Crime and unjust punishment in Russia

The Lancet
Tom Parfitt

A year after the controversial death in a Moscow detention centre of Sergei Magnitsky—a 37-year-old lawyer who was denied vital medical treatment—Russia is promising an overhaul of its antiquated prison system. But will the reforms bring real change to health-care provision?

It was 1830 h on November 16, 2009, when Sergei Magnitsky was transferred to the Matrosskaya Tishina detention centre in Moscow. The 37-year-old lawyer had been healthy when he was arrested a year earlier on fraud charges that colleagues said were trumped-up in revenge for his work for Hermitage, an international investment fund that passed evidence about corrupt officials to Russian media. Yet within 4 hours of arriving at Matrosskaya Tishina (Sailors’ Rest), Magnitsky was dead.

In the past year the Magnitsky Affair, as it is known in Russia, has become emblematic of the country’s woeful human rights record and its—sometimes wilful—neglect of the sick in prison. 6 weeks after Magnitsky was found lifeless in his cell, the public oversight commission (ONK) for Moscow’s pretrial detention centres published a scathing report describing the events that led up to his death.

The watchdog found he had been diagnosed with gall stones, pancreatitis, and calculous cholecystitis while in custody, but prison officials had consistently ignored his condition or refused him adequate treatment. The head of one facility where the lawyer was held told the commission: “I did not consider Magnitsky sick. Detainees often try to pass themselves off as sick in order to get better conditions.”

In the last 3 days of his life, the commission determined, Magnitsky was vomiting and suffering from acute abdominal pain. He was inspected by doctors but they decided to leave him alone in his cell without medical supervision. When a guard finally noticed him lying motionless on the floor, orderlies rushed to revive him but it was already too late.

Unlike the relatives of many prisoners, Magnitsky’s colleagues at Hermitage had the resources to make a fuss. “This is not about business, this is about the complete breakdown of the justice system”, said chief executive William Browder in a television interview shortly after the death. “If you can have an innocent man on trumped-up charges taken hostage and then slowly killed through mistreatment in prison. It’s medieval.”

In the past year, Browder and his supporters have produced a series of online films which describe the alleged corruption the lawyer exposed. They claim Magnitsky’s health was deliberately neglected as a means of pressuring him to testify against Hermitage employees. As a result of the campaign, US secretary of state Hillary Clinton and British foreign secretary William Hague, have both urged a thorough investigation of the death. Meanwhile, Russia’s president, Dmitry Medvedev responded by firing 20 top managers from the prison system, officially known as the Federal Service for Execution of Punishments (FSIN). Whether the Magnitsky case will prompt real reform of health care in prisons, however, remains a topic of intense debate.

Russia’s sprawling prison network of prisons and “corrective colonies” has 131 hospitals, 59 tuberculosis clinics, nine drug addiction clinics, and medical stations at every institution, although many are in poor shape. More than 90% of the country’s 864 000 inmates are suffering health problems according to a report published by the prosecutor general’s office in August. The report found that 60% of clinics were using outdated equipment, and in total the prison health-care system was receiving only 24% of necessary funding.

There have been some signs of tentative change. In spring this year, the lower house of parliament approved revisions to the criminal code that will soften sentences for defendants convicted of economic crimes. In September, FSIN produced a strategy document that defined broad targets such as increasing funding for health care and bringing treatment in prisons into line with civilian health-care facilities. And earlier this month the head of the notorious Butyrka remand centre near Moscow—where Magnitsky was denied an ultrasound scan—made headlines when he announced prisoners would soon have access to sunbeds, as well as a new ultrasound machine and other medical services.

Also this year, Russia pushed forward with plans to separate first-time offenders from recidivists; a move that is hoped will reduce attacks on defenceless new prisoners. However, critics believe many of the changes are cosmetic. “The prison system retains its totalitarian spirit”, says Lev Ponomaryov, one of Russia’s most respected human rights activists. “Torture is widespread. The head of each institution is a god, a tsar, while the convicts are treated as inhuman. Until that culture of sadism ends we can’t talk of improvements.”

Ponomaryov says talented doctors have fled the prison system, high levels of corruption mean federal funds for medical equipment are often embezzled, and drugs brought to patients by relatives are stolen or held up by guards.

The death of Vera Trifonova on April 30 was another indication that cruel practices are ingrained. Trifonova, aged 52, a real estate agent accused of fraud who was suffering from severe diabetes, died in Matrosskaya Tishina after prison officials had advised a court she should not be released for treatment.
Nadezhda Radnayeva, chief specialist at the Fund for Protection of Prisoners, a Moscow-based non-governmental organisation (NGO), says: “we receive so many complaints from prisoners who say that whatever their illness they are told, ‘take this Aspirin, and off you go’.”

Radnayeva says doctors consistently under-record the seriousness of prisoners’ illnesses, in order to deny them the right to hospital treatment and better food. In one ongoing case in a prison in Mordovia region, authorities have refused to give disabled status to a prisoner who is paralysed from the waist down. The prisoner, who cannot negotiate stairs, paid cigarettes to other inmates to bring him food from the canteen to his cell. “When the cigarettes ran out he didn’t eat for a week”, says Radnayeva.

Ponomaryov believes the system needs fundamental revision. “The problem is that doctors are also men in epaulettes (officers)”, he says. “At the end of the day, they do what the head of the prison says, even if that means a cover up.” As an example, he cites the case of four men who died in a prison colony in Kopeysk in Chelyabinsk region in June, 2008, after guards battered a dozen inmates for refusing to submit to humiliations like washing their faces in a toilet bowl. The four perished after they were left unattended in separate cells. Prison administrators are now undergoing trial for trying to hide the murders by faking an uprising in the prison.

In the light of such scandals, the bosses of FSIN seem to be in favour of passing medical care to civil control. The service did not respond to a request for interview from The Lancet, but its deputy director, Vasily Bolshakov, told the Novaya Gazeta newspaper in July he was “all for” the transfer. “Unfortunately, the ministry of health and social development is against it”, he added. “After the death of Magnitsky we immediately suggested they take medical care from us, and then a second time this year. But both times the ministry turned us down saying it was unnecessary and unsuitable.” The health ministry has since denied it received these approaches from FSIN.

As a compromise, FSIN says it is conducting an experiment in two regions to make doctors directly responsible to the service’s federal headquarters, rather than to prison governors.

Mikhail Volik, director of the Moscow office of AIDS Foundation East West (AFEW), a Dutch NGO that is a member of WHO’s “Health in Prisons” programme, says integration with civil health care is vital. According to AFEW, 6·4% of Russia’s prison population, or about 55 000 people, are HIV positive. That means more than one in ten of Russia’s 540 000 officially registered HIV sufferers are behind bars.

“You have to remember that good prison health is good public health because all these inmates will be released one day”, says Volik. “So there needs to be more attention to HIV in prisons. Despite inmates accounting for more than 10% of the countrywide epidemic only 1% of the federal AIDS budget is dedicated to care for inmates.”

Yet the answer is not only about improving care and diagnostics on the inside. “Most people with HIV in jail arrive with it on the first day”, says Volik. Only improved harm reduction in wider society and a change of attitudes will help stem the problem, he adds. Injecting drug use (the main cause of HIV because of shared needles) is still seen as “more of a crime than a disease”. As it is, the flow of HIV sufferers into jail has punishing results. Their weak immune systems make them vulnerable to rampant tuberculosis, one of the chief causes of death in those with the virus.

A final battleground in the fight for prison health is the make-up of public oversight commissions, or ONKs. Moscow’s commission showed its teeth last year when it issued its damning report on the death of Magnitsky. But Zoya Svetova, a member of the Moscow commission, told reporters this month that “military and security veterans are trying to seize control of the ONK.” She said bodies controlled by the law enforcement agencies planned to propose and confirm the veterans as members, with the aim of stifling the commission’s work to expose violations in prison.

“This is an attempt to transform public control into a mere decoration, devoid of any real substance”, Ponomaryov, the human rights defender, told The Lancet. срочный займ на карту hairy women zp-pdl.com https://zp-pdl.com/get-quick-online-payday-loan-now.php hairy girls