Andréia Azevedo Soares with Fadi Meroueh / WHO Bulletin 2021
Fadi Meroueh talks to Andréia Azevedo Soares about ensuring health equity and harm reduction services in prisons, and the challenges presented by the COVID-19 pandemic.
Q: What are the main differences you have encountered working as a doctor outside and inside prisons?
A: For me one of the biggest differences is the way doctors are pressured into different and often conflicting roles inside correctional facilities. This can make it difficult for the doctor to retain independence and loyalty to the patient. For example, magistrates may ask doctors to certify that an inmate can make a court appearance. In my view such requests should be refused. If a judge or a lawyer wants to know whether a patient is prepared to go to court, he should hire an expert in such matters to make that assessment. Similarly, prison guards have a tendency to ask for information about a prisoner’s health as though the doctor were part of the prison’s security staff, something I find completely unacceptable.
Q: Does that often happen?
A: Absolutely. It has happened to me when I have called the guards to say a patient needs to go to the emergency room. They ask me what is wrong with the prisoner – usually because they have security concerns. But should I tell them? No. Prisoners may be deprived of their freedom but not of their health rights. Medical privacy and independence of medicine are key principles, and the struggle to maintain them in prison has been going on for 30 years in France. It is a long battle. Another difference is the way doctors and patients tend to relate to each other inside prisons. When someone is incarcerated, they lose contact with friends and family. Their lives become the penitentiary and they are often enclosed in a cell which may measure just a few square metres. As a result, there is a different doctor–patient dynamic in the consulting room.