“Following a European Union and Council of Europe survey of prison hospitals it became clear that that the medical department should be independent of the penitentiary system”, said Roza Babayan, a public health consultant. “The penitentiary medical system in Armenia has never been reformed and had remained at the Soviet era standard”, said Babayan. The system is a closed-type and is under the responsibility of the head of the penitentiary institutions. This health system is the only one in Armenia which functions without a license, and its staff has never engaged in the continuous medical education required by the law for public healthcare staff in Armenia every 5 years. “This suggests that none of the accepted health standards of the Republic of Armenia were applicable for the medical services it provided”, said Babayan.

A comprehensive needs assessment report on the conditions of the prisons and a survey on prison healthcare units, including treatment of mental illness patients, were carried out by the joint EU/Council of Europe project for strengthening health care and human rights protection of prisoners in Armenia.

As a result of this research, the medical department was transferred from the penitentiary system to the Ministry of Justice to eliminate any corruption risks and any arbitrariness of the managers of the penitentiary institutions. A state medical non-profit organisation was established, which is due to start its work in September 2018.

“Transmitting the medical department to the Ministry of Justice, is the guarantee of independence of the staff, who will not have to negotiate a chain of managers of the penitentiary system each time they prescribe a medicine or send a prisoner to the hospital”, said Babayan. Previously it was up to the head of the penitentiary institution, and not a medical expert, to agree to a medical treatment or to reject it. As a result treatments were often delayed, and there were also cases of mortalities.”

 Improvement of technical and material conditions on the way, as license is at stake

The project purchased 180 000 euros worth of medical equipment for prison healthcare institutions.

Araik Hakobyan, the Chief Medical Expert of the Penitentiary Department, said that “The equipment was a huge support for us, since we were poorly equipped, with basic equipment only in a few institutions.” He mentioned that all eleven penitentiary institutions, except the prison hospital, received medical equipment. “In the past, when medical services were needed, the patient was sent to the prison hospital, and this was not a good solution for serious emergency cases or the more minor cases which shouldn’t require hospitalisation. There is no such problem now.”

An improvement of health care services, material conditions and an increase in medical staffing levels are high on the agenda of the newly establishing entity as it plans to get its license. As the medical department of the penitentiary institutions is understaffed with a 126 members for around 3,500 prisoners, and a lack of specialists is another problem. “There is a lack of specialists to use some of the new equipment but the newly establishing entity is in the process of recruitment and we expect this issue will be resolved”, said Hakobyan.

 Informed means more protected

A manual for persons in custody was prepared by the project to inform them about their rights and access to legal assistance. Rosa Babayan mentioned that the manual will help prisoners understand how to protect their rights and who is responsible for different fields in the system.

Another milestone of the project was the development of a database on health care in prisons. “We did not have any statistics on the health care in prisons, it was a separate system. However, the data is important for the overall health care system to understand the index case, once prisoners with sicknesses are release", said Babayan. The database also solves issues related to budgeting and target spending. “Before, there was an approximate figure at the end of the fiscal year, this will be more accurate.” she said.

These concrete results reflect the added value of the partnership between the European Union and the Council of Europe.

 Code of medical ethics trainings to better highlight what “torture” might mean

The project also ran cascade training sessions on medical ethics based on curricula developed by international and national Council of Europe consultants and carried out by trainers who followed the “training of trainers” sessions. Approximately 800 medical and non-medical staff were trained on the code of medical ethics, violence in prison, mental health promotion, healthcare for vulnerable groups, infectious diseases and preventive physical healthcare.

Arshak Gasparyan, Head of Social Justice NGO, which conducted training sessions on medical ethics, said: “A legislative base for medical ethics is missing in Armenia, but we were taught international standards, as well as the “Istanbul protocols” concerning the definition of torture and the prevention of torture."

Gasparyan said that ethical issues were explained and introduced through practical case studies, educational videos and debates on how to work effectively with respect of ethics and human rights. He noted that it was important for people to understand the relationship between doctors and prisoners, which may not always be guaranteed by legislation, but through the code of medical ethics and the protection of the international standards, it can and should be placed above any law.