview with Asuman, Murchison Bay Prison, November 10, 2010.

[45] Human Rights Watch interview with Ronald, Muduuma Prison, November 12, 2010.

[46] Human Rights Watch interview with Brian, Murchison Bay Prison, November 13, 2010.

[47] Human Rights Watch interview with Phillip, Muduuma Prison, November 12, 2010.

[48] Human Rights Watch interview with Ronald, Muduuma Prison, November 12, 2010.

[49] Human Rights Watch interview with Hellene, 16, Butuntumura Prison, November 11, 2010.

[50] Human Rights Watch interview with Nathan, Muduuma Prison, November 12, 2010.

[51] Human Rights Watch interviews with Dorothy, Butuntumura Prison, November 11, 2010; Owen, Kitalya Farm Prison, February 28, 2011.

[52] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 10 and 11(a).

[53] Human Rights Watch interview with Mutebi, Muduuma Prison, November 12, 2010.

[54] Human Rights Watch interview with William, Muinaina Farm Prison, March 4, 2011.

[55] Prisons Act of 2006, sec. 70.

[56] Human Rights Watch interviews with Hassan, Masaka Ssaza Prison, November 22, 2010; Jonathan, Masaka Ssaza Prison, November 22, 2010; OC, Masaka Ssaza Prison, November 22, 2010; Kakuru, Butuntumura Prison, November 11, 2010 . Prisoners previously held at additional prisons noted that lack of a fence or lack of separate female exercise area had led to them being locked in the ward all day. Human Rights Watch interviews with Charles, Muinaina Farm Prison, March 3, 2011; Harvey, Muinaina Farm Prison, March 3, 2011; Gloria, Jinja Women’s Prison, March 2, 2011.

[57] Human Rights Watch interview with Byamukama, Masaka Ssaza Prison, November 22, 2010.

[58] Manfred Nowak, “U.N. Covenant on Civil and Political Rights, CCPR Commentary,” (2nd edition) (Khel: N.P. Engel, 2005), pp. 165, 172-75, 244-29. See, for example, cases against Uruguay such as Buffo Carball v. Uruguay, No. 33/1978, Massiotti v. Uruguay, No. 25/1978; Madagascar: Marais v. Madagascar, No. 49/1979, Wight v. Madagascar, No. 115/1982; Jamaica: Robinson v. Jamaica, No. 731/1996, Pennant v. Jamaica, No. 647/1995; Russia: Lantsova v. Russian Federation, No. 763/1997.

[59] UN Standard Minimum Rules for the Treatment of Prisoners, para. 20(1). This standard has been cited with approval by the UN Human Rights Committee when examining the minimum standards that a state must observe for those deprived of their liberty, “regardless of a state party’s level of development.” See Mukong v. Cameroon, No. 458/1991, para. 9.3.

[60] The Prisons Act of 2006, sec. 69(1).

[61] The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” p. 10.

[62] Prisoners receive 680 grams of maize meal, 148 grams of beans, and 15 grams of salt daily. Human Rights Watch interview with prison medical authority, UPS, November 18, 2010; UPS, “Work Plan and Budget,” p. 5. Prisoners who were fortunate enough to have relatives bring them provisions could have these rations supplemented.

[63] Human Rights Watch interview with Catherine, Jinja Women’s Prison, March 2, 2011; Human Rights Watch interview with Elizabeth, Jinja Women’s Prison, March 2, 2011.

[64] Human Rights Watch interview with Mark, Muinaina Farm Prison, March 4, 2011.

[65] Human Rights Watch interviews with Owen, Kitalya Farm Prison, February 28, 2011; Moses, Kitalya Farm Prison, February 28, 2011; Gilbert, Kitalya Farm Prison, February 28, 2011; Ross, Masafu Prison, March 8, 2011; Matovu, Kitalya Farm Prison, February 28, 2011; Emmanuel, Kitalya Farm Prison, February 28, 2011.

[66] Human Rights Watch interview with Julius, Kitalya Farm Prison, February 28, 2011.

[67] Human Rights Watch interview with enrolled midwife, Kitalya Farm Prison, February 28, 2011. The prison medical authority also reported: “In 2008, we had a nutrition assessment, which observed that the intake was not commensurate to the requirements for prisoners, especially in the farm. We recommended an improvement be made available for the prisoners on the farm. The implementation is not yet there. I don’t know what that situation is.” Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[68] Letter from prison authorities to Human Rights Watch, June 29, 2011.

[69] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010. See also UPS, “Work Plan and Budget,” p. 5 (demonstrating that the diet is deficient in fat and calcium, and consists of no Vitamin A or C whatsoever); Human Rights Watch interview with doctor, Murchison Bay Hospital, November 10, 2010 (noting that eye conditions as a result of lack of Vitamin A are “very common”); The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report on Uganda Prisons Service,” p. iv (concluding that “[t]he quality of the food served did not meet all the basic food nutrients necessary for a healthy balanced diet”).

[70] The Prisons Act of 2006, sec. 59(3).

[71] Human Rights Watch interviews with Betty, Masaka Ssaza Prison, November 22, 2010; Alice, Masaka Main Prison, November 23, 2010; Harriet, Masaka Main Prison, November 23, 2010.

[72] Human Rights Watch interviews with Christine, Fort Portal Women’s Prison, November 15, 2010; Priscilla, Fort Portal Women’s Prison, November 17, 2010; OC, Fort Portal Women’s Prison, November 17, 2010; Mary, Jinja Women’s Prison, March 2, 2011; Stella, Jinja Women’s Prison, March 2, 2011; Beatrice, Jinja Women’s Prison, March 2, 2011; OC, Jinja Women’s Prison, March 2, 2011; Hannah, Luzira Women’s Prison, November 10, 2010; OC, Masaka Main Prison, November 23, 2010.

[73] Human Rights Watch interviews with Gloria, Jinja Women’s Prison, March 2, 2011; Stella, Jinja Women’s Prison, March 2, 2011.

[74] Human Rights Watch interview with Harriet, Masaka Main Prison, November 23, 2010. See also Human Rights Watch interviews with Leah, Luzira Women’s Prison, November 10, 2010; Olivia, Masaka Main Prison, November 23.

[75] The World Health Organization recommends that mothers known to be HIV-infected should only give infant formula as a replacement when safe water and sanitation are assured, sufficient formula can reliably be provided, and it may be prepared cleanly and carry a low risk of diarrhea and malnutrition. WHO, “Guidelines on HIV and Infant Feeding, http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf (accessed May 13, 2011), pp. 7-8. In Uganda, national guidelines recommend that HIV-positive mothers opt for replacement feeding if affordable, feasible, acceptable, sustainable and safe, yet acknowledge that most Ugandan mothers cannot meet this standard. Richard Hasunira, Aaron Muhinda, Rosette Mutambi and Beatrice Were, “Uganda,” in Missing the Target: Failing Women, Failing Children: HIV, Vertical Transmission, and Women’s Health, International Treatment Preparedness Coalition, May 2009, p. 62.

[76] Body of Principles, prin. 31.

[77] The Prison Act of 2006, sec. 59(2)-(4).

[78] Food and firewood requirements for 2009/10 should have totaled slightly under 21.73 billion Uganda shillings ($8.67 million); however, as a significant proportion of food is grown on UPS farms (totaling 4.35 billion shillings or $1.74 million), and 17.27 billion shillings ($6.89 million) were allocated from funding from the government of Uganda under that year’s budget, no substantial funding gap should have existed. The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” pp. 11-12. In 2011, the prison medical authority reported that 24 billion Uganda shillings ($9.58) were required to provide adequate food for all the prisoners, but the governmental budget available for food that year and the following one would be 14 billion Uganda shillings ($5.59 million), with the gap covered by prison-produced food. Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[79] The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” pp. 11-12.

[80] Human Rights Watch interview with Phillip, Muduuma Prison, November 12, 2010. See also Human Rights Watch interview with Paul, Muduuma Prison, November 12, 2010. International standards and Ugandan law dictate that drinking water be available to every prisoner whenever he or she needs it. UN Standard Minimum Rules for the Treatment of Prisoners, para. 20(2); Prisons Act of 2006, sec. 69(2).

[81] Human Rights Watch interviews with David, Kitalya Farm Prison, February 28, 2011; Emmanuel, Kitalya Farm Prison, February 28, 2011; Matovu, Kitalya Farm Prison, February 28, 2011; Moses, Kitalya Farm Prison, February 28, 2011; Joseph, Kitalya Farm Prison, February 28, 2011.

[82] Human Rights Watch interview with Gilbert, Kitalya Farm Prison, February 28, 2011.

[83] Human Rights Watch interviews with OC, Muinaina Farm Prison, March 3, 2011; OC, Mutufu Prison, March 7, 2011; OC, Kitalya Farm Prison, February 28, 2011. Ugandan government sources have also noted the inadequate provision of clean drinking water in some prisons. The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report on Uganda Prisons Service,” p. v; UPS, “Work Plan and Budget,” p. 4.

[84] Human Rights Watch interview with Andrew, Bubukwanga Prison, November 16, 2010.

[85] Human Rights Watch interview with Douglas, Bubukwanga Prison, November 16, 2010.

[86] Human Rights Watch interviews with Lubega, 17, Bubukwanga Prison, November 16, 2010; Christopher, 17, Bubukwanga Prison, November 16, 2010.

[87] Human Rights Watch interview with OC, Muinaina Farm Prison, March 3, 2011.

[88] Human Rights Watch interviews with Mukasa, Luzira Upper Prison, November 9, 2010; Fred, Luzira Upper Prison, November 8, 2010; Harvey, Muinaina Farm Prison, March 3, 2011; Ralph, Luzira Upper Prison, November 9, 2010; Jacob, Luzira Upper Prison, November 8, 2010.

[89] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 12-14.

[90] Human Rights Watch interviews with George, Mutufu Prison, March 7, 2011; Odong, Mutufu Prison, March 7, 2011; Thomas, Mutufu Prison, March 7, 2011; Jared, Mutufu Prison, March 7, 2011.

[91] Human Rights Watch interviews with Musa, Muduuma Prison, November 12, 2010; Timothy, Muduuma Prison, November 12, 2010.

[92] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 12-14.

[93] Human Rights Watch interviews with Grace, Masaka Ssaza Prison, November 22, 2010; Ross, Masafu Prison, March 8, 2011. Systems where prisoners are obliged to use buckets in their cells as toilets which they then empty—known as “slopping out”—have been condemned by the European Committee on the Prevention of Torture and the European Court of Human Rights as a violation of the prohibition on inhuman and degrading treatment.

[94] Human Rights Watch interview with OC, Masafu Prison, March 8, 2011.

[95] Human Rights Watch interviews with Timothy, Muduuma Prison, November 12, 2010; Onyango, Muduuma Prison, November 12, 2010.

[96] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 15-19.

[97] Ibid., para. 19.

[98] This includes toilet paper, towels, soap, toothbrushes, and toothpaste. UPS, “Work Plan and Budget,” p. 5.

[99] Human Rights Watch interviews with OC, Masaka Ssaza Prison, November 22, 2010; OC, Muduuma Prison, November 12, 2010; OC, Muinaina Farm Prison, March 3, 2011; OC, Masafu Prison, March 8, 2011; OC, Fort Portal Women’s Prison, November 15, 2010.

[100] Human Rights Watch interviews with Musa, Muduuma Prison, November 12, 2010; Mafabi, Butuntumura, November 11, 2010; Terrence, Fort Portal Men’s, November 17, 2010.

[101] Human Rights Watch interviews with Patrick, Muduuma Prison, November 12, 2010; George, Mutufu Prison, March 7, 2011; Brian, Murchison Bay, November 13, 2010; Esther, Fort Portal Women’s, November 17, 2010.

[102] UN Standard Minimum Rules for the Treatment of Prisoners, para. 71(1).

[103] Ibid., art. 72(2).

[104] The International Labor Organization’s Convention 29 on Forced Labor, which Uganda has ratified, states that only convicts can be compelled to work in prison; such work must at all times be supervised by a public authority; and prisoners may not be “hired to or placed at the disposal of private individuals, companies or associations,” which means that prison labor for private entities may be only by consent of the prisoner, whether convict or remand. International Labor Organization, “Convention 29 on Forced Labor,” ratified by Uganda on June 4, 1963, http://www.ilo.org/ilolex/cgi-lex/convde.pl?C029 (accessed April 11, 2011); Lee Swepston, “Prison Labour and International Human Rights,” Industrial Relations Research Association, June 2001, http://www.leeswepston.net/prison.htm (accessed April 11, 2011). UN Standard Minimum Rules for the Treatment of Prisoners, para. 73(1).

[105] International Labor Organization, “Convention 29 on Forced Labor,” art. 11. See also UN Standard Minimum Rules for the Treatment of Prisoners, para. 71(2) (stating that prison labor is subject to the “physical and mental fitness” of prisoners as determined by a medical officer).

[106] International Labor Organization, “Convention 29 on Forced Labor,” arts. 12-14. UN Standard Minimum Rules for the Treatment of Prisoners, para. 73(2). Both the UN Standard Minimum Rules and Uganda’s Prisons Act provide for prisoners’ rights to remuneration for their work. Standard Minimum Rules for the Treatment of Prisoners, paras. 76(1), (2), and (3). Prisons Act of 2006, sec. 57.

[107] Initial Report to the Human Rights Committee: Uganda, U.N. Doc. CCPR/C/UGA/2003/1, 2003, http://www.unhchr.ch/tbs/doc.nsf/898586b1dc7b4043c1256a450044f331/341b0ac3c7807592c1256db0002d4858/$FILE/G0340506.pdf (accessed August 11, 2010).

[108] Mary Karugaba, “Prisoners to be Paid for Work,” New Vision, April 14, 2011.

[109] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 74(1) and (2).

[110] Human Rights Watch interview with Matovu, Kitalya Farm Prison, February 28, 2011.

[111] JLOS stated that one of its major achievements in reducing labor was the mechanization of farm prisons, reducing the number of hours worked per day from eight hours to seven hours in 2009-2010. Justice Law and Order Sector, “Annual Performance Report,” September 2010. Private landowners who had previously hired prison labor reported that prisoners worked as many as nine hours a day on their land, sometimes seven days a week. Human Rights Watch interviews with farmers, near Sentema Prison and Kasangati Prison, January 20, 2011; farmers near Ntenjeru Prison, January 21, 2011.

[112] Human Rights Watch interviews with Phillip, Muduuma Prison, November 12, 2010; Timothy, Muduuma Prison, November 12, 2010; Milton, Fort Portal Men’s, November 17, 2010; Terrence, Fort Portal Men’s, November 17, 2010.

[113] Human Rights Watch interview with Ronald, Muduuma Prison, November 12, 2010; Musa, Muduuma Prison, November 12, 2010.

[114] Human Rights Watch interview with Musa, Muduuma Prison, November 12, 2010.

[115] Human Rights Watch interviews with Milton, Fort Portal Men’s Prison, November 17, 2010; Hussein, Fort Portal Men’s Prison, November 17, 2010

[116] Human Rights Watch interviews with William, Muinaina Prison, March 3, 2011; Musa, Muduuma Prison, November 12, 2010; Onyango, Muduuma Prison, November 12, 2010; Busingye, Bubukwanga Prison, November 16, 2010; Ross, Muinaina Prison, March 8, 2011.

[117] Human Rights Watch field observation, Kitalya Farm Prison, February 28, 2011.

[118] Human Rights Watch interviews with Musa, Muduuma Prison, November 12, 2010; Ronald, Muduuma Prison, November 12, 2010; Timothy, Muduuma Prison, November 12, 2010; Onyango, Muduuma Prison, November 12, 2010; Joseph, Kitalya Farm Prison, February 28, 2011.

[119] Human Rights Watch interviews with Ronald, Muduuma Prison, November 12, 2010; Timothy, Muduuma Prison, November 12, 2010.

[120] Human Rights Watch interviews with Ronald, Muduuma Prison, November 12, 2010; Timothy, Muduuma Prison, November 12, 2010; Onyango, Muduuma Prison, November 12, 2010. These initiation rituals were called “Black Mamba” or “cane crosses,” because when two prisoners beat the newcomer, the lashes made an “X” mark on his back. Human Rights Watch interviews with Timothy, Muduuma Prison, November 12, 2010; Joseph, Kitalya Farm Prison, February 28, 2011.

[121] Human Rights Watch interviews with Edgar, Murchison Bay, November 13, 2010; Pius, Muinaina Prison, March 3, 2011; Kevin, Muinaina Prison, March 3, 2011; Edmund, March 4, 2011.

[122] Human Rights Watch interview with Edgar, Murchison Bay, November 13, 2010.

[123] Human Rights Watch interview with Duncan, Muinaina Prison, March 4, 2011.

[124] Human Rights Watch interviews with Emma, Jinja Women’s Prison, March 2, 2011; Catherine, Jinja Women’s Prison, March 2, 2011.

[125] Human Rights Watch interview with Catherine, Jinja Women’s Prison, March 2, 2011.

[126] Prisons Act of 2006, sec. 97.

[127] UN Standard Minimum Rules for the Treatment of Prisoners, paras. 28-32.

[128] Human Rights Watch interview with Joseph, Kitalya Farm Prison, February 28, 2011.

[129] Human Rights Watch interview with OC, Muduuma Prison, November 12, 2010; OC, Masaka Ssaza Prison, November 22, 2010; OC, Jinja Women’s Prison, March 2, 2011; OC, Muinaina Prison, March 4, 2011; OC, Mutufu Prison, March 7, 2011; OC, Masafu Prison, March 8, 2011. UPS relies on “internally generated” revenue in its budget, and internally generated revenue climbed from 1.45 billion shillings (approximately $600,000) in FY 2005/06 to 1.95 billion shillings (approximately $800,000) in FY 2008/09, with the exception of FY2007/08. The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” p. 4.

[130] Human Rights Watch interview with OC, Masaka Ssaza Prison, November 22, 2010; OC, Muinaina Prison, March 4, 2011; OC, Mutufu Prison, March 7, 2011; OC, Masafu Prison, March 8, 2011.

[131] Human Rights Watch interview with OC, Masaka Ssaza Prison, November 22, 2010.

[132] Human Rights Watch interview with OC, Masafu Prison, March 8, 2011.

[133] Ibid.

[134] Human Rights Watch interview with OC, prison and date withheld.

[135] Human Rights Watch interview with OC, Muinaina Farm Prison, March 4, 2011.

[136] The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” p. iv. The auditor general further declared that lack of documentation and accountability led to under-declaration and under-supply of food, compounding food shortages in prisons. Ibid., p. 12.

[137] At Muinana Farm Prison, Human Rights Watch researchers found remanded and committed prisoners working. Prison escape records also indicated that a remanded prisoner from Muinaina Farm Prison was reported by prison authorities to have escaped from the “M/Shamba,” indicating the “main” government-owned field, in 2010. Letter from prison authorities to Human Rights Watch, June 29, 2011.

[138] Human Rights Watch interview with OC, Muinaina Prison, March 4, 2011.

[139] Human Rights Watch interviews with farmers, near Sentema and Kasangati Prisons, January 20, 2011; farmers, near Ntenjeru Prison, January 21, 2011. An OC with 100 prisoners working six days a week could earn around 7,200,000 Uganda shillings a month (approximately $3,060). Prisoners had various colloquial terms for work for private contractors such as, “ekigaali,” “kibawula,” “parties,”and “bed shamba two.” By contrast, going to work on prison land is called “federo” or “main shamba.”

[140] Human Rights Watch interviews with personnel, Sentema Prison, January 20, 2011; OC, Kasangati Prison, January 20, 2011; orderly sergeant, Ntenjeru Prison, January 21, 2011; farmers, near Sentema Prison and Kasangati prisons, January 20, 2011; farmers, near Ntenjeru Prison, January 21, 2011.

[141] Ibid.

[142] Ibid.

[143] Email communication from prison authorities to Human Rights Watch, May 19, 2011.

[144] Ibid.

[145] Data provided to Human Rights Watch by prison authorities on prisoner escapes in 2010 indicated that remanded prisoners escaped from “labour party,” “outside party,” “building party,” and “bricks party.” These categories were distinct from categories (such as “M/shamba” or “staff shamba”) indicating that prisoners had escaped during labor on prison-owned land or staff farms. Letter from prison authorities to Human Rights Watch, June 29, 2011.

[146] Anthony Wesaka and Angelo Izama, “Police, Prisons on the Spot over Inmates Forced Labour,” The Monitor, June 27, 2010.

[147] Penal Code Act of 1950, sec. 168. Human Rights Watch interviews with Washington, Muduuma Prison, November 12, 2010; Nathan, Muduuma Prison, November 12, 2010; Patrick, Muduuma Prison, November 12, 2010; Phillip, Muduuma Prison, November 12, 2010; Paul, Muduuma Prison, November 12, 2010; Ronald, Muduuma Prison, November 12, 2010; Timothy, Muduuma Prison, November 12, 2010; Onyango, Muduuma Prison, November 12, 2010.

[148] Email communication from prison authorities to Human Rights Watch, May 19, 2011. Information provided by prison authorities to Human Rights Watch on prisoner escapes in 2010 indicated that remanded and convicted prisoners were reported to have escaped from “staff shamba [field].” Letter from prison authorities to Human Rights Watch, June 29, 2011.

[149] Human Rights Watch interview with OC, Muinaina Prison, March 4, 2011. Wardens make roughly between 250,000 Uganda shillings and 375,000 shillings (approximately $100 to $160) per month in salary. Housing in barracks for wardens and their families is also usually provided. Human Rights Watch interview with OC, Mutufu Prison, March 7, 2011.

[150] Human Rights Watch interviews with Harvey, Muinaina Prison, March 3, 2011; Eric, Muinaina Prison, March 3, 2011; Edward, Muinaina Prison, March 4, 2011; Duncan, Muinaina Prison, March 4, 2011.

[151] Human Rights Watch interview with OC, Muinaina Prison, March 4, 2011.

[152] Human Rights Watch interviews with Harvey, Muinaina Prison, March 3, 2011; Eric, Muinaina Prison, March 3, 2011; Edward, Muinaina Prison, March 4, 2011; Duncan, Muinaina Prison, March 4, 2011.

[153] Human Rights Watch interview with Eric, Muinaina Prison, March 3, 2011; Duncan, Muinaina Prison, March 4, 2011.

[154] Human Rights Watch interviews with Rosemary, Butuntumura Prison, November 11, 2010; Sylvia, Fort Portal Women’s, November 15, 2010; Christine, Fort Portal Women’s, November 15, 2010; Emma, Jinja Women’s, March 2, 2011; Catherine, Jinja Women’s, March 2, 2011; OC, Masafu Prison, March 8, 2011.

[155] Email communication from prison authorities to Human Rights Watch, May 19, 2011.

[156] Human Rights Watch interviews with Owen, Kitalya Farm Prison, February 28, 2011; David, Kitalya Farm Prison, February 28, 2011; Emmanuel, Kitalya Farm Prison, February 28, 2011; Gilbert, Kitalya Farm Prison, February 28, 2011; Julius, Kitalya Farm Prison, February 28, 2011; Moses, Kitalya Farm Prison, February 28, 2011; Joseph, Kitalya Farm Prison, February 28, 2011.

[157] For example, some prisoners at Masaka Ssaza, Masaka, Jinja Main, Muinaina, and Masafu stated that they were paid 200 to 500 Uganda shillings for work on private farms. Prisoners with authority to supervise other prisoners were sometimes given 500 Uganda shillings ($0.25) out of the warden’s tips while others were not, and in many cases, no prisoner received any remuneration. Human Rights Watch interviews with Ali, Murchison Bay, November 20, 2010; Mafabi, Butuntumura Prison, November 11, 2010; Musa, Muduuma Prison, November 12, 2010.

[158] Under Ugandan law, prisoners upon admission to prison are to be provided with written information on regulations related to the treatment of prisoners in that category; disciplinary requirements of the institution; and the complaints procedure. Prisons Act of 2006, sec. 58(5)(a)-(c). Furthermore, “A prisoner shall not be punished for a prison offence until the prisoner has had an opportunity of hearing the charge against him or her and making a defence and where necessary and practicable, the prisoner shall be allowed the services of an interpreter.” Prisons Act of 2006, sec. 96.

[159] Prisons Act of 2006, sec. 85.

[160] See, e.g., Human Rights Watch interviews with Okello, Luzira Upper Prison, November 8, 2010; Samuel, Fort Portal Men’s Prison, November 15, 2010; Kakuru, Butuntumura Prison, November 11, 2010; Akello, Luzira Women’s Prison, November 10, 2010; Agatha, Luzira Women’s Prison, November 9, 2010; Abigail, Fort Portal Women’s Prison, November 15, 2010; Isaac, Jinja Main Prison, March 1, 2011; OC, Fort Portal Prison, November 15, 2010.

[161] Human Rights Watch interviews with OC, Fort Portal Prison, November 15, 2010; OC, Masaka Ssaza Prison, November 22, 2010; OC, Muinaina Farm Prison, March 3, 2011; OC, Masafu Prison, March 8, 2011.

[162] Prisons Act of 2006, sec. 95; Human Rights Watch interviews with OC, Masaka Ssaza Prison, November 22, 2010; deputy OC, Jinja Main Prison, March 1, 2011; OC, Fort Portal Prison, November 15, 2010.

[163] Prisoners consistently said that smoking (cigarettes or marijuana), engaging in same-sex sexual conduct, refusing or delaying to work, trying to escape, fighting with other prisoners, or stealing would entail either a beating, incarceration in an isolation cell, or both. In some cases, minor disciplinary offences also were considered to merit these punishments, such as dirtying the shower area leading to a beating or use of a mobile phone to a week in an isolation cell. Frequently, prisoners expressed to researchers their fear that speaking with outsiders about the problems in prison would earn them a beating. Prisoners also said that they were beaten at some prisons when they requested medical care. Punishment for sexual conduct was particularly severe.

[164] According to prison authorities, “There is … one punishment that is currently outlawed and that’s Corporal Punishment. This is now treated as assault and purely a Police case [case to be investigated by police].” Email communication from prison authorities to Human Rights Watch, May 19, 2011.

[165] ICCPR, art. 7; Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Convention against Torture), adopted December 10, 2984, G.A. res. 39/46, annex, 39 U.N. GAOR Supp. (No. 51) at 197, U.N. Doc. A/39/51 (1984), entered into force June 26, 1987), acceded to by Uganda on November 3, 1986.

[166] Human Rights Watch interviews with OC, Muinaina Farm Prison, March 3, 2011; OC, Mutufu Prison, March 7, 2011; OC, Masafu Prison, March 8, 2011; OC, Masaka Ssaza Prison, November 22, 2010.

[167] Human Rights Watch interview with health worker, Murchison Bay Hospital, November 10, 2010.

[168] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[169] Foundation for Human Rights Initiative, “The Human Rights Status Report,” pp. 20-21; Uganda Human Rights Commission, “12th Annual Report,” 2009, p. 44.; The African Centre for Treatment and Rehabilitation of Torture Victims, “The Nature of Torture in Uganda: A Study Conducted in Luwero; Wakiso; Gulu; Arua; Soroti; Jinja; Bushenyi and Kasese Districts,” November 2010.

[170] Email correspondence from prison authorities to Human Rights Watch, May 19, 2011.

[171] Prisoners at Jinja Main Prison reported that since the arrival of a new OC, inmates are no longer beaten.

[172] Human Rights Watch facility assessment of Bubukwanga Prison, November 16, 2010.

[173] Human Rights Watch interviews with Martin, Bubukwanga Prison, November 16, 2010; Christopher, 17, Bubukwanga Prison, November 16, 2010; Johnson, Bubukwanga Prison, November 16, 2010; Otto, Bubukwanga Prison, November 16, 2010; Gideon, 15, Bubukwanga Prison, November 16, 2010.

[174] Human Rights Watch interviews with Gideon, 15, Bubukwanga Prison, November 16, 2010; Christopher, 17, Bubukwanga Prison, November 16, 2010.

[175] Human Rights Watch interview with Martin, Bubukwanga Prison, November 16, 2010.

[176] Human Rights Watch interviews with Logan, Butuntumura Prison, November 11, 2010 (5 strokes); Alice, Masaka Main Prison, November 23, 2010 (5 strokes); Saul, Masaka Ssaza Prison, November 22, 2010 (5 strokes); Betty, Masaka Ssaza Prison, November 22, 2010 (7 strokes); Akello, Luzira Women’s Prison, November 10, 2010 (10 strokes); Alex, Murchison Bay Prison, November 10, 2010 (10 strokes); Mukasa, Luzira Upper Prison, November 9, 2010 (10 strokes); Christopher, 17, Bubukwanga Prison, November 16, 2010 (10 strokes); Mary, Jinja Women’s Prison, March 2, 2011 (10 strokes); Mafabi, Butuntumura Prison, November 11, 2010 (15 strokes); Kenneth, Masafu Prison, March 8, 2011 (15 or 20 strokes); Ross, Masafu Prison, March 8, 2011 (20 strokes); Odong, Mutufu Prison, March 7, 2011 (20 strokes); Ali, Murchison Bay Prison, November 20, 2010 (20 strokes); Matovu, Kitalya Farm Prison, February 28, 2011 (24 strokes); Noah, Fort Portal Men’s Prison, November 15, 2010 (30 strokes); Human Rights Watch interview with Emmanuel, Kitalya Farm Prison, February 28, 2011 (40 strokes); Owen, Kitalya, February 28, 2011 (40 strokes); Peter, Masaka Main Prison, November 23, 2010 (50 strokes); Joseph, Kitalya Farm Prison, February 28, 2011 (50 strokes); Human Rights Watch interview with Gilbert, Kitalya Farm Prison, February 28, 2011 (80 strokes); Daudi, Murchison Bay Prison, November 20, 2010 (almost 100 strokes); Evan, Masaka Main Prison, November 23, 2010 (countless); Priscilla, Fort Portal Women’s Prison, November 17, 2010 (countless).

[177] Human Rights Watch facility tour with prison warden, Luzira Upper Prison, November 9, 2010 (“That [punishment system] is theirs, we are not concerned.”); Human Rights Watch interview with OC, Muduuma Prison, November 12, 2010 (“The prisoners do help in running the prison.”).

[178] Human Rights Watch interviews with Owen, Kitalya Farm Prison, February 28, 2011; William, Muinaina Farm Prison, March 4, 2011; George, Mutufu Prison, March 7, 2011; Kevin, Muinaina Farm Prison, March 3, 2011; Walter, Mutufu Prison, March 7, 2011; Matthew, Masafu Prison, March 8, 2011; Eric, Muinaina Farm Prison, March 3, 2011; Moses, Kitalya Farm Prison, February 28, 2011; Mark, Muinaina Farm Prison, March 4, 2011; Matovu, Kitalya Farm Prison, February 28, 2011; Odong, Mutufu Prison, March 7, 2011.

[179] Mental disabilities, as discussed in this report, include diagnosable mental, behavioral, or emotional conditions that substantially interfere with or limit one or more major life activity. Persons with mental health problems also refer to themselves as having psychosocial disabilities, a term that reflects the interaction between psychological differences and social/cultural limits for behavior as well as the stigma that the society attaches to persons with mental impairments.

[180] Human Rights Watch interview with Ali, Murchison Bay Prison, November 20, 2010.

[181] Human Rights Watch interviews with Elizabeth, Jinja Women’s Prison, March 2, 2011; Pius, Muinaina Prison, March 3, 2011.

[182] Human Rights Watch interviews with Elizabeth, Jinja Women’s Prison, March 2, 2011; Tumwesigye, Jinja Main Prison, March 1, 2011.

[183] Human Rights Watch interview with Daudi, Murchison Bay Prison, November 20, 2010 (describing an incident that took place at a farm prison).

[184] Human Rights Watch interview with Ali, Murchison Bay Prison, November 20, 2010 (describing an incident at a farm prison).

[185] Human Rights Watch interview with Owen, Kitalya Farm Prison, February 28, 2011.

[186] Human Rights Watch interview with Matthew, Masafu Prison, March 8, 2011. The prisoner with authority in Matthew’s ward confirmed, “He has had no medical treatment.” Human Rights Watch interview with Stephen, Masafu Prison, March 8, 2011.

[187] Prisons Act of 2006, sec. 81(1).

[188] Prisons Act of 2006, sec. 81(2). Furthermore, punishment by confinement should only take place after an examination and certification of fitness by a medical officer. Prisons Act of 2006, sec. 94.

[189] Prisoners confirmed the use of isolation cell punishment at: Luzira Upper, Luzira Women’s, Murchison Bay, Butuntumura, Fort Portal Women’s, Masaka Ssaza, Masaka Main, Jinja Main, and Muinaina Farm Prisons.

[190] Human Rights Watch interviews with OC, Fort Portal Women’s Prison, November 15, 2010; OC, Masaka Ssaza Prison, November 22, 2010; OC, Masaka Main Prison, November 23, 2010; OC, Jinja Main Prison, March 1, 2011.

[191] Human Rights Watch interviews with Tess, Masaka Ssaza Prison, November 22, 2010 (one month); Asuman, Murchison Bay Prison, November 10, 2010 (two months at Mbarara and Kitalya); Allan, Masaka Main Prison, November 23, 2010 (two months); Evan, Masaka Main Prison, November 23, 2010 (two months); Adam, Masaka Main Prison, November 23, 2010 (three months); Joshua, Masaka Main Prison, November 23, 2010 (three months); Akello, Luzira Women’s Prison, November 10, 2010 (seven months); Gabriel, Jinja Main Prison, March 1, 2011 (one year); Humphrey, Jinja Main Prison, March 1, 2011 (one year); Tumwesigye, Jinja Main Prison, March 1, 2011 (one year).

[192] Human Rights Watch interview with Esther, Fort Portal Women’s Prison, November 17, 2010.

[193] Human Rights Watch interview with Logan, Butuntumura Prison, November 11, 2010.

[194] Human Rights Watch interview with Gabriel, Jinja Main Prison, March 1, 2011.

[195] Human Rights Watch interview with Betty, Masaka Ssaza Prison, November 22, 2010.

[196] Human Rights Watch interview with Joshua, Masaka Main Prison, November 23, 2010.

[197] Human Rights Watch interview with Elizabeth, Jinja Women’s Prison, March 2, 2011.

[198] Human Rights Watch interview with Owen, Kitalya Farm Prison, February 28, 2011.

[199] Human Rights Watch interview with Allan, Masaka Main Prison, November 23, 2010.

[200] Human Rights Watch interview with Ralph, Luzira Upper Prison, November 9, 2010.

[201] Human Rights Watch interview with Gabriel, Jinja Main Prison, March 1, 2011.

[202] Human Rights Watch interview with Abdul, Luzira Upper Prison, November 8, 2010.

[203] Constitution of 1995, art. 24. The Prisons Act also explicitly states that prisoners are entitled to “be treated with the respect due to his/her inherent dignity and value as a human being.” Prisons Act of 2006, sec. 57(a).

[204] See, e.g., UN Human Rights Committee, Communication No. 1184/2003: Australia 27/04/2006, March 2006, para. 9.4.

[205] Human Rights Watch facility assessment, Jinja Main Prison, March 1, 2011. The prison warden, however, contended that the man was bewitched and so it was not necessary to take him for medical treatment. Ibid. The OC at Masaka Ssaza Prison said that he had isolated “a man with mental problems” in the same cell used for punishment while he was awaiting transport to Murchison Bay Hospital. Human Rights Watch interview with OC, Masaka Ssaza Prison, November 22, 2010.

[206] Human Rights Watch interview with deputy OC, Jinja Main Prison, March 1, 2011.

[207] Human Rights Watch interview with Tumwesigye, Jinja Main Prison, March 1, 2011

[208] See, e.g., Universal Declaration of Human Rights (UDHR), adopted December 10, 1948, G.A. Res. 217A(III), U.N. Doc. A/810 at 71 (1948), art. 25(1); International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 49, U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3, entered into force January 3, 1976, acceded to by Uganda on January 21, 1987, art. 12; Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989), entered into force September 2, 1990, ratified by Uganda on August 17, 1990, art. 24; African [Banjul] Charter on Human and Peoples’ Rights, adopted June 27, 1981, OAU Doc. CAB/LEG/67/3 rev. 5, 21 I.L.M. 58 (1982), entered into force October 21, 1986, ratified by Uganda May 10, 1986, art. 16.

[209] See, e.g., ICESCR, arts. 12(1) and 2.2; ICCPR, arts. 6, 7 and 10(1); Convention against Torture, art. 16; ICESCR, General Comment No. 14, para. 34. For a comprehensive discussion of the international legal instruments, international resolutions, and model standards related to detainee health, see Rick Lines, “The Right to Health of Prisoners in International Human Rights Law,” International Journal of Prisoner Health, vol. 4(1), 2008, pp. 3-53; Rick Lines, “From Equivalence of Standards to Equivalence of Objectives: The Entitlement of Prisoners to Health Care Standards Higher than Those Outside Prisons,” International Journal of Prisoner Health, vol. 2(4), 2006, pp. 1-12.

[210] The Human Rights Committee has repeatedly determined that the ICCPR requires governments to provide “adequate medical care during detention.” See, e.g., Pinto v. Trinidad and Tobago (Communication No. 232/1987), Report of the Human Rights Committee, vol. 2, UN Doc A/45/40, p. 69. The Committee Against Torture—the monitoring body of the Convention Against Torture—has also found that failure to provide adequate medical care can violate the CAT’s prohibition of cruel, inhuman or degrading treatment. United Nations (UN) Committee against Torture (CAT), “Concluding Observations: New Zealand,” (1998) UN Doc. A/53/44, para. 175.

[211] Concluding Observations of the Human Rights Committee: Republic of Moldova, CCPR/CO/75/MDA, 2002, http://www.unhchr.ch/tbs/doc.nsf/0/7945fe5e4947c21bc1256c3300339d88?Opendocument (accessed December 20, 2010), para. 9.

[212] Prisons Act 2006, sec. 57(f).

[213] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[214] Ibid.

[215] Prison authorities wrote to Human Rights Watch that “few health units are submitting returns and those submitted are incomplete” and not submitted in a timely manner. Letter to Human Rights Watch from prison authorities, June 29, 2011. Information collected by prison authorities and provided to Human Rights Watch on the number of reported health conditions was not comprehensive or representative of the prison population and is not presented in this report.

[216] UPS, “Work Plan and Budget,” p. 4. See also Human Rights Watch interview with prison medical authority, UPS, November 18, 2010 (“Most of our structures are very poor. They don’t allow in air or sufficient light. What do you expect? The transfer of infections such as TB take advantage of that. And they are overcrowded. You can see the scenario.”). As well as being the most common opportunistic infection among people living with HIV in Africa, TB is pervasive in African prisons because of overcrowding, poor ventilation, and lack of prevention practices. UNODC, UNAIDS and World Bank, “HIV and Prisons in Sub-Saharan Africa: Opportunities for Action,” p. 2; E. Rutta et al., “Tuberculosis in a Prison Population in Mwanza, Tanzania (1994-1997),” The International Journal of Tuberculosis and Lung Disease, vol. 5(8), 2001, pp. 703-06.

[217] Tabu Butagira and Lulu Jemimah, “Prisons Chief—Sodomy Is My Biggest Headache,” The Monitor, June 21, 2009, http://allafrica.com/stories/200811240127.html (accessed April 10, 2011).

[218] Human Rights Watch interview with director, National TB and Leprosy Programme, March 10, 2011; World Health Organization, “Global Tuberculosis Control: A Short Update to the 2009 Report,” 2009, http://whqlibdoc.who.int/publications/2009/9789241598866_eng.pdf (accessed October 6, 2010), p.5. High-burden countries are defined as the countries that rank first to 22nd in the world in terms of absolute numbers of TB cases and which have received particular attention at the global level since 2000. Ibid, p. 4.

[219] Republic of Uganda Ministry of Health, “Manual of the National Tuberculosis and Leprosy Programme,” March 2010, p. 3.

[220] Uganda Prisons Service and United Nations Office on Drugs and Crime (UNODC), “A Rapid Situation Assessment of HIV/STI/TB and Drug Abuse Among Prisoners in Uganda Prisons Service: Final Report,” 2008, http://www.unodc.org/documents/hiv-aids/publications/RSA_Report.pdf (accessed August 11, 2010).

[221] UPS, “Work Plan and Budget,” p. 10.

[222] Human Rights Watch interview with Johnson, Bubukwanga Prison, November 16, 2010.

[223] Joint United Nations Programme on HIV/AIDS (UNAIDS), “WHO Guidelines on HIV Infection and AIDS in Prisons,” UNAIDS Best Practice Collection, 1993, http://data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf (accessed March 3, 2010), pp. 7-8.

[224] TB screening was reported by officers at Fort Portal Women’s and Men’s Prisons, Masaka Ssaza and Masaka Main Prisons, Murchison Bay and Luzira Upper Prisons.

[225] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[226] UPS, “Work Plan and Budget,” p. 12.

[227] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[228] Human Rights Watch interview with Jonathan, Masaka Ssaza Prison, November 22, 2010; Pius, Muinaina Farm Prison, March 3, 2011; William, Muinaina Farm Prison, March 4, 2011.

[229] UPS, “Work Plan and Budget,” p. 12.

[230] Human Rights Watch interview with director, National TB and Leprosy Programme, March 10, 2011.

[231] Ibid.

[232] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011. National TB guidelines in Uganda note that prisoners are a risk group for drug-resistant tuberculosis. Republic of Uganda Ministry of Health, “Manual of the National Tuberculosis and Leprosy Program,” p. 47.

[233] Between 1996 and 2006, the coverage of directly observed treatment, short-course (DOTS) expanded from 0 to 100 percent. The DOTS treatment success rate among new sputum smear positive cases was 73 percent. World Health Organization, “Country Profile: Uganda,” 2008, http://www.who.int/tb/publications/global_report/2008/pdf/uga.pdf (accessed August 10, 2010). DOTS coverage is defined as the percentage of the national population living in areas where health services have adopted DOTS. DOTS treatment success rate is defined as the percentage of new smear-positive patients that are cured (negative on sputum smear examination), plus the percentage that complete a course of treatment, without bacteriological confirmation of a cure.

[234] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[235] Ibid.

[236] Human Rights Watch interview with Saul, Masaka Ssaza Prison, November 22, 2010.

[237] Letter from prison authorities to Human Rights Watch, June 29, 2011. Data on prisoner deaths were incomplete and therefore total mortality from TB in the prison system in 2010 could not be ascertained.

[238] See, e.g., Human Rights Watch interviews with Lubega, 17, Bubukwanga Prison, November 16, 2010; OC, Muduuma Prison, November 12, 2010. Furthermore, serious shortages of TB medications at those facilities which do dispense drugs have occurred in Uganda as a result of delays in supply by the Global Drug Facility. Human Rights Watch interview with director, National TB and Leprosy Programme, March 10, 2011.

[239] Human Rights Watch interview with Gilbert, Kitalya Farm Prison, February 28, 2011.

[240] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[241] Ibid.

[242] Prisons Act of 2006, sec. 83(2).

[243] Human Rights Watch interviews with psychiatric nurse, Masaka Main, November 23, 2010; doctor, Murchison Bay Hospital, November 10, 2010; OC, Masaka Ssaza Prison, November 22, 2010.

[244] UNAIDS, “Report on the Global AIDS Epidemic: Annex 1,” 2010, http://www.unaids.org/documents/20101123_GlobalReport_Annexes1_em.pdf (accessed May 5, 2011), p. 181. This prevalence is down from rates over 10 percent through much of the 1990’s, but an increase from 2007’s 5.4 percent. World Health Organization, UNAIDS, and UNICEF, “Epidemiological Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response: Uganda,” 2008, http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_UG.pdf (accessed August 10, 2010).

[245] UPS and UNODC, “A Rapid Situation Assessment of HIV/STI/TB and Drug Abuse Among Prisoners in Uganda Prisons Service.”

[246] Sinamoakosa Isaac and Mwiruwabo James, Uganda Network of AIDS Support Organizations, “Participatory Action Research Report: Treatment Thematic Area,” November 26, 2009 (on file with Human Rights Watch); Foundation for Human Rights Initiative, “The Human Rights Status Report,” p. 42; Uganda Human Rights Commission, “12th Annual Report,” pp. 38-39.

[247] Human Rights Watch interviews with prison warden, Kitalya Farm Prison, February 28, 2011; OC, Muinaina Farm Prison, March 4, 2011; Tabu Butagira and Lulu Jemimah, “Prisons Chief—Sodomy Is My Biggest Headache,” The Monitor, June 21, 2009, http://allafrica.com/stories/200811240127.html (accessed April 10, 2011). To a far lesser extent than male prisoners, female prisoners also stated that sexual activity occurred and that it was punished. Human Rights Watch interview with Stella, Jinja Women’s Prison, March 2, 2011 (“The wardens had beaten up some people who were engaging in [same-sex sexual activity], but I hadn’t seen. There is a girl here we suspect, the prisoners do isolate her. Even the wardens stopped her from going outside.”); Vivian, Jinja women’s Prison, March 2, 2011 (“I heard about it [same-sex sexual activity] in Kamuli, between two women. The ladies complained about them, and reported that they engaged in lesbian activities.”).

[248] See, e.g., Human Rights Watch interviews with Yusuf, Murchison Bay Prison, November 13, 2010 (“It is common....Food is traded for sex—that’s how it’s done.”); Peter, Masaka Main Prison, November 23, 2010 (“Some people try to befriend the new people here on remand. They give them things like sugar cubes. Then they will take them to the toilet and have sexual activities…. I found two people having sex, many times.”); Adam, Masaka Main Prison, November 23, 2010 (“People who have been here more than two years without visitors are sometimes accepting any offer because they need to survive. Sugar, bread, or anything you can eat is given to these people, and they are enticed to having sex.”); Joshua, Masaka Main Prison, November 23, 2010 (“The rich people [with visitors] give the poor people [those without visitors] things like soap, sugar, or bread in exchange for sex. When they catch them, they take them to the cell.”); Kevin, Muinaina Farm Prison, March 3, 2011 (“It is the prison leaders who engage in homosexuality. They [non-leaders] become their wives. They prepare food for them.”); Tobias, Muinaina Farm Prison, March 4, 2011 (“It is because of greed, of not being able to avail yourself with the essential things you would need. So one who had money would send for things like rice, meat—the other would be attracted to those things and they would ask him to have sex with him so he can give him food. He even gives him money to buy whatever he wanted.”); Gabriel, Jinja Main Prison, March 1, 2011 (“Some also use enticements, like edibles. Someone can use rice meal.”); Ralph, Luzira Upper Prison, November 9, 2010 (“Sex? Yes, they do that. Someone may exchange rice, or food—he gets what he wants.”).

[249] Human Rights Watch interview with Gilbert, Kitalya Farm Prison, February 28, 2011.

[250] Human Rights Watch interview with Mukasa, Luzira Upper Prison, November 9, 2010.

[251] Human Rights Watch interviews with Brian, Murchison Bay Prison, November 13, 2010; Henry, Murchison Bay Prison, November 20, 2010; Allan, Masaka Main Prison, November 23, 2010; Owen, Kitalya Farm Prison, February 28, 2011; Peter, Masaka Main Prison, November 23, 2010.

[252] Human Rights Watch interview with Joshua, Masaka Main Prison, November 23, 2010.

[253] Human Rights Watch interview with Noah, Fort Portal Men’s Prison, November 15, 2010.

[254] Human Rights Watch interview with Jacob, Luzira Upper Prison, November 8, 2011. See also Human Rights Watch interviews with Brian, Murchison Bay Prison, November 13, 2010; Edmund, Muinaina Farm Prison, March 4, 2011.

[255] UNAIDS, “WHO Guidelines on HIV Infection and AIDS in Prisons,” UNAIDS Best Practice Collection, 1993, http://data.unaids.org/Publications/IRC-pub01/JC277-WHO-Guidel-Prisons_en.pdf (accessed March 3, 2010), p. 5. WHO, UNAIDS, UNODC, “Policy Brief: Reduction of HIV Transmission in Prisons,” Doc. No. WHO/HIV/2004.05 (2004), p. 2. In 2007, the WHO, UNODC, and UNAIDS noted that studies have found condom provision in prisons to be feasible, acceptable to prisoners, acceptable to prison staff, and did not have negative consequences such as compromising prison safety or security. Furthermore, “[f]ears about the provision of condoms leading to more consensual and non-consensual sex were not realized.” WHO, UNODC, UNAIDS, “Interventions to Address HIV in Prisons: Prevention of Sexual Transmission,” 2007, p. 13.

[256] Penal Code Act of 1950, cap. 120, sec. 145.

[257] UPS, “Work Plan and Budget,” pp. 10-12.

[258] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010. Prisoners’ reactions to the idea of distributing condoms in the prison ranged from bewilderment (“what is the use of it as a prisoner?”) to disapproval (“they should not be here, those who do it should be arrested”) to fear that the introduction could lead to an increase in a practice of which many inmates strongly disapprove (“it would promote homosexuality”). Human Rights Watch interviews with Edgar, Murchison Bay Prison, November 13, 2010; Peter, Masaka Main Prison, November 23, 2010; Kakooza, Masaka Main Prison, November 23, 2010.

[259] Human Rights Watch interview with Kiyonga, Luzira Upper Prison, November 9, 2010.

[260] These include the AIDS Support Organization (TASO) and the AIDS Information Center. Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[261] Human Rights Watch interviews with Okello, Luzira Upper Prison, November 8, 2010; Saul, Masaka Ssaza Prison, November 22, 2010.

[262] UPS, “Work Plan and Budget,” pp. 10-12.

[263] Informed consent is a well-established element of international guidance on HIV testing. WHO and UNAIDS, “Guidance on Provider-Initiated HIV Testing and Counselling in Health Facilities,” March 2007, http://whqlibdoc.who.int/publications/2007/9789241595568_eng.pdf (accessed June 26, 2011).

[264] Human Rights Watch interviews with Enid, Luzira Women’s Prison, November 9, 2010.

[265] Between 2004 and 2009, the number of people on antiretroviral therapy rose from 44,000 to 200,413. However, a significant gap of people requiring ART who were not receiving it still existed. WHO, UNIDS, and UNICEF, “Epidemiological Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response: Uganda,” 2008, http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_UG.pdf (accessed August 10, 2010); UNAIDS, “Report on the Global AIDS Epidemic: Annex 2,” 2010, http://www.unaids.org/documents/20101123_GlobalReport_Annexes2_em.pdf (accessed May 5, 2011), p. 252.

[266] UNODC and UPS reported in 2008 that only 100 prisoners on antiretroviral therapy could be documented, but in that same year the Uganda Human Rights Commission suggested that 2,050 prisoners (out of a total population of 28,205) were on ART and cotrimoxazole (Septrin). UPS and UNODC, “A Rapid Situation Assessment of HIV/STI/TB and Drug Abuse Among Prisoners in Uganda Prisons Service.” Uganda Human Rights Commission, “11th Annual Report of the Uganda Human Rights Commission to the Parliament of Uganda,” 2008, p. 45. On the day of researchers’ visits, 345 patients at Luzira Upper were reportedly on some form of HIV treatment; 56 at Murchison Bay were reportedly on ART. Human Rights Watch interview with Kiyonga, Luzira Upper Prison, November 9, 2010; Human Rights Watch interview with doctor, Murchison Bay Hospital, November 10, 2010. Prison authorities reported to Human Rights Watch that, at the 15 prisons providing data during the period of July to December 2010, 1,465 prisoners were on ART. Letter from prison authorities to Human Rights Watch, June 29, 2011.

[267] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[268] Ibid.

[269] Human Rights Watch interview with OC, Muduuma Prison, November 12, 2010.

[270] Human Rights Watch interview with Washington, Muduuma Prison, November 12, 2010.

[271] Human Rights Watch interviews with Logan, Butuntumura Prison, November 11, 2010; Kakura, Butuntumura Prison, November 11, 2010.

[272] Letter from prison authorities to Human Rights Watch, June 29, 2011. Data on prisoner deaths were incomplete and therefore total mortality from HIV/AIDS in the prison system in 2010 could not be ascertained.

[273] Human Rights Watch interview with prison warden, Kitalya Farm Prison, February 28, 2011.

[274] Human Rights Watch interview with OC, Muinaina Farm Prison, March 3, 2011.

[275] Drug shortages or stockouts for ARVs have been reported regularly in Uganda as a result of problems in the supply and distribution system. See, e.g., Government of Uganda, “UNGASS Country Progress Report Uganda: January 2008-December 2009,” March 2010, p. 33; Richard Hasunira, Aaron Muhinda, Rosette Mutambi and Beatrice Were, “Uganda,” in Missing the Target: Failing Women, Failing Children: HIV, Vertical Transmission, and Women’s Health, International Treatment Preparedness Coalition, May 2009, p. 56.

[276] World Health Organization, “Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach: 2010 Revision,” 2010, http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf (accessed May 5, 2011), p. 19.

[277] Human Rights Watch interview with doctor, Murchison Bay Hospital, November 10, 2010.

[278] WHO, “Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach,” 2006, http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf (accessed March 4, 2010), p. 70.

[279] Human Rights Watch interviews with Gerard, Murchison Bay Prison, November 20, 2010; nurse, Luzira Upper Prison, November 9, 2010; Kenneth, Masafu Prison, March 8, 2011.

[280] Human Rights Watch interview with Kenneth, Masafu Prison, March 8, 2011. HIV-positive prisoners do not routinely receive government-provided food supplements outside of the Luzira/Murchison Bay complex.

[281] Human Rights Watch interviews with Matthew, Masafu Prison, March 8, 2011; Washington, Muduuma Prison, November 12, 2010; Gerard, Murchison Bay Prison, November 20, 2010; Kenneth, Masafu Prison, March 8, 2011.

[282] Human Rights Watch interview with Okello, Luzira Upper Prison, November 8, 2010.

[283] Human Rights Watch interview with Rebecca, Luzira Women’s Prison, November 10, 2010.

[284] Human Rights Watch interview with Gerard, Murchison Bay Prison, November 20, 2010.

[285] Government of Uganda Ministry of Health, “National Health Policy: Reducing Poverty Through Promoting People’s Health,” May 2009, http://www.health.go.ug/National_Health.pdf (accessed August 11, 2010), p. 2.

[286] Ibid., p. 14.

[287] Human Rights Watch interview with OC, Muinaina Farm Prison, March 3, 2011. See also Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[288] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[289] Human Rights Watch interview with OC, Fort Portal Prison, November 15, 2010.

[290]Human Rights Watch interviews with OC, Masaka Ssaza Prison, November 22, 2010; OC, Masafu Prison, March 8, 2011; OC, Muinaina Farm Prison, March 4, 2011; warden, Kitalya Farm Prison, February 28, 2011; OC, Masaka Main Prison, November 23, 2010.

[291] Human Rights Watch interviews with OC, Masafu Prison, March 8, 2011; OC, Jinja Main Prison, March 2, 2011.

[292] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011.

[293] UPS, “Work Plan and Budget,” pp. 12-13.

[294] Human Rights Watch interviews with OC, Murchison Bay Prison, November 10, 2010; psychiatric nurse, Masaka Main Prison, November 23, 2010.

[295]Human Rights Watch interviews with OC, Masaka Ssaza Prison, November 22, 2010; OC, Masaka Main Prison, November 23, 2010; OC, Masafu Prison, March 8, 2011.

[296] Human Rights Watch interview with OC, Masafu Prison, March 8, 2011.

[297] The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” p. 29. In 2010 prison authorities also reported deaths from malaria. Letter from prison authorities to Human Rights Watch, June 29, 2011.

[298] World Health Organization, “Malaria and HIV Interactions and their Implications for Public Health Policy,” 2005, http://www.who.int/hiv/pub/prev_care/malariahiv.pdf (accessed May 4, 2011).

[299] Human Rights Watch interviews with Simon, 14, Bubukwanga Prison, November 16, 2010; Christopher, 17, Bubukwanga Prison, November 16, 2010; Isaac, Jinja Main Prison, March 1, 2011; Thomas, Mutufu Prison, March 7, 2011. See also, Hudson Apunyo, “10 Inmates Die in Lira Prison,” The Monitor, April 17, 2006, http://allafrica.com/stories/200408170111.html (accessed April 10, 2011).

[300] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011; UPS, “Work Plan and Budget,” pp. 12-13.

[301] Human Rights Watch interview with George, Matufu Prison, March 7, 2011.

[302] UPS, “Work Plan and Budget,” p. 4; Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[303] See, e.g., Human Rights Watch interview with Ralph, Luzira Upper Prison, November 9, 2010. Diarrhea was a cause of death among prisoners in 2007/08 and 2008/09, and cholera in 2005/06. The Republic of Uganda Office of the Auditor General, “Value for Money Audit Report of Uganda Prisons Service,” p. 28.

[304] UPS, “Work Plan and Budget,” p. 5. Diarrhea and dysentery were both reported among the causes of prisoner deaths in 2010. Letter from prison authorities to Human Rights Watch, June 29, 2011.

[305] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[306] Human Rights Watch interview with Jonathan, Masaka Ssaza Prison, November 22, 2010.

[307] Human Rights Watch interviews with doctor, Murchison Bay Hospital, November 10, 2010; psychiatric nurse, Masaka Main Prison, November 23, 2010; UPS, “Work Plan and Budget,” p. 5.

[308] Human Rights Watch interview with psychiatric nurse, Masaka Main, November 23, 2010.

[309] Human Rights Watch interview with Kaahwa, Bubukwanga Prison, November 16, 2010; Human Rights Watch interview with Ekanya, Bubukwanga Prison, November 16, 2010; Human Rights Watch interview with Otto, Bubukwanga Prison, November 16, 2010; Human Rights Watch interview with Gideon, 15, Bubukwanga Prison, November 16, 2010.

[310] UNODC and UNAIDS, “Women and HIV in Prison Settings,” September 2008, http://www.unodc.org/documents/hiv-aids/Women%20and%20HIV%20in%20prison%20settings.pdf (accessed March 3, 2010), p. 2. See also Vetten, “The Imprisonment of Women in Africa,” in Jeremy Sarkin, ed., Human Rights in African Prisons, (Cape Town: HSRC Press, 2008).

[311] Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol), adopted by the 2nd Ordinary Session of the Assembly of the Union, Maputo, CAB/LEG/66.6 (September 13, 2000); entered into force November 25, 2005. Ratified by Uganda on July 22, 2010.

[312] Maputo Protocol, article 24.

[313] UN Standard Minimum Rules for the Treatment of Prisoners, para. 23.

[314] Brenda J. van den Bergh, Alex Gatherer and Lars F. Møller, “Women’s Health in Prison: Urgent Need for Improvement in Gender Equity and Social Justice,” Bulletin of the World Health Organization, vol. 87, 2009, p. 406.

[315] Human Rights Watch interview with Christine, Fort Portal Women’s Prison, November 15, 2010.

[316] Human Rights Watch interview with Lydia, Masafu Prison, March 8, 2011.

[317] Human Rights Watch interview with OC, Murchison Bay Prison, November 10, 2010.

[318] Human Rights Watch interview with Agatha, Luzira Women’s Prison, November 9, 2010; Mercy, Luzira Women’s Prison, November 9, 2010.

[319] Human Rights watch interview with Grace, Masaka Ssaza Prison, November 22, 2010.

[320] Human Rights Watch interview with Mercy, Luzira Women’s Prison, November 9, 2010.

[321] Human Rights Watch interview with Dorothy, Butuntumura Prison, November 11, 2010.

[322] Human Rights Watch interview with Hannah, Luzira Women’s Prison, November 10, 2010.

[323] Human Rights Watch interview with prison medical authority, UPS, November 18, 2010.

[324] World Health Organization, “Rapid Advice: Use of Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Inmates,” November 2009, http://www.who.int/hiv/pub/mtct/rapid_advice_mtct.pdf (accessed March 3, 2010), p. 13.

[325] Human Rights Watch interview with Hellene, 16, Butuntumura Prison, November 11, 2010.

[326] Human Rights Watch interviews with Hellene, 16, Butuntumura Prison, November 11, 2010; Christine, Fort Portal Women’s, November 15, 2010; Betty, Masaka Ssaza Prison, November 22, 2010; Mary, Jinja Women’s Prison, March 2, 2011; Vivian, Jinja Women’s Prison, March 2, 20111; Stella, Jinja Women’s Prison, March 2, 2011; Elizabeth, Jinja Women’s Prison, March 2, 2011; Catherine, Jinja Women’s Prison, March 2, 2011.

[327] Human Rights Watch interviews with Esther, Fort Portal Women’s Prison, November 17, 2010; Priscilla, Fort Portal Women’s Prison, November 17, 2010.

[328] See, e.g., Human Rights Watch interviews with Hellene, 16, Butuntumura Prison, November 11, 2010; Betty, Masaka Ssaza Prison, November 22, 2010; Mary, March 2, 2011; Catherine, Jinja Women’s Prison, March 2, 2011.

[329] Human Rights Watch interview with Hellene, 16, Butuntumura Prison, November 11, 2010.

[330] Human Rights Watch interview with Mary, Jinja Women’s Prison, March 2, 2011.

[331] Penal Code Act of 1950, sec. 11.

[332] Trial on Indictments Act, sec. 45.

[333] The lack of a psychiatrist on staff has resulted in reliance on a doctor visiting from Butabika Hospital, Uganda’s sole psychiatric center. However, the doctor’s visit can be as infrequent as once a month. Human Rights Watch interview with OC, Murchison Bay, November 10, 2010. The lack of personnel trained in mental health and therefore able to determine competency to stand trial is an issue not only in the prison system but in the country as a whole, where there are only 32 psychiatrists nationwide. Human Rights Watch interview with president, Uganda Medical Association, March 11, 2011.

[334] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011. JLOS has highlighted one of its key challenges as “the absence of medical-legal policy and guidelines [such as] handling of criminal lunatics among others.” Justice, Law, and Order Sector, “Annual Performance Report, 2009-2010,” September 2010.

[335] Human Rights Watch interview with Miriam, Fort Portal Women’s Prison, November 15, 2010; Elliot, Murchison Bay, November 13, 2010; Mutebi, Muduuma Prison, November 12, 2010; Paul, Muduuma Prison, November 12, 2010; Felix, Fort Portal Prison, November 15, 2010; Drani, Fort Portal Prison, November 15, 2010.

[336] Individuals found not guilty “by reason of insanity” (or who are found guilty and sentenced to death as minors) must await orders from the Minister of Justice and Constitutional Affairs for his decision on whether that person will be detained in a prison, a hospital, or other place of custody, or alternatively released. Trial on Indictments Act, secs. 48 and 105. In reality, however, because the Minister of Justice flouts his statutory duty to resolve such cases, these prisoners remain in legal limbo for years without knowing how long they will be detained, where they should be detained, or whether they are entitled to release. Human Rights Watch, “Uganda: Languishing Behind Bars: Resolve Overdue Cases of Prisoners with Mental Disabilities,” April 28, 2011, http://www.hrw.org/en/news/2011/04/28/uganda-languishing-behind-bars.

[337] This statistic was derived using an entry screening process by UPS, still in its very early stages. Human Rights Watch interview with prison medical authority, UPS, March 11, 2011. Uganda has ratified the Convention on the Rights of Persons with Disabilities. Convention on the Rights of Persons with Disabilities (CRPD), adopted December 13, 2006 by G.A. Res. 61/106, Annex I, U.N.GAOR, 61st Sess., Supp. No. 49 at 65, U.N. Doc A/61/49 (2006), entered into force May 3, 2008, U.N. Doc. A/61/61, signed by Uganda on March 30, 2007 and ratified by Uganda on September 25, 2008.

[338] See, e.g., Human Rights Watch facility tour with prison officer, Luzira Upper Prison, November 9, 2010; Kiyonga, Luzira Upper Prison, November 9, 2010; Fred, Luzira Upper Prison, November 8, 2010.

[339] UPS, “Work Plan and Budget,” pp. 12-13.

[340] Human Rights Watch interview with president, Uganda Medical Association, March 11, 2011.

[341] Letter from prison authorities to Human Rights Watch, June 29, 2011.

[342] See, e.g., Human Rights Watch interview with Mutebi, Muduuma Prison, November 12, 2010; Human Rights Watch interview with Paul, Muduuma Prison, November 12, 2010; Human Rights Watch interview with psychiatric nurse, Masaka Main Prison, November 23, 2010.

[343] Human Rights Watch interview with president, Uganda Medical Association, March 11, 2011.

[344] Human Rights Watch interview with prison medical authority, UPS, March 11, 2011; Human Rights Watch interview with psychiatric nurse, Masaka Main Prison, November 23, 2010.

[345] Ibid. Luzira Upper and Murchison Bay each have wards housing 15 to 20 inmates with mental health problems. Human Rights Watch facility tour with prison warden, Luzira Upper Prison, November 9, 2010; interview with OC, Murchison Bay Prison, November 13, 2010.

[346] At Jinja Main, a major regional center, Human Rights Watch researchers found a prisoner with “mental problems” shut away in an isolation cell. He reported that he had received no medication or visits from a health worker. Human Rights Watch facility assessment of Jinja Main Prison, March 2, 2011. A psychiatrist visits Murchison Bay from the Butabika mental hospital, and a clinical psychiatric officer and psychiatric nurse are on staff. But even at Murchison Bay Hospital, prisoners housed in the mental health cell reported simply receiving medication from another inmate. Human Rights Watch interviews with Elliot, Murchison Bay Prison, November 13, 2010; Ali, Murchison Bay Prison, November 20, 2010; Drani, Fort Portal Men’s Prison, November 15, 2010.

[347] Human Rights Watch interview with president, Uganda Medical Association, March 11, 2011.