Organisation of health care
Ministry in charge
Ministry of Justice
Every prison facility has a health care unit
A new hospital was built in the correctional facility (JVA) of Leipzig (Saxony), replacing the former prison hospital built in 1913. The new facility can hold up to 80 prisoners (men and women). It has single and double rooms. In the former hospital, up to six patients could be assigned to the same room. The hospital specialises in psychiatry, but it also treats physical illnesses. An agreement enables prisoners from Saxony-Anhalt and Thuringia to be hospitalised in Leipzig.
The types of care provided vary according to the prison size. At least one health unit is present in each of them. It allows for the provision of routine care.
Most of the time, specialists (dentists, dermatologists, etc.) are consulted outside of the prison. Visits must be authorised by a general practitioner.
The number of health care staff varies from one state to another.
Prisoners requiring hospitalisation are usually transferred to a prison hospital, such as Hohenasperg (Stuttgart), Lingen (Bremen and Lower Saxony), Willich (Düsseldorf) and Plötzensee (Berlin). They are transferred to a public hospital when the administration considers that they do not present any risk.
Access to health care
Health care is free
The prison administration does not usually pay for expensive treatments (electric wheelchairs, dentures) for prisoners serving short sentences.
A medical examination is performed upon admission
The timing of the examination and procedures vary according to the prison or state. Chest X-rays (diagnosis of tuberculosis) and blood tests are usually done to detect transmittable diseases (hepatitis A, B and C and HIV).
A female inmate was kept in her cell 23 hours a day during her quarantine when she entered a juvenile detention centre in Schleswig. She was not given access to the showers, despite a handwritten request which went unanswered. She was not allowed to see her lawyer. She filed a complaint for these reasons and won the case.
A medical file is opened upon admission
Sometimes the medical file opened upon prison admission consists of two parts. One is accessible to the prisoner, the other is reserved for medical staff.
Prisoners can access health care units after
- a written request
- an oral request
The process depends on the prison or the state.
Medical examinations are carried out on a confidential basis
in most cases
This confidentiality is not always guaranteed in case of signs of addictions or possible self-mutilation.
Continuity of care is ensured throughout imprisonment. It is not provided after release.
There is no coordination between prisons and public health services.
Prisoners do not choose their doctor. Care is provided by the prison doctors. The quality of care highly depends on the prisons’ investments.
Physical health care
The most common diseases are of infectious origin (hepatitis A, B or C). Addictive disorders are usually associated with them.
All people with an infectious disease (HIV/AIDS, tuberculosis, hepatitis) receive treatment. Late treatment is common.
Few prisoners with Hepatitis C had access to treatment. An interstate working group was tasked with developing a project to treat the disease in prisons in cooperation with the Minister of Justice of Hesse. The aim of the project was to successfully demonstrate that it was possible to treat more prisoners by setting standards in the areas of prevention, diagnosis and treatment of the disease. The first model of the project was presented on 19 May 2022.
Preventative measures for epidemic and contagious diseases are implemented.
Inmates of a Hamburg prison testified about the conditions of detention during their quarantine after they contracted COVID-19. Only one lunch was received by the inmates in two days, the other meals did not reach them. No care was provided, and access to hygiene and health measures were limited: no toilet paper, no medication, no shower. Outings were not permitted, windows could not be opened, and guards did not respond to calls from inmates. This type of complaint was common in this prison, but denied by the authorities.
The authorities have reduced their efforts to implement risk reduction programmes, particularly in Bavaria. No needle exchange programmes are offered. In Fühlsbüttel prison (Hamburg), the automated machine which allowed to exchange needles has been removed.
Condom distribution is very rare.
Mental health care
The NPM (Nationale Stelle zur Verhütung von Folter) indicated that one prisoner was in solitary confinement in 2021 for over a year in the correctional facility of Bautzen (Saxony) due to his mental illness and a lack of understanding of this illness. He could not be transferred to the Leipzig prison hospital, as it lacked available spaces. The NPM noted similar cases in the correctional facility of Schwalmstadt (Hesse).
The CPT observed that psychiatric care was inadequate in the Bayreuth and Gelsenkirchen prisons. Prison management had trouble transferring prisoners with acute mental disorders to a suitable therapeutic environment.
Mental health concerns increased in Hamburg’s prisons as of the beginning of the COVID19 pandemic. This increase was accompanied by an increase in the daily doses of medication to treat mental health concerns. Some dosages doubled and even tripled. Member of Parliament Carola Ensslen showed concern about the role of medication in the treatment of mental health concerns and feared that it would replace therapy.
The law states that prisoners suffering from addictions may be placed in detoxification centres.
Six states provide comprehensive treatments for addictions in some prisons1. All prisons are obliged to offer methadone substitution treatment. It is administered by prison staff under the supervision of medical staff and social workers.
Most patients receive a single detoxification course with substitution treatment. Only a minority of prisoners with addictions access treatment for more than six months.
Marlene Mortler, Federal Commissioner for Drug Control, laments the fact that prisoners do not always have access to methadone, an opiate substitution treatment. Half of the Bavarian prisons do not provide treatment for heroin addiction. The difficulty in accessing substitution treatment promotes the black market for drugs in prison and increases the risk of infections from used syringes.
In 2016, the European Court of Human Rights described the refusal to provide substitution treatment to a dependent prisoner, as “inhuman treatment”.
Lana Osment, “The Complexity of Rehabilitation in Open and Closed Prison Setting”, Lund University, 2018, p. 14. ↩
The Die Linke party in Hamburg is calling for an alternative to urine tests for the purpose of drug testing. Their local representative suggested a possible alternative that would maintain the dignity of the people tested: blood samples from the fingertip. Die Linke filed a request with the Senate, who rejected it. The Senate argued that measures aiming to detect drug consumption must not involve physical contact, which would be the case with a blood sample. To support its decision, it also noted that urine tests provide much faster results and can detect substance use over a longer period.
Drugs such as cannabis and methamphetamine were found repeatedly in prisons in Saxony. Three prison officers were suspected of distributing drugs to three inmates in Waldheim prison. One official allegedly hid illicit substances in food deliveries for a kitchen group. Those accused of trafficking were removed from their positions.