Beirut — Provide Protection, Medical Care, Accelerate Releases
Several Egyptian prisons and police stations have had suspected Covid-19 outbreaks in recent weeks amid a strict official information blackout, Human Rights Watch said today.
Accounts by witnesses to Human Rights Watch, leaked letters from two prisons, as well as credible reports by local rights groups and media indicate that at least 14 prisoners and detainees have died, most likely from Covid-19 complications, in 10 detention facilities as of July 15. Even though scores of prisoners and detainees, at a minimum, have shown mild to severe Covid-19 symptoms, prisons had insufficient medical care and virtually no access to testing for the virus or symptom screening. The authorities have released about 13,000 prisoners since late February, but that number is insufficient to ease overcrowding in congested prisons and jails.
"Egyptian authorities should take immediate steps to provide everyone in detention with adequate medical care and measures to contain the Covid-19 outbreak," said Joe Stork, deputy Middle East and North Africa director at Human Rights Watch. "It is essential for Egypt to address the spread of the virus by accelerating prisoner releases."
Human Rights Watch interviewed five prisoners in three prisons as well as 10 relatives, friends, and acquaintances of 11 prisoners in six other prisons and a police station. Human Rights Watch also reviewed scores of official statements and media and human rights reports as well as World Health Organization (WHO) and Egypt's Health Ministry's guidance documents on Covid-19. The Interior Ministry, the State Information Service, and the Egyptian embassy in Washington, DC did not respond to questions Human Rights Watch sent on July 3 and July 15.
Witness accounts and reports make clear that overcrowding has made social distancing impossible. Prison authorities appear to have done no contact tracing measures and have done little to isolate prisoners who show symptoms. In some cases, the authorities designate one or more cells in the same prison for any inmates who develop Covid-19 symptoms. Prison authorities have apparently taken no special measures to protect groups at higher risk such as older inmates and those with pre-existing medical conditions. Officers in at least three prisons did not allow inmates to obtain or wear masks, witnesses said.
All those interviewed said inmates rely mostly on medicines and disinfectants delivered by their families when prison administrators allow it. A relative of a prisoner in al-Qanater Men's prison said that a doctor was routinely conducting medical examinations of inmates and isolating suspected cases, the only account of such treatment among those interviewed.
The Geneva-based independent human rights group Committee for Justice said it has documented over 190 suspected Covid-19 cases in 12 prisons and 29 polices stations, including over 160 inmates and 30 individuals among Interior Ministry employees and soldiers. These include 14 suspected deaths of inmates in five police stations and five prisons in four governorates.
The prisoners and relatives interviewed said there was no adequate medical care in detention facilities, and particularly no effective system for medical emergency evacuation or intervention. Of the 14 deaths, only 9 prisoners had been transferred to a hospital, in some cases just hours before they died. "This illness requires care and rest, and this is impossible to get in the swamp he was in," a relative of one of these prisoners said.
The authorities have imposed a comprehensive information blackout on detention sites. The Interior Ministry has banned all prison visits, including by lawyers, since March 10. The Supreme Media Regulatory Council, a government entity that censors and oversees media, warned several times of "legal action" against any media outlet or journalists who report on Covid-19 in Egypt in ways that depart from official statements.
Prisoners fear collective punishment in case of leaked news from their prison, people interviewed said. People interviewed for this report and previously said that National Security officers in prisons routinely summon inmates and interrogate them whenever any news about their prisons was published. Punishments can include transfers to distant prisons or confiscating prisoners' belongings, including necessary hygiene products and clothes. In one prison, inmates said they were beaten and physically abused for complaining about their conditions.
A relative of a prisoner at one of Cairo's main prisons, with hundreds of prisoners, said that their relative showed Covid-19 symptoms, including a cough, body aches, loss of taste and smell, and fever, and that about half a dozen inmates in his cell showed similar symptoms in late May and early June. The person said families were able to deliver medications and food on a semi-regular basis but that prison administrators provided very little. Their relative told them that all wards in that prison had prisoners with Covid-19 symptoms but that no testing was available.
The prison administration designated one or two cells for prisoners who opted to self-isolate after developing Covid-19 symptoms but did not require them to isolate. The prison officers told prisoners they would transfer ill inmates to a hospital if they had five days of fever or serious breathing difficulties, this person said.
An inmate in the same prison said that families delivered a few oxygen tanks and pulse oximeters - which measure oxygen levels in the blood - for the small prison clinic. He said that prison doctors stopped coming to the prison after officers allowed inmates who are doctors to take over responsibility for caring for sick fellow inmates. These measures do not meet international standards of prisoners' treatment, Human Rights Watch said.
A prisoner at Tora Tahqiq prison, part of Cairo's Tora Prison Complex, said that protection measures taken there were "all decorative." In March, when the number of Covid-19 cases in Egypt began rising, the prison administration offered PCR (Polymerase Chain Reaction) tests for two prisoners only, he said, but provided no further tests though several prisoners developed respiratory illness. He said that no officers, soldiers, or prison staff were wearing masks or taking any precautions.
Egyptian authorities should carry out widespread testing of inmates, accelerate releases, make information relating to the prevalence of Covid-19 in prisons public, and allow prisoners regular communication with their lawyers and families, Human Rights Watch said. The government should establish an online public database on prisons in Egypt, including updated information about their capacity and occupancy.
"Instead of providing adequate medical care and health measures needed to prevent the spread of Covid-19, the Egyptian government tries to obscure a serious health crisis in prisons," Stork said. "Prisoners and their families, and the Egyptian public, deserve to know the health risks they face and what the government is doing to address those risks."
Prisoners' Right to Treatment, and the Reality
International human rights laws, including the UN Standard Minimum Rules for the Treatment of Prisoners (Mandela Rules), state that prisoners should enjoy the same standards of health care that are available in the community; that prisons should ensure prompt access to medical care in urgent cases; that clinical decisions should only be made by responsible healthcare professionals and may not be overruled or ignored by non-medical prison staff; and that a physician should have daily access to any prisoner who is sick or complains about their health.
In May, the WHO released a joint statement, together with the UN Office of the High Commissioner for Human Rights and other UN agencies, saying that "health response to Covid-19 in closed settings alone is insufficient." The statement called on governments to consider prisoner release mechanisms and to limit the deprivation of liberty.
Egyptian prison laws provide for some health care rights. Interior Ministry Decree 79 of 1961 (Internal Regulations for Prisons) state that one main task for prison doctors is to protect prisoners from "epidemic diseases," including with medical quarantine. The 1956 Prisons Law requires prison authorities to immediately inform the inmate's family in case of serious illness.
In reality, local and international laws are little respected. Egyptian prisons are inaccessible to independent groups and have for decades had no meaningful judicial or independent oversight. Prisons are congested and unhygienic. Since President Abdel Fattah al-Sisi effectively took power in 2013, scores and most likely hundreds of prisoners have died in detention, many following torture and/or inadequate medical care. Almost none of these deaths has been meaningfully investigated. Two UN Experts wrote in November 2019, well before the Covid-19 pandemic, that Egypt's abusive detention conditions "may be placing the health and lives of thousands more prisoners at severe risk."
Responding to criticism about conditions in detention sites during the pandemic, the Interior Ministry released several video statements claiming it has conducted "comprehensive medical screening" for Covid-19 among prisoners. One of these videos, on April 16, shows health workers taking swabs from several well-known political prisoners. The video statements say that detention sites and prisons are routinely "disinfected." The videos show spraying and fogging (applying chemicals for disinfection) of outdoor spaces in some prisons, a process not recommended by the WHO. The videos also show what it describes as "automated gates of disinfection," which spray people passing through them at entrances to places of detention. This, according to the WHO, does not reduce a person's ability to spread the virus, could actually be harmful, and "is not recommended under any circumstances."
Physicians in Egyptian prisons are Heath Ministry employees or Interior Ministry doctors trained in the Police Academy to become medical officers, and not institutionally independent. Egyptian laws do not provide for sufficient clinical independence of prison doctors, as the law requires them to obtain officers' approval for many decisions.
The authorities rarely release medical reports to families or lawyers. Important decisions, such as to provide access to medical care inside or outside the prison, appear to be mainly made by the National Security Agency officer in each prison, the de-facto authority over the prison warden and other officers, rather than by prison doctors. The majority of prisons in Egypt do not possess a sufficiently equipped medical facility.
In the above-noted circumstances, it is hard to assess with certainty inmate medical illnesses, including whether they have been infected with Covid-19.
Given the absence of testing in certain environments, the WHO defines ways of determining whether someone is "suspected" of having Covid-19, including having symptoms of severe acute respiratory illness without any alternate diagnosis. The WHO also said that governments can adopt different definitions of suspected and probable cases depending on the context. Human Rights Watch reviewed Health Ministry statements that modified its definition of suspected and probable cases several times since March with the increasing prevalence of infection.
Human Rights Watch used a recent guidance, issued by the ministry on June 24, which said that suspected Covid-19 cases include those suffering from fever or one or more acute respiratory symptoms, or sudden loss of taste and smell, in the absence of other apparent causes. The statement said that probable cases include suspected cases for whom chest CT or X-rays show certain pathologic features or those who have been in contact with other probable cases or undiagnosed death cases who had respiratory symptoms.
Based on interviews with seven doctors, it appears that testing generally has been extremely limited in Egypt, including for the public, and the Health Ministry instructed medical teams to treat and admit patients based on symptoms as well as chest X-ray or CT scans and blood counts. The government has provided little information about the number of tests it has conducted since February, when the first Covid-19 case in Egypt was discovered. But al-Shorouk, a private newspaper, quoted a Health Ministry official who said that the government raised the number to 4,000 PCR tests a day. Another official said in a television interview the government had conducted about 200,000 tests by May 27.
Suspected Covid-19 Deaths
The Committee for Justice shared with Human Rights Watch the names of 14 inmates who died from suspected Covid-19 in five police stations and five prisons in Cairo, al-Sharqia, al-Dakahlia, and al-Gharbia governorates as of July 15. Two died in May and the rest in June and one in July. Human Rights Watch interviewed two acquaintances of three of those inmates. The authorities do not appear to have conducted independent investigations into these deaths.
Of the 14, nine died in a hospital after being transferred from detention. Three of them were transferred only a few hours before their death, apparently when their condition was too advanced for medical intervention to be useful. Eight of the 14 were over age 50.
Central Security Forces Camp Death
Hamdy Abdel Aal Ryaan, 58, died on June 21 in the prison inside the Central Security Forces camp in Ramadan 10 City, in al-Sharqia governorate, after being held in pretrial detention for 15 months. A relative said authorities transferred him to a hospital only when he was dying though he had been in critical condition for several days, and that the death certificate stated "not yet determined" as the cause of death. The Interior Ministry has traditionally used prisons inside Central Security Forces camps, many of them unofficial and therefore illegal detention sites, apparently as prisons are severely overcrowded.
When he was arrested, Ryaan was unable to walk easily owing to compound fractures from being shot by security forces in 2013. He also was on a regime of anti-coagulant medication to prevent the recurrence of blood clots, which he experienced once before in the right leg, and therefore also was susceptible to easier and longer than normal bleeding. Ryaan likely had over 20 inmates in his cell, the acquaintance said.
The authorities should have considered releasing him on medical grounds, particularly since he had been detained without trial for more than 15 months. Ryaan had a fever for a few days and showed other Covid-19 symptoms shortly before he died.
The relative said that authorities provided almost no medical care to Ryaan inside the prison and had refused delivery of medications until June when, the relative believes, more inmates were showing symptoms of Covid-19.
Ryaan's death was also reported by al-Shehab Center for Human Rights, an independent human rights group.
Gamasa Maximum Security Prison
Saeed Ghobashy, 58, died on June 28 in Gamasa Maximum Security Prison, where he apparently had Covid-19 symptoms and was isolated inside the prison for two weeks without sufficient medical care, the Committee for Justice said. A relative of another inmate inside the prison said that families are fearful for their imprisoned relatives for lack of visits and communication. She said that the prison authority did not allow families to deliver disinfectants or face masks. She also said that only a limited amount of medicines was allowed and that sometimes dietary supplements such as vitamin C were also not allowed. She said that recently released prisoners told her that in March a group of Health Ministry doctors came to examine prisoners and isolated about nine of them but did not inform them whether they had Covid-19.
Three Suspected Covid-19 Deaths in al-Mahalla Police Station
The Committee for Justice has documented three deaths in al-Mahalla First Police Station in al-Gharbia governorate. The deaths were also reported by the al-Shehab Center and several news websites. Two inmates, Hassan Ziadah and Moawad Mohamed Suleiman, died on June 7 and 11 and Ziad Hassan Shaltoot on June 24. The three inmates were held in pretrial detention on political grounds with charges relating to alleged involvement in anti-government protests and banned groups. The three died in al-Mahalla Public Hospital, and Shaltoot and Suleiman appear to have been transferred a day or less before their deaths. "I don't want any inmate dying in the police station," a police officer said, according to a researcher at the Committee for Justice.
A relative of Suleiman, 65, a retired math teacher who lives outside Egypt, said that officers informed the family the he died from a heart attack. Later the family learned that he had shown Covid-19 symptoms. The relative said the authorities did not offer adequate medical care. "When they began thinking he should be transferred to a hospital, he was already dying," the relative said. "His situation was very difficult for four or five days before he died."
The relative said that authorities arrested Suleiman in late April and held him incommunicado for two or three weeks before his family was able to locate him in al-Mahalla. The family learned that the authorities took him in May before the Supreme State Security Prosecution in Cairo without lawyers. The authorities gave no forensic or medical reports to the family following his death. The relative said the family had been able to deliver food but was unable to see Suleiman.
The relative was also a friend of Hassan Ziadah, 56, an English language teacher. He said the authorities transferred Ziadah to al-Mahalla Public Hospital, one of the hospitals the Health Ministry designated for Covid-19 patients, four or five days before he died. He said Ziadah had been handcuffed to his hospital bed most of that time.
Suspected Cases in Maximum Security Scorpion Prison
The 992 Maximum Security Prison known as the Scorpion (al-Aqrab), part of Cairo's Tora Prison Complex, is where authorities detain those claimed to be high risks to national security. Even before the spread of Covid-19 in Egypt, Scorpion authorities have banned visits for months at a time. Human Rights Watch previously documented several cases in this prison in which lack of essential medical care may have contributed to inmate deaths.
We Record, an independent group of human rights and political activists, said on June 15 that the authorities designated one ward in a wing in the H1 building for Covid-19 isolation. The group also said that prisoners were told on June 28 that "there was no remaining space" to isolate additional cases. We Record said they were unable to determine whether all those isolated in the designated wing were originally Scorpion inmates. Local media reported on June 21, based on an allegedly leaked letter by the prisoners, that there has been a large outbreak of the virus inside the prison.
Dr. Amr Abu Khalil, 58, a well-known psychiatrist, has been detained in pretrial detention in the Scorpion since October. His brother, Haytham Abu Khalil, an anchor at the Turkey-based opposition Al-Sharq TV, said that Abu Khalil was suffering from difficulty breathing, fever, and fatigue among other symptoms in the last two weeks of June and had pre-existing medical conditions, including diabetes, inflammation of peripheral nerves, and a hernia.
Human Rights Watch previously documented the arrest of Amr Abu Khalil at his clinic in Alexandria in October, most likely as a reprisal against Haytham Abu Khalil's reporting on Egypt in his TV show.
The authorities have extended Abu Khalil's detention most recently on June 27 without a proper judicial hearing. The authorities have not allowed him any visits since his arrest, his brother said.
Suspected Cases in Several Prisons
Minya Maximum Security Prison
A smuggled letter handwritten by two inmates in Minya maximum security prison, inside Minya Prison Complex, and provided to Human Rights Watch, described harrowing detention conditions with a large number of inmates showing Covid-19 symptoms and an absence of sufficient care. Two were in critical condition and were transferred to the prison hospital. The letter said water cuts were routine and lasted for up to 20 hours at a time and that there was no sufficient ventilation.
The letter writers named several officers who had severely punished prisoners who objected to their detention conditions, including stripping them to their underwear, beating them with sticks and electric stun guns as well as sending several of them to solitary confinement. They cited at least two incidents of mass beatings, in December and in June, and named 30 prisoners who were beaten. They named two prisoners who had attempted suicide.
Tora Tahqiq Prison
The Interior Ministry tried to obfuscate news about the death of a Tora Tahqiq prison employee, Sayed Ahmed Hegazy, on May 29, about two weeks after showing symptoms and a few days after he tested positive for the virus. Hegazy's job, one prisoner said, included distributing vouchers for purchases in the prison cafeteria, which entailed extensive interaction with prisoners and their families. Hegazy's family told the independent news website Mada Masr that the Interior Ministry provided him with no medical help and that he went on medical leave on May 18, a few days after he became sick.
The family of Yasser al-Baz, a Canadian-Egyptian citizen in pretrial detention for 16 months and released on July 2, said in media statements that he developed Covid-19 symptoms in Tora Tahqiq Prison in late June.
A relative of another inmate told the Committee for Justice that he developed Covid-19 symptoms in June including a cough and high fever but that a prison officer told inmates he would not allow hospital transfers except for severe breathing difficulties. The relative said the inmate shares a cell with about 18 others, many of whom developed Covid-19 symptoms, and that the prison administration did not always allow families to deliver food and medicines to this group despite apparent illnesses.
Wadi al-Natrun Maximum-Security Prison 440
A relative of an inmate in the Maximum-Security Prison 440 in Wadi al-Natrun Prison Complex, in al-Beheira governorate north of Cairo, shared with Human Rights Watch a smuggled handwritten letter in which the inmate described having severe symptoms of Covid-19 in June, including high fever, cough, and body aches. The person said that his imprisoned relative was the third in his cell to develop symptoms and that prison officials refused to transfer them to a hospital saying these were just flu symptoms and that they would recover.
Effective Incommunicado Detention Under the Pretext of Covid-19
Since the ban on prison visits on March 10, thousands of inmates have been kept effectively in incommunicado detention with scant if any communication with lawyers and family members. Egyptian prison laws provide for phone and written communication but authorities frequently do not comply.
The isolation has become even more abusive as authorities routinely fail to transfer inmates for their detention renewal hearings before prosecutors and judges, removing the remaining thin judicial review over pretrial detention orders. This has severely affected families of detainees anxious over the well-being of their detained loved ones. The authorities often deny detainees permission to receive letters, food, or medications from relatives, who in many cases travel long distances and line up in unsheltered waiting areas for long hours, just to be turned back with no news about their loved ones.
Solafa Magdy, a Journalist
Taghrid Zahran, mother of an imprisoned journalist, Solafa Magdy, visited al-Qanater Women's Prison every Wednesday since early March on the hope that prison officers would allow her to get a letter from her daughter, but they refused. Zahran told the independent Daaarb news website that the family does not know anything about what has happened to Magdy since the March 10 ban on visits. The authorities arrested Magdy and her husband, Hossam al-Sayad, a photojournalist, in November and have kept them in pretrial detention since accusing them of spreading false news.
On April 3, the UN Office of the High Commissioner for Human Rights urged Egypt to release "those convicted of non-violent offences and those who are in pre-trial detention, who make up just below one third of those in jail." The statement noted that "Egypt's prisons and detention facilities are often overcrowded, unsanitary, and suffer from a lack of resources. Detainees are routinely denied access to adequate medical care and treatment."
Human Rights Watch reviewed official records showing that authorities have released approximately 13,000 convicted prisoners in eight batches since late February under three presidential decrees ordering the Interior Ministry to forgive the remaining part of the sentence for certain categories of prisoners. There were no official statements linking these releases to Covid-19 and they excluded all those convicted for political dissent. Among the 13,000 are 3,157 prisoners, including some convicted of murder and other serious crimes, named in a May 22 presidential decree. Egyptian authorities have rarely released information about the size of its prison population. The UN April statement estimated it as over 114,000. It is not clear if this estimate includes detainees in police stations. According to semi-official figures, prisons are 300 percent and police stations are 160 percent over capacity.
Prosecutors and judges have separately ordered the release of a small number of detainees, at most several dozen, who have been in pretrial detention for months, in some cases years. Those released include, in March, political science professor Hassan Naf'a, political activist Shady al-Ghazaly Harb, and 13 other activists; and in May and June, a journalist, Hassan al-Banna, Canadian-Egyptian, Yasser al-Baz, and an American-Egyptian, Mohamed Amasha.
During the Covid-19 pandemic, the authorities have cracked down on peaceful critics and jailed scores of health workers, journalists, and critics. Media reports indicate that the authorities have meanwhile arrested thousands of people for violating the Covid-19 nighttime curfew that was lifted in late June. It is unclear how many of those remain in detention.