Table 8: TB and the Right of All Persons Deprived of Their Liberty to be Treated with Humanity
Examples of Human Rights Violations
- Prisoners diagnosed with TB are not provided medical treatment or medicines.
- Prisoners are detained in facilities that are overcrowded and/or have poor hygiene.
- Prisoners diagnosed with TB are not provided adequate nutrition.
|Human Rights Standards||Treaty Body Interpretation|
|ICCPR 10(1) All persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person.||HRC: Expressing concern to Moldova at the conditions in detention facilities, including the prevalence of disease. The Committee “reminds the State party of its obligation to ensure the health and life of all persons deprived of their liberty. Danger to the health and lives of detainees as a result of the spread of contagious diseases and inadequate care amounts to a violation of article 10 of the Covenant and may also include a violation of articles 9 and 6.” The Committee recommends that Moldova prevent the spread of disease in detention facilities and provide “appropriate medical treatment to persons who have contracted diseases, either in prison or prior to their detention.” CCPR/CO/75/MDA (2002).
HRC: Expressing concern to Georgia about the large number of cases of tuberculosis reported in prisons and specifically urges the State to “improve the hygiene, diet and general conditions of detention of and provide appropriate medical care to detainees as provided for in article 10 of the Covenant.” CCPR/CO/74/GEO (2002).
HRC: Expressing concern to Ukraine at the “high incidence of HIV/AIDS and tuberculosis among detainees in facilities of the State party is also a cause for concern, along with the absence of specialized care for pre-trial detainees” and recommending that the State “should guarantee the right of detainees to be treated humanely and with respect for their dignity, particularly by relieving overcrowding, providing hygienic facilities, and assuring access to health care and adequate food.” CCPR/C/UKR/CO/6 (2006).
Joint Statement on compulsory drug detention and rehabilitation centres (ILO et al., 2012):
Compulsory drug detention and rehabilitation centres raise human rights issues and threaten the health of detainees, including through increased vulnerability to HIV and [TB] infection….
The UN entities… call on States that operate compulsory drug detention and rehabilitation centres to close them without delay and to release the individuals detained. Upon release, appropriate health care services should be provided to those in need of such services, on a voluntary basis, at community level [including] HIV and TB prevention, treatment, care and support….
Where a State is unable to close the centres rapidly, without undue delay, we urge… [the] provision of health care services pending closure of the centres, including for treatment of HIV and other sexually transmitted infections (STIs), TB and opportunistic infections…
Time to act to prevent and control tuberculosis among inmates (International Union Against Tuberculosis and Lung Disease, 2012):
Urging health authorities, technical agencies, civil society organisations and donor agencies to:
i) adapt and implement the… Stop TB strategy in penitentiary settings;
ii) conduct screening of new inmates, periodic screening of prisoners and penitentiary services staff to detect active TB in a timely manner, and ensure contact tracing;
iii) ensure airborne infection control, including protective measures for staff,8 and promote provider-initiated HIV testing and counselling to detect HIV and TB-HIV co-infected individuals…;
iv) provide access to early diagnosis and effective treatment of all types of TB, including ensure early initiation of antiretroviral therapy for people living with HIV who have active TB;
vi) … provide preventive therapy both for those individuals who become infected with TB in penitentiary services and for those found to be infected while in penitentiary services;
vii) ensure a continuum of care for released prisoners… and for individuals who are on treatment for either infection or disease before entering the penitentiary services;
viii) monitor the TB and TB-HIV situation in the penitentiary services… and link recording and reporting in the penitentiary services to the national health information system;
ix) encourage and facilitate collaborative efforts between the penitentiary and civilian health services;
x) provide psychological counselling and support for prisoners to improve TB and HIV treatment adherence;
xi) … rais[e] awareness about TB among prisoners and penitentiary medical and non-medical staff through continuing education;
xii) and promote operational research to build evidence for enhanced TB prevention, control and care in penitentiary services.
Women’s health in prison: Action guidance and checklists to review current policies and practices (WHO, UNODC, 2011):
Para. 1. The underlying importance of human rights should underpin all thinking and all policy development for all those in compulsory detention.
Para. 3. Key services to be provided should include… specialist health care, which is readily provided and adjusted to meet the needs of women, such as for… chronic health conditions, HIV and AIDS (including counselling and support), hepatitis, tuberculosis (TB) and other infectious diseases.
WHO Guidance on ethics of tuberculosis prevention, care and control (WHO, 2010):
Involuntary isolation and detention as last-resort measures. Isolation or detention should never be implemented as a form of punishment…. In the rare event that isolation or detention is to be used, it must take place in adequate settings, with appropriate infection control measures, as specified more fully in WHO guidance. In addition, reasonable social supports should be provided to isolated patients and their dependants, taking into account the local system’s capacity.
The Madrid Recommendation (WHO, 2010):
Recognizing the urgent need in all prison systems for “measures to use alternatives to imprisonment where possible and to reduce overcrowding in prisons”, “counselling, screening and treatment programmes for infectious diseases, including HIV/AIDS, tuberculosis, hepatitis B and C and sexually transmitted infections”; “guaranteed throughcare for prisoners upon entry and after release from prison” and “ training of all prison staff in the prevention, treatment and control of communicable diseases”.
Guidelines for control of tuberculosis in prisons (USAID, Tuberculosis Coalition for Technical Assistance, International Committee of the Red Cross, 2009).
WHO Policy Guidelines for Collaborative TB and HIV Services for Injecting and Other Drug Users (WHO, 2008):
Recommendation 11. Medical examination upon entry and any time thereafter, conforming to internationally accepted standards of medical confidentiality and care, should be available for all prisoners. Prisoners should obtain health care equivalent to that provided for the civilian population, and care should be continuous on transfer in and out of places of detention.
Principles and Best Practices on the Protection of Persons Deprived of Liberty in the Americas (IACHR, 2008):
Principle X. Persons deprived of liberty shall have the right to health, understood to mean the enjoyment of the highest possible level of physical, mental, and social well-being, including… special measures to meet the particular health needs of persons deprived of liberty belonging to vulnerable or high risk groups, such as… people living with HIV-AIDS, tuberculosis…
Patients’ Charter for Tuberculosis Care (World Care Council, 2006):
Care. The right to free and equitable access to tuberculosis care, from diagnosis through treatment completion, regardless of resources, race, gender, age, language, legal status, religious beliefs, sexual orientation, culture, or having another illness. The right to receive medical advice and treatment which fully meets the new International Standards for Tuberculosis Care, centering on patient needs, including those with [MDR-TB] or [TB-HIV] coinfections and preventative treatment for young children and others considered to be at high risk.