Beirut — Egyptian prison authorities should immediately provide jailed pro-Muslim Brotherhood activist Aisha al-Shater with critically needed medical care, allow her family visits, and release her if there is no evidence of criminal wrongdoing, Human Rights Watch said today.
Prison authorities have kept al-Shater, 39, in abusive detention conditions for more than a year, including months of solitary confinement and over a year without family visits. Authorities allowed her two short hospital visits in October 2019 but took her back to solitary confinement. Doctors believe she has aplastic anemia and bone marrow failure, serious medical conditions that can be life-threatening and require expert medical care. Of particular concern is a heightened risk of infection due to low white blood cell counts.
"As if arbitrary arrest was not enough, Aisha al-Shater has had to endure inhumane prison conditions and her family has been living in anguish knowing almost nothing about her health," said Joe Stork, deputy Middle East and North Africa director at Human Rights Watch. "Now, faced with a medical crisis, prison authorities should ensure she receives sufficient care by independent doctors."
Police and National Security Agency officers in November 2018 arrested around 40 lawyers and humanitarian activists and volunteers, including al-Shater and her husband, lawyer Mohamed Abu Hourayra, who were active with the Egyptian Coordination for Rights and Freedoms. A relative told Human Rights Watch that one reason she was arrested is that her father, Khairat al-Shater, imprisoned since 2013, was the deputy chairman of the now-banned Muslim Brotherhood.
Sources close to al-Shater's family said that in October 2019, prison authorities transferred her to Cairo University's Qasr al-Aini hospital twice for medical treatment. On October 8, al-Shater was admitted for two days and then on October 31, she was readmitted for a week. Before being transferred to Qasr al-Aini, she apparently suffered acute episodes of fatigue and severe bleeding.
On November 25, after a public outcry, Prosecutor-General Hamada al-Sawy ordered the State Security Prosecution to open an investigation into al-Shater's complaints about lack of appropriate medical care. The family said they learned through some inmates that al-Shater was transferred to the prison hospital a few days after that, but they were not able to get in touch with her.
Authorities should immediately transfer al-Shater to a fully-equipped medical facility, allow independent doctors to examine her, and make available to her family and lawyers detailed information about her medical condition, Human Rights Watch said. Human Rights Watch and other rights organizations have found that prison hospitals in Egypt often lack necessary medical equipment, medicines, and specialized doctors, and doctors who work in prisons or prison hospitals are subject to chain of command by Interior Ministry officers and often cannot make crucial clinical decisions independently. According to Egypt's 1961 prison law, when a doctor determines that the prison hospital is not able to treat a case, only prison authorities can authorize a decision to transfer the prisoner to an outside hospital or call a specialist. Al-Shater's mother, Azza Tawfik, said on Facebook that the family offered to pay for her treatment in a private hospital but prison authorities refused.
After having been "disappeared" for 20 days after her arrest, al-Shater appeared before a State Security prosecutor on November 21, 2018, who ordered her pretrial detention on charges of "joining a terrorist group." Authorities held her in an undisclosed location, probably in a National Security Agency building in Cairo, until January 2019, when they moved her to al-Qanater women's prison. A relative told Human Rights Watch that Aisha al-Shater has spent at least the last nine months in solitary confinement. The relative also said that prison authorities have prevented her lawyers and family from visiting, and no one has been able to see her since her arrest although the family obtained, at least once, a judge's permission to visit her.
In June 2019, the Turkey-based opposition TV station Mekamleen broadcast a leaked sound clip of what the station said was a recording of al-Shater's remarks before a judge reviewing her detention, and in which she said that she had been kept in solitary confinement in a cell that measured less than 2 meters by 2 meters without sanitary facilities. In the leaked clip, al-Shater said that she has been using a bucket as a bathroom and that she has been forbidden family visits or seeing her children since her arrest.
The relative said that prison authorities have not allowed the family to officially obtain medical records for al-Shater or information on her condition. The relative said the little information they had was after she spoke with her lawyer briefly during a detention renewal hearing on November 7.
According to media reports, authorities had postponed al-Shater's detention renewal hearing for two days because of her deteriorating health. She was then transferred in an ambulance on November 7 to a Cairo criminal court reviewing her detention. When the session ended, "they took her from a rear door" to prevent her from seeing or talking with her family, her sister told journalists. On December 17, the court renewed al-Shater's detention for 45 more days. She was transferred to the court again in an ambulance.
According to a one-page medical report from Qasr al-Aini hospital from early November which a source unofficially provided to Human Rights Watch, al-Shater was suspected of having pancytopenia (decrease in red and white blood cells and platelets) potentially due to aplastic anaemia from myelodysplastic syndrome, a serious bone marrow disorder. The report said that the onset of al-Shater's illness was "acute" and "progressing." The report also said she experienced heavy menstrual bleeding and was given a bone marrow aspiration and administrated three blood transfusions and 36 units of platelets. She was also given Filgrastim, a medicine that stimulates white blood cell production.
A relative of al-Shater said that they showed the report to independent doctors who said she should be transferred to the Nasser Institute for Research and Treatment, a government hospital in Cairo, whose staff includes doctors specialized in bone marrow disorders.
Authorities cannot curtail the right to health as a punishment and prisoners should receive medical care without discrimination due to their legal status and that is at least equivalent to the standards available in the community. The United Nations "Mandela Rules," which provide authoritative guidance on detention practices, state that prisoners have a right to medical care, including diagnostic and treatment, oﬀered by suﬃcient, well-qualiﬁed medical personnel operating with clinical independence. Prisoners also have rights to suﬃcient living space, appropriate ventilation, lighting, heat, sanitation, clean water, and adequate and nutritious food. The Mandela Rules also set a 15-day maximum on confinement in isolation.
In 2017, President Abdel Fattah al-Sisi's government introduced amendments to prison laws that provide for up to six months in solitary confinement. Such prolonged solitary confinement can amount to torture.
In November 2019, two UN experts said that Egypt's abusive detention conditions "may be placing the health and lives of thousands more prisoners at severe risk" and that such abuses including lack of sufficient medical care "may have directly led" to the death of former President Mohamed Morsy.
"The Prosecutor General's order to investigate al-Shater's complaints is meaningless without ensuring she is able to receive appropriate, sufficient medical care and communicate with her family and lawyers," Stork said.