Whatever you do, don’t get sick in prison

Conditions in Iran’s prisons are generally known to be quite poor, so it’s common for prisoners to contract various illnesses, and to sometimes have to spend time in hospital — all of which are state-run, and many of which have low standards of healthcare. But inmates report that staff at prison clinics are hesitant to refer inmates on to hospitals. When they do, hospitals frequently fail to care for prisoners’ healthcare needs, and in some cases serious conditions are simply not looked after. The reasons? Despite contractural agreements, Iran’s prison service is not paying its bills. And inmates held on charges linked to national security have it worse in some ways because, contrary to Iranian law, the prosecutor is allowed to make medical decisions. 

 “Hospitals send back prisoners who are in critical condition and refuse to operate on them,” said one inmate from Rajai Shahr Prison. Currently in a bed at the emergency room at the prison’s clinic, he awaits medical attention. His lips are purple and he has lost sensation in his hands and feet. The clinic specialist has prescribed surgery, and other doctors consulted his medical records and have confirmed this is what the patient requires. 

Fellow inmates of the patient at Rajai Shahr’s clinic tell me that the week he was admitted, he had collapsed three times during the course of normal prison routines. He was only sent to the clinic after the ward representative took up his case with officials. 

But three months ago, the same patient was sent to an external hospital, only to be sent back to prison after a cursory examination and the doctors refused to operate on him. The reason? His surgery was expensive and the hospital did not trust Iran’s Prison Organization to pay for it. After a specialist delivered a prognosis, the head of the prison clinic dismissed it. “The doctor is full of nonsense,” he said. “I’ll prescribe an MRI to see if surgery is necessary. In any case we do not have a budget to pay the hospital bill for your surgery.”

“M,” a prisoner held at Rajaei Shahr on charges of endangering national security, became seriously ill after he was interrogated over a period of more than two years. He collapses on a regular basis, and in February this year, after suffering three fainting spells within a period of 24 hours, he was transferred to Imam Khomeini Hospital in Tehran.

Inmates who know M say he was a strong and healthy young man when he was first arrived at the prison. But after enduring heavy blows to the head during interrogations, he now shows symptoms similar to those of epilepsy. But every time the ward representative and his ward-mates take him to the clinic, prison medical staff refuse to hospitalize him. Instead, they drag him back to his cell where he usually collapses as he makes his way to his bunk.

On one occasion when M was sent to a hospital, the official responsible for admitting patients told him that the Prison Organization had not paid its bills for two years and as a result they were not willing to accept new patients. “This situation is not limited to Mr. M,” said another inmate at the ward for prisoners of conscience. “We usually have prisoners who are sent to the hospital but they are sent back without receiving any real treatment. The head of the prison clinic has told us time and again: ‘We have budget problems and we have even difficulty in acquiring the medication. So for now, please don’t get sick!’”

....or else pay for your own treatment

In February 2016, officials working at clinics of the various wards at Rajai Shahr Prison were ordered to inform inmates that the prison could no longer afford to send them to hospitals. Instead, inmates would be required to make arrangements with their families to organize appointments with doctors and hospitals. And they were told they had to pay all expenses, including transportation, themselves.

“We can’t get medication from the clinic at Rajai Shahr,” an inmate who suffers from a kidney disease told IranWire. “At best, they’ll give us a few acetaminophen, aspirin or stomach pills. We even have to buy prescriptions  issued by the clinic’s doctor from outside the prison. But even this is not simple: we have to get a thousand signatures from prison officials before they release the medication to us after a thorough inspection — which might take weeks. Sometimes the medication is totally lost, or some of it disappears.”

Behrouz is an inmate at Evin Prison. “The process for admission to hospital and getting permission from the prison system is too time-consuming and tiresome,” he told me. “Often, I have chosen to suffer pain and illness rather than subject myself to this torturous process. But sometimes, if it is a matter of life or death, there is no option. The quality of the state-owned hospitals that have contracts with the prison are very low, and they are often staffed mainly by medical students.  It is better to wait for appointments at better hospitals with the help of our families.”

Behrouz says the inmates have to pay for everything: medication, external equipment needed for MRIs, and so on.  “Some of my fellow inmates have been returned to prison without receiving treatment because they did not have 1,000 tomans (33 cents) for a syringe, 2,000 tomans for emergency visits, or 40,000 tomans [around $13] for an MRI outfit.” Behrouz said these demands are unreasonable because prisoners are not allowed to have cash while in prison. “Even if it were not an offence,” he said, “Some prisons really do not have any money to pay for such necessary expenses anyway.”

The prosecutor makes medical decisions

Another prisoner I spoke with at Evin’s Ward 7 said his life was at risk. He suffers from a heart condition and is not receiving proper care. “When prisoners like Hoda Saber or Shahrokh Zamani die in prison there is an outcry, but nobody cares about us who are still alive. Just trying to get a permit to be sent to a hospital outside the prison is enough to give you a heart attack. It is much more difficult for political and prisoners held on security charges because, contrary to the law and moral principles, we must get a permit not from specialists or a medical team — but from the prosecutor. This means that a non-medical authority is interfering in medical matters. And if you have signed a letter or statement of protest, if you have stood by your beliefs, then you will not get a permit. Only in your dreams.”  

Pahlevan is on the ward at Evin reserved especially for financial criminals. He has been in prison for a long time for a bounced check. “Right in the middle of my treatment, they transferred me from the hospital bed back to the prison,” he said when I asked him about his experience in the hospital. “I am not a murderer, I was not planning to escape — I didn't have the energy to escape. I just was unable to pay hospital expenses. I was told I had to have two operations, but since I couldn't settle my account with the hospital, they refused to perform the second operation. The medical staff at the hospital were all young and inexperienced and treated us prisoners without any humane consideration. They didn't even examine me. They just listened to me for a few minutes, prescribed the medication that I myself had asked for and then sent me out of the examination room. After years of treatment and surgeries, I came across a doctor who told me that there was nothing wrong with me. ‘Don’t pretend to be sick to entertain yourself or to escape,’ he said. ‘Your illness is psychological not physical.’”

And there are even worse stories, most of them not isolated.  Ramazan Ahmad Kamal, a Kurdish Syrian political prisoner at Rajai Shahr Prison, lost the use of a hand because he was operated on by non-specialist doctors at the prison who failed to sterilize equipment before using it during his surgery. He said they did not even complete the procedure. Kamal was taken to prison in 2009 after he was shot by Iranian border guards in the stomach, left shoulder and thigh. After seven years, he remains in prison, the bullets still lodged in his body.

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