Organisation of health care
Ministry in charge
Ministry of Justice (Federal Public Service Justice)
For many years, medical personnel have been requesting a transfer of jursidiction to the Federal Public Service Health. According to political representatives, this is under consideration.
Every prison facility has a health care unit
Some facilities have a medical-surgical centre where examinations and procedures are carried out.
Number of medical staff (FTE)
Data not disclosed
General and specialised medical care is usually provided in detention facilities.
Medical teams are insufficient in number and skills. There is an absence of specialists across the board: physiotherapists, dentists, ophthalmologists, dermatologists.
The medical team is usually made up of nurses. On-call medical service is generally limited to daytime hours.
A shortage of medical staff is a major problem. Sometimes, a doctor has to examine 20 to 50 prisoners within a two-hour period.
The working conditions for healthcare professionals are seen as difficult: insufficient equipment, finances, training, organisation, etc.
Prisons without a medical-surgical centre transfer inmate patients to public hospitals.
Access to health care
Health care is free
Medicines are generally free, but certain things must be paid for by inmates (for example, dental prostheses).
A medical examination is performed upon admission
Prisoners can access health care units after
Two health reports published in 2017 from the Belgian Health Care Knowledge Centre (KCE) and supervisory commissions depict an alarming situation:
- Half of the prison population says they are in poor health: prisoners see a general practitioner an average of 18 times a year, and a psychiatrist three times a year;
- Consultations are often very short: sometimes two to four minutes per patient;
- The wait for a specialist appointment is long: two months for the dentist.
Medical examinations are carried out on a confidential basis
in most cases
Medical confidentiality is generally respected. However, some violations are reported, especially in the case of outpatient consultations in rooms with multiple beds.
Continuity of care for inmates poses a problem: there is no protocol to link medical follow-up before, during and after imprisonment.
Nurses usually dispense medicine, although sometimes wardens or prisoners handle distribution. Some wardens do not always respect medical prescriptions.
Certain hospitalisations involve security measures, which often delay access to health care.
In 2017, 40% of medical transfers at St-Gilles prison were carried out with a delay.
Physical health care
Skin diseases remain a major problem in prison. AIDS, tuberculosis, hepatitis C, heart disease and diabetes are especially prevalent among inmates.
Patients with an infectious disease, such as tuberculosis or scabies (disease associated with poor hygiene), are side-lined. Directors sometimes place prisoners with the same illness (diabetics, drug addicts, etc.) in the same section, usually for practical reasons like organising movement. These people are sometimes denied the right to work. As a result, medical services regularly see these inmates suffer from ostracisation or discrimination.
Prisoners’ loved ones sounded the alarm on COVID management. For the Belgian section of the International Prison Observatory (OIP-SB), the decisions made by prison staff over the last previous years had been “arbitrary and incoherent”. Health protocols had not been managed properly and visits were sometimes cut short or cancelled without a valid reason. Lawyer Marie Berquin, the organisation’s vice president, said, “We’re no longer in a state of emergency. Procedures should have been established with clear rules for every prisoner and that isn’t the case.”
Risk reduction actions are limited. There are only a few pilot projects (including for suicide-related risks).
Mental health care
In principle, mental health patients (perpetrators of offences who are recognised as not being responsible for their actions) stay in a specialised facility. There are five of these facilities, in Ghent, Antwerp, Paifve, Mons and Tournai. (See “Prison Estate”). They are divided into three categories:
- Social Defence Establishment (EDS): there is one in Paifve, reserved exclusively for inmates who are mental health patients. It is managed by the prison administration
- Civil Hospitals: there are two, in Mons and Tournai. They have a section reserved for mental health patients. The entire facility reports to the Ministry of Health. Patients wait in prison psychiatric wings between two to four years, without adequate care, for a place to become available. The prolonged wait to be placed in a civil hospital was denounced by the Council of Europe’s Committee for the Prevention of Torture (CPT). Belgium was condemned by the European Court of Human Rights in September 2016 in pilot judgement W.D. v. Belgium.
- Forensic psychiatry centres: there are two, in Ghent and in Antwerp. This type of facility only accepts mental health patients. Its operation is mixed. The FPS Justice manages security and infrastructure, and the Ministry of Health manages treatment.Three new forensic psychiatry centres have been announced in Aalst, Wavre and Paifve, with no specific timeline. The psychosocial service is understaffed in almost all of the country’s prisons.
In a public statement on 13 July 2017, the CPT noted the particular situation of mental health patients within social movements. These patients appear to be even more vulnerable than other prisoners (see “Prison Staff”).
The European Court of Human Rights (ECHR) condemns Belgium following the complaint of five detainees (Judgment Venken and Others v. Belgium). They claim to have been interned in the psychiatric wings of an ordinary prison. The ECHR recognised that the applicants had not had access to appropriate care and that they had not had any effective means of redress to change their situation. The Court concluded on April 6, 2021 that there had been a violation of Articles 3 and 5§1 of the European Convention on Human Rights.
There is a high number of drug addicts. A study reveals that 33% of the prisoners questioned say that they use drugs on a regular basis.
Another study reveals that 68% of prisoners are considered to be highly dependent on legal or illegal psychotropics. Antidepressants are used for lack of a genuine course of care. 43% of the prescriptions issued are for antidepressants and anti-anxiety drugs.
Two researchers from the ‘Neederland Studicentrum Criminaliteit’ found in April 2019 that 37% of people in prison in Flanders suffer from serious psychological disorders. Of these cases, 21% are the result of drug use, 10% of alcohol use and 4% of the effects of drug addiction. The use of psychotropic drugs such as benzodiazepines, antidepressants and antipsychotics is three times higher than in the general population. The risk of suicide is also greater. This trend is more prevalent among men than women.
Several actors and projects seek to intervene and ensure a preventative approach within the institutions. According to research, 50% of prisoners have access to prevention programs.
Actions regarding risk reduction are limited. Only a few pilot projects exist (including those related to suicide).
On average, at least one prisoner out of every three in the Belgian correctional system would use drugs. Those incarcerated at Gand prison had the option of participating in a 40-week supervision program twice a year. The program, partially funded by prisoners’ jobs, aimed to combat drug use in prisons. Federal Minister for Justice Vincent Van Quickenborne hoped to launch this program in other Belgian prisons.
There is a disproportionate number of people with mental disorders, and the lack of mental health professionals is significant. Requests for external support for the treatment of psychiatric illnesses may, in certain cases, entail a waiting period of one to two years.