The widespread and systematic use of medical negligence as an instrument of punishment is an ongoing trend in Bahrain. The government’s crackdown on Bahraini political prisoners first became apparent during Bahrain’s mass pro-democracy protests in 2011. Indeed, as of 22 November 2011, the Bahrain Centre for Human Rights reported that, 500 prisoners of conscience were behind bars, making Bahrain the top country globally in political prisoners per capita. Other human rights groups, such as Amnesty International, echoing concerns over the number of political prisoners have also expressed concern over the lack of adequate medical care in Bahrain’s prisons.

The healthcare system in Bahraini prisons is characterized by regular instances of negligence, delay in care, and arbitrary exercise of authority, which coincides with purposeful ill-treatment, resulting in an overall lack of adequate care for prisoners. This failure to provide detainees with adequate healthcare has contributed to the widespread deterioration of health of those suffering from injuries or serious chronic illnesses, as well as torture.

Jau prison

As Bahrain’s primary prison, the Jau Rehabilitation and Reform Center (Jau prison), has an officially recorded prison population of 2,500. As a result, it is currently 15% over its capacity. But while the prison is overcrowded, its medical facilities are severely understaffed. There only two physicians, both general practitioners, on alternating shifts, and there are up to only three medical staff on duty at any given time. Prisoners in need of specialist care for illnesses that require close medical management, such as dental surgery, sickle-cell anemia, multiple sclerosis, or cancer, require referral to different medical facilities, since Jau prison does not have the necessary diagnostic equipment like X-ray machines or specialist doctors. However, those prisoners are often denied referral. Instead of adequately treating many health concerns, the Jau prison clinic typically prescribes and dispenses common over-the-counter painkillers for every complaint, including rashes and indigestion.

Ahmed Merza Ismaeel

Ahmed Merza Ismaeel was arrested on 11 September 2013 and suffers from sickle-cell anemia, putting him at a heightened risk of infection and stroke. His personal physician noted that his condition is severe and requires admission to the hospital for treatment. Despite this, Jau prison authorities coerced him into surrendering his right to be transferred for a scheduled hospital appointment for treatment.

In summer 2017, prison guards threatened Ismaeel with physical assault and solitary confinement if he did not sign papers cancelling his appointment. Ismaeel has been in need of a gallbladder removal operation since July 2016 due to chronic gallstones – a common complication of sickle-cell anemia. This led to severe health complications in December 2016, when the concentration of hemoglobin in Ismaeel’s blood dropped to a dangerous level and he was diagnosed with jaundice. He was hospitalized in January 2017, marking the last time he had been given a course of treatment in hospital. Since his discharge, he has received no specialist care or painkillers for the pain accompanying sickle-cell anemia.

Elias Faisal al-Mulla

Elias Faisal al-Mulla, 27, was arrested on 11 May 2012 and suffers from stage three colon cancer. His family does not receive regular updates regarding his medical condition despite making several requests. In March 2015, al-Mulla was reportedly subjected to tear gas inhalation during a protest that was met with violence at Jau prison. The incident left him with severe stomach cramps. He stopped asking to visit the clinic after he reported that security forces and the doctor had both beaten him in his stomach when he asked for medical treatment. Despite being hospitalized due to bloody vomiting on 1 August 2015, two months later the prison administration refused to release his medical reports to his family. Eight weeks later, it was disclosed that al-Mulla had stage-three colon cancer with partial diffusion into the lymph system.

Despite his illness, officers transferred him back to Jau prison during the same month as his diagnosis, and less than a week after he underwent a colon biopsy. He was held there throughout the course of his chemotherapy during 2015 and 2016, while his hospital appointments were being arbitrarily postponed and interrupted. Al-Mulla had been waiting to receive his prescription medication since August 2018, while the prison clinic authorities claim that technical errors have further delayed the process. As of early September, al-Mulla had yet to receive his medication.

Mohamed Ali Jaafar

Mohamed Ali Jaafar, who had multiple sclerosis (MS) prior to his detention, has also reported a  lack of access to his medication. Since his detention in 2014, Jaafar has requested annual Magnetic Resonance Imaging (MRI) scans typically prescribed for patients with his condition, but has yet to receive them.

Redha Merza Mushaima

Redha Merza Mushaima, 30, was arrested on 4 March 2014 and has reported that officers had kicked him in the face, ears and head. The beatings worsened a pre-existing hand injury, broke his teeth, and caused severe and persistent head and back pains. Officers had also smashed his head against the wall and inserted sharp objects into his ear, causing hearing loss in one ear.  During his imprisonment in Jau, Redha has requested access to medication for his many torture-induced injuries but the prison guards have continuously refused. In addition to beatings and torture, officials have verbally abused him and subjected him to hours in solitary confinement as punishment.

Other prisoners and detainees have also reported being denied necessary and adequate medical care. Among them is Ahmed Abdullah al-Arab, who was tried while still a minor. He alleges officials beat him at the time of his detention in 2015. He now suffers from severe back pain that prevents him from standing or sitting comfortably. A doctor at the prison clinic had advised that he should be transferred to obtain X-rays necessary for diagnosis and treatment, but this has yet to happen. Similarly Mohamed Merza Moosa showed signs of good health prior to his detention, but now suffers from chronic back pain due to alleged beatings after his detention in 2011. A doctor had advised that he is in need of an orthopedic mattress, which was not provided by the Jau prison administration.

Poor sanitation conditions at Jau prison

The conditions at Jau prison violate international standards for detention. Prisoners are kept in severely overcrowded and unhygienic environments, where some of the rooms in the buildings are infested with insects and have broken toilets. Cases of skin disease and allergic reactions are frequent. Both Mohamed Ali Jaafar and Ahmed Merza Ismaeel have had skin outbreaks due to the unclean environment. In October 2017, Jau inmate Sayed Ahmed Redha Hemaidan contracted an eye infection due to the prison’s poor sanitary conditions.

Isa Town Detention Center for Women

Isa Town Women’s Prison is the only women’s detention center in Bahrain. Detainees held at this facility have described an environment of extreme and constant stress that wears on their mental state. Health conditions are poor, especially with regards to women’s health issues. Unclean bathrooms and showers coupled with limited access to toilets contribute to a high number of urinary tract infections. While each prison cell contains 10 beds, it is reported that sometimes more than 15 women are assigned to one cell. Prisoners of Isa Town Detention Center are subjected to daily verbal harassment, physical abuse, and threats of sexual assault by the prison guards.

Hajer Mansoor Hassan

Hajer Mansoor Hassan, 49, imprisoned in reprisal for the activism of her exiled son-in-law Sayed Ahmed al-Wadaei, has not been allowed to obtain her medical records and has yet to receive the diagnosis of her breast cysts despite repeated requests. On 16 September 2018, Isa Town prison guards assaulted Hajer and her cellmates. She has since suffered a dangerous drop in her blood glucose level and had to be hospitalized. She was left with bruises from the assault and was held in solitary confinement for several hours.

Fawziya Mashaalla Haji

Fawziya Mashaalla Haji, 56, has been detained since December 2017 on charges of sheltering fugitives. She suffers from severe health conditions including chronic heart problems, low blood pressure, asthma, vertigo, shortness of breath, heart palpitations, chest pain, and several digestive problems ranging from stomach to colon issues. On 11 March 2018, she fainted while in custody and was transferred to the clinic at the Ministry of Interior facility known as al-Qalaa. She was treated for only a few hours before being transferred back to prison. On 22 May, she lost consciousness due to a drop in her blood sugar level. Some of the medications she had been taking had not been provided to her in detention. She had reported various instances of harassment and intimidation. A driver for the Criminal Investigations Directorate (CID), responsible for transporting prisoners to hospitals, intimidated her by intentionally driving recklessly. The authorities also threatened Fawziya when she requested dental treatment. They told her to choose between “accepting the pain and signing a statement to reject dental treatment” or “having her teeth pulled out.” Fawziya offered to pay for her own treatment, citing the lack of adequate treatment offered in the Bahraini prison. However, the prison administration refused her family’s offer to pay for the treatment.

Conclusion and recommendations

As a state party to the International Covenant on Economic, Social and Cultural Rights, Bahrain is legally obliged to respect, protect and fulfill “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Rule 24 of the UN Standard Minimum Rules for the Treatment of Prisoners (The Mandela Rules) states that “the provision of health care for prisoners is a State responsibility” and “prisoners should enjoy the same standards of health care that are available in the community” without discrimination. According to Rule 27 of The Mandela Rules, prisoners who require specialist treatment must be transferred to specialized institutions or hospitals when such treatment is not available in prison.

Failure to provide adequate health care to prisoners violates the absolute prohibition of torture and other cruel, inhuman or degrading treatment or punishment, included under Article 7 of the International Covenant on Civil and Political Rights, to which Bahrain is also state party.

Discriminating against political prisoners and interfering with the provision of healthcare violate the principles of non-interference and non-discrimination of medical impartiality. Defenders for Medical Impartiality (DMI) calls on Bahraini prison authorities and all other detention centers in Bahrain to abide by international human rights laws and standards in their treatment of detainees and prisoners. DMI calls on Bahrain to take immediate measures to meet its human rights obligations to all those held in state custody, and to establish practices that will ensure the provision of medical care to prisoners. DMI additionally urges the authorities to provide necessary medical treatment to all those in need, and to investigate claims of torture and ill treatment by prison officials and hold those accountable for their unlawful actions.