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VII. Hygiene and Health Care

Filthy and overcrowded, juvenile detention centers in Rio de Janeiro do not meet basic standards of health and hygiene.  Youths often wear the same clothes for three weeks before they are laundered.  Many share tattered foam mattresses; others sleep on the floor.  At night, they must defecate and urinate in plastic jugs because guards will not let them out of their cells to use the toilets.  They may not be able to bathe for several days at a time, either because the guards do not allow them to use the showers or because of a lack of running water.  Youths in most facilities must depend on their family members to bring them soap, toothpaste, and toilet paper; those who do not have visitors must do without.

These problems are compounded by the cavalier attitude of many detention center officials, starting with the system’s director.  “There is a lot less in these children’s houses,” Dr. Sérgio Novo said, telling us that Rio’s detention centers were cleaner than many of their homes.¹⁹²

As a stark indication of the lack of hygienic conditions in Rio de Janeiro’s detention centers, youths and staff must endure periodic outbreaks of scabies, a contagious parasitic disease caused by infestation of the Scarcoptes scabiei mite.¹⁹³  The overcrowded conditions in most detention centers, infrequent laundering of bedding and clothing, and the lack of soap make these facilities ideal for the transmission of scabies.  Detention centers do not treat youths who contract scabies, increasing the likelihood that it will spread throughout the detainee population.  As a result, a public defender told Human Rights Watch, “Scabies is a problem in all of the facilities in the system.”¹⁹⁴

Bedding and Clothing

The lack of beds and mattresses was a problem in all of the facilities we visited, meaning that youths shared mattresses or slept on the floor.  “I don’t have a mattress,” said Justino R., a detainee who had spent seven months in Santo Expedito.  “Half of us don’t have mattresses.”¹⁹⁵  Similarly, Carlos A., an eighteen-year-old in Cai Baixada, told us, “The mattresses aren’t big enough, and there aren’t enough for all.”¹⁹⁶  “They sleep on concrete there,” the father of one youth in Santo Expedito said.  “They don’t have mattresses.  They don’t have anything.”¹⁹⁷  Alícia Q., an eighteen-year-old in Santos Dumont, reported that because there were twelve beds in her dormitory for sixteen girls, the girls often slept two to a bed.¹⁹⁸

Luciano G., an eighteen-year-old who had spent a little over a month in Santo Expedito, was one of the few detainees we spoke with who did have a mattress.  “But it’s very bad.  It’s old and very thin,” he said.  He showed us a tattered foam sleeping pad perhaps two-thirds its original size.  He added, “Not everybody has a mattress.  Those who don’t have one sleep with somebody else.  They have to share a mattress.”¹⁹⁹

The detention centers visited by Human Rights Watch do not provide youths with a change of clothing if they do not have their own, and these facilities did not regularly launder clothing.  As a result, youths frequently went several weeks without a change of clothes.  For example, Miguel L., a twenty-one-year-old in Padre Severino, told us that he had not changed his clothes in two weeks;²⁰⁰ and fifteen-year-old Vitor M., also in Padre Severino, reported that he changed clothes every three to four weeks.²⁰¹  Carlos A., the eighteen-year-old in CAI-Baixada, told Human Rights Watch, “They don’t have cleaning here.  They don’t do cleaning. . . .  I received clean clothes today [Monday], and I’ll turn them in on Wednesday.  We wear the same clothes two or three days.”²⁰²

Youths in Santo Expedito, in particular, consistently reported problems in laundering their clothing.  “We have the same clothing for three weeks,” Paulo E., held in Santo Expedito, told us.²⁰³  Luciano G., also in Santo Expedito, told us that he only had two changes of clothing.  “Right now it’s difficult to exchange them,” he said, explaining that the detention center had not laundered his clothing for two weeks.  He washed the clothes himself in an effort to maintain a basic level of personal hygiene.  “My mother brings soap for me,” he told us.²⁰⁴  “I only have these clothes,” said seventeen-year-old Alex C., another Santo Expedito detainee.  “We do the laundry ourselves.  Our mothers bring us soap.”  He returned to this subject at the end of our interview, when we asked him what changes he would like to see at the detention center, suggesting that the detention center give every youth two changes of clothing so that they could wear one while the other was being laundered.²⁰⁵

When we asked an official in Santo Expedito’s laundry room how often clothing was washed, he replied, “We only have one washer and one drier that work.  Clothing, that’s now done once a week.  When things are working normally, laundry is twice a week.”²⁰⁶

Personal Hygiene and Access to Water

All of the facilities we visited had toilets, but youths were not always allowed out of their cells to use them, particularly at night.  “There are no bathrooms in the rooms, so the adolescents use a jug and empty it out the window,” observed a worker in CAI-Baixada.²⁰⁷  Even when youths have access to them, the toilets are often broken or blocked up.  “They don’t have proper bathrooms,” said the mother of a seventeen-year-old in Santo Expedito.  “The boys are filthy.  It’s dirty in there, sweaty and humid.”  Noting that these conditions facilitate the spread of scabies and similar diseases, she told us, “There’s a kid there with scabies all over his buttocks, penis, and hands.”²⁰⁸

We heard similar reports that youths were not allowed to bathe regularly. We heard of only one detention center that provided soap, and some detention centers did not issue toilet paper to youths.  “They don’t let us take showers,” said Dário P., an eighteen-year-old in CAI-Baixada.²⁰⁹  Twenty-one-year-old Miguel L. told us that Padre Severino did not always issue toilet paper to youths; he used water to clean himself, but he told us that the water in the detention center was frequently cut off.²¹⁰  Ronaldo O., eighteen, reported the same problem with a lack of toilet paper in Santo Expedito.²¹¹  Access to clean drinking water was also a problem in most of the facilities we visited.

Youths depend on visiting family members to bring them soap, toothpaste, toothbrushes, and other toiletries.  “We don’t have toothpaste,” Carlos A., a CAI-Baixada detainee, told us.  “I have soap, but that’s because my mother brings it for me.”²¹²  Enrique P., detained in Santo Expedito, voiced a similar complaint.  “We need toiletries,” he said.  “They only give us soap.  No toothpaste.  We only have that if our mothers bring it on the days they visit.”²¹³  And Marinete Laureano, the director of Santos Dumont, identified the need for soap and toothpaste as a priority in her detention center.²¹⁴

The Outbreak of Scabies

Staff at the Escola Santo Expedito, the Instituto Padre Severino, and the CAI-Baixada detention center informed us that scabies was rampant among the youth population at each facility.  When we toured the centers and spoke with youths, they complained of skin rashes and severe itching.  Many of these youths showed us large, red, pimple-like spots on their arms and legs; others had crusty patches spread over their bodies.

While not particularly dangerous, scabies is exceedingly unpleasant and carries a significant risk of secondary infections.  If left untreated, scabies causes severe itching and may spread over the body.  Those with scabies are at risk of secondary bacterial infections if they scratch the affected areas.  In addition, because scabies may be transmitted by skin contact, the failure to treat youths puts detention center staff and their families at risk of contracting the disease.

We highlight scabies in this section because its prevalence indicates a widespread disregard for the right of youths in detention to facilities and services that meet basic standards of health and human dignity.  Regular laundering of clothing and bedding, the opportunity to bathe daily with soap and hot water, and separate mattresses for each youth would reduce the risk of contracting scabies.  Those who do contract the disease can be treated with lotions that are readily available.  Nevertheless, every detainee that we interviewed told us that health officials did not treat scabies.  “They don’t have medications,” said Carlos A., an eighteen-year-old detainee in CAI-Baixada, showing us his arms and legs, which were covered with scabies.²¹⁵  As one DEGASE health care worker commented to us, “This problem has been going on for nine years.”²¹⁶

Scabies is not the only disease that thrives in unhygienic conditions, and the need for medical supplies is not limited to medication for the treatment of scabies.  “There’s a huge lack of medication here,” said Dário P., an eighteen-year-old in Cai Baixada.  “They lack a lot of things.”²¹⁷  An official at the detention center corroborated this account, saying, “The family members have to buy whatever prescription medications they need.”²¹⁸  We heard similar accounts in all of the institutions we visited.

When we spoke to Dr. Sérgio Novo about the outbreak of scabies in Rio de Janeiro’s detention centers, he downplayed the problem, telling us that such outbreaks were common during the winter months of June, July, and August.  “During other times of the year, we have problems with eye inflammations,” he said, presumably referring to conjunctivitis.²¹⁹  We received no response to our written request that the state provide adequate medical treatment to detained youths with scabies.²²⁰

The Right to the Highest Attainable Standard of Health

All individuals have the right to enjoy the highest attainable standard of health, a right that is guaranteed by article 12 of the International Covenant on Economic, Social and Cultural Rights and reaffirmed in the Convention on the Rights of the Child, the International Convention on the Elimination of All Forms of Racial Discrimination, and the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights (known as the Protocol of San Salvador).²²¹  The state also has an affirmative obligation to provide for the basic health needs of those it detains.  As the Human Rights Committee has observed, states have “a positive obligation toward persons who are particularly vulnerable because of their status as persons deprived of liberty.”²²²  This obligation flows from the right of individuals in detention to be treated with humanity and with respect for the inherent dignity of the human person, a right guaranteed by article 10(1) of the International Covenant on Civil and Political Rights (ICCPR).

The U.N. Rules for the Protection of Juveniles, “intended to establish minimum standards accepted by the United Nations for the protection of juveniles deprived of their liberty in all forms,” call for the following measures, among others, to protect the health and ensure the human dignity of children in detention:

• Adequate preventive and remedial medical care.²²³
• Prompt examination by a doctor of every youth who is ill, complains of illness, or demonstrates symptoms of physical or mental difficulties.²²⁴
• Separate and sufficient bedding, which should be clean when issued, kept in good order, and changed often enough to ensure cleanliness.²²⁵
• Accessible and clean sanitary installations.²²⁶
• Clean drinking water available to all youths at all times.²²⁷

In addition, the state’s failure to provide adequate medical treatment to detained children with scabies may amount to cruel, inhuman, and degrading treatment.

As a matter of priority, DEGASE and the Secretariat of Health should conduct thorough medical examinations of all youths in the Escola Santo Expedito, the Instituto Padre Severino, and CAI-Baixada detention center; provide immediate treatment to all youths found to be infected with scabies, with follow-up treatment as necessary; wash all clothing, bedding, and towels in boiling water and follow the other steps outlined by DEGASE’s health unit to prevent a recurrence of the disease; provide youths with sufficient soap and adequate opportunity to bathe; provide every youth with his or her own mattress and bedding; and ensure that living areas and sanitary facilities are cleaned frequently enough to meet all requirements of health and human dignity.²²⁸