Organisation of health care
Ministry in charge
Ministry of Justice
Every prison facility has a health care unit
Number of medical staff (FTE)
All the levels of medical care are provided: primary (general medicine), secondary (specialized medicine) and tertiary (hospitalization). The average waiting time to see a specialist is 90 days, to see a doctor it is 14 days.
Inmates notice that their health problems are usually treated with basic medication. Cases of ill-treated hepatitis C patients were identified. Prisoners sometimes do not have access to the care they need, because the treatment is not available at the prison hospital or is too expensive. The consent to be treated outside the prison, mostly needed to access a specialist or an expensive treatment, is difficult to obtain.
Each prison has a care unit and a dental service. The presence of health-care staff is not always insured at night. The emergency services are called in case of need. According to the CPT, the number of full-time nurses and care staff is insufficient 1.
In 2016, the Commissioner for Human Rights considered one of the main issues of the prison healthcare system was the lack of doctors. The lack of medical personnel and specialists is felt particularly in the pre-trial detention centres and in solitary confinement. The problem tends to increase during medical staff vacations (summertime).
Health-care professionals are usually unqualified for the responsibilities they receive. Inmates complain about the superficiality of the exams and the quality of the treatment prescribed.
The CPT has a positive input on the therapeutic unit in Strzelce Opolskie. The unit has a capacity of 64 people. The medical staff includes two psychologists, a therapist and an educator. Inmates can enjoy a large range of activities and individual therapies2.
European Committee for the Prevention of Torture, “Report to the Polish Government on the visit to Poland from 11 to 22 May 2017”, 2018, pp.35-36. ↩
There are 13 hospitals for the prisoners and 37 specialised wards. The national ratio is 13 beds per 1,000 prisoners (two times the ratio for the rest of the population).
Access to health care
Health care is free
A medical examination is performed upon admission
The first appointment is a medical interview and a physical examination. The interview and the examination must be concluded within three days after the arrival of the inmates. Within 14 days, the inmate must have access to dental care and a radiological examination, which must be performed every two years1.
The CPT notices that the medical examination at the entrance is superficial. The examination is usually limited to few general questions without full physical examination.
The deadline of three days if often missed. Several prisoners have to wait from few days to a week to proceed to the examination. According to the minors interviewed by the CPT, the medical examination at the entrance for juveniles is also superficial and delayed2.
Helsinki Foundation for Human Rights, “Improving Prison Conditions by Strengthening the Monitoring of HIV, HCV, TB and Harm Reduction”, 2015, p.38. ↩
European Committee for the Prevention of Torture, “Report to the Polish Government on the visit to Poland from 11 to 22 May 2017”, 2018, p. 37-44. ↩
A medical file is opened upon admission
Prisoners can access health care units after
- a written request
- an oral request
Medical examinations are carried out on a confidential basis
in most cases
The respect of the medical secret is guaranteed for most prisoners. A custodial officer accompanies high-risk prisoners.
However, there are still complaints on its violation. In general, the medical examinations take place without the presence of a custodial officer, unless the doctor requests it1.
Inmates are guaranteed continual medical care throughout the duration of their prison sentence. Twenty medical appointments per year must be insured, including three dentist consultations.
Medicines are provided for free by an authorized member of the administration.
In 2015, the Helsinki Foundation for Human Rights pointed again the lack of specialized treatment. A person suffering from HIV/Aid denounced that the administration was not providing the antiretroviral medication he needed.
In case of medical emergencies, if the inmate cannot be transferred to a prison hospital, s/he must be transferred to a health centre outside the prison at his/her expense. This measure, however, is not put into practice.
Physical health care
The most common diseases in prison are hepatitis C, tuberculosis and HIV/Aids. 4,000 detainees are screened annually by prison health services for HIV/Aids. On average, 4% of the results are positive. However, it is likely that inmates hide a possible HIV status. 30 to 50 new infections are detected each year.
Between 8,500 and 9,000 tests for hepatitis C are performed annually. An average of 900 samples are positive.
Each year, 400 cases of tuberculosis are detected. The medical admission procedure includes the screening for tuberculosis1.
European Committee for the Prevention of Torture, “Report to the Polish Government on the visit to Poland from 11 to 22 May 2017”, 2018. ↩
Preventive measures for epidemic or communicable diseases are implemented on the recommendation of a doctor. In some prisons, the absence of washbasins in sanitary facilities is a factor favouring the transmission of epidemic diseases between inmates1.
The authorities do not seem to be interested in preventing HIV/Aids, for example by increasing the number of condoms available to prisoners. The inmates have an insufficient knowledge of the disease and the causes of the infection. A prisoner infected with HIV testified in 2015 that he did not receive proper treatment when he arrived, and his wife had to bring him the necessary medicine1.
Prisoners with HIV/Aids are allowed to stay alone in their cell. All staff receives training on basic information on HIV/Aids, its causes, prevention and treatments. Screening and treatment of sexually transmitted diseases are compulsory.
However, the CPT observes that harm reduction (e.g. needle exchange programmes) or preventive measures (e.g. condoms supply) are still not introduced, despites its previous recommendations2.
Helsinki Foundation for Human Rights, “Report on the Human Rights of Persons Deprived of Liberty”, 2017, p.20. ↩
European Committee for the Prevention of Torture, “Report to the Polish Government on the visit to Poland from 11 to 22 May 2017”, 2018, 2018, p.38. ↩
Mental health care
Several thousand inmates suffering mental disorders are placed in specialized institutions, under the responsibility of the Ministry of Justice.
It is possible, however, that some people with psychiatric disorders are placed in unsuitable units.
In some prisons, there are therapeutic units for prisoners with non-psychotic mental disorders or sexual disorders, prisoners addicted to drugs or alcohol. Convicts are sent to such units after previous diagnosis and stay there only for the duration of the therapy.
Supervisors and medical staff working in specialized units are trained to take care of people with mental disorders. The Commissioner for Human Rights advocates for a better training for these professionals. Inmates with mental disorders can sometimes be monitored by non-psychiatry specialists.
In the Warsaw-Mokotów Prison, inmates are kept attached for an average of 12 hours. The CPT recommends no longer than six hours.
According to the Prison Service’s internal regulation, there are 100 prisoners per tutor and 200 prisoners per one prison psychologist1.
In 2016, the Polish National Preventive Mechanism addressed a general motion to the Prison Service General Director indicating that the standard of psychological care for prisoners adopted by the prison service is inadequate to their needs. Moreover, the NPM findings showed that in practice one psychologist took care of more than 200 prisoners.
Central Council of Penitentiary Services, “Ordonnance of the Prison Service General Director 19/16”, 14 April 2016. ↩
Inmates with addictions benefit from seven different specific programmes. Methadone is the most common treatment. These programs require daily visits to the infirmary and prisoners are often unable to work. There are also awareness campaigns to combat addiction to drugs and to reduce the effects of tobacco.
There are 31 units for people with alcohol-related disorders and 15 for drug addiction. Inmates are monitored for a period from three to six months. They participate in meetings where they learn to fight against the mechanisms of addiction and develop their motivation to maintain abstinence.
Methadone programmes are available in all the establishments visited by the CPT in 2017.
The quality of the psychiatric care is considered to be deficient. The CPT notes that there are no activities proposed, particularly in the Warsaw-Mokotów Prison.
The psychological assistance of inmates is hindered by the lack of psychologists. According to the Commissioner for Human Rights, prisons should have a full-time psychologist for 200 inmates. Some psychologists take care of 276.5 prisoners. Limited budgets and psychologist’s long-term sick leaves aggravated the situation1.