General 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. Medical personnel are usually only on duty during the day.¹

Most dentists are part of a mobile team who offer their services for a few days a month in each prison. Many prisoners complain about the quality of dental care (too many extractions, not enough anaesthetic, poorly done fillings). Some of them do not go to dentists because of poor treatments.² There are no dentists in Tongres, and prisoners must go to another facility, which causes longer wait times.³ In Lantin, the wait times to see a dentist are up to four months.⁴

The working conditions for healthcare professionals are seen as difficult: insufficient equipment, finances, training, organisation, etc. Treatment rooms do not have all the necessary equipment. This is especially the case for the physiotherapy room in Ittre prison, where prisoners cannot always get the treatments prescribed.⁵

Prisoners complain that medical appointments are too short and not thorough enough. The shortage of medical personnel is partly to blame. Some appointments last only one minute or take place at the reception desk. The attitude of health personnel is described as “formal” and “distant”.⁶

Prisons without a medical-surgical centre transfer sick prisoners to public hospitals (Loi de principes, Article 93).
Lantin prison rents four beds in a secure room at the public hospital La Citadelle in Liège.¹

Prisoners have the right to receive treatment in prison (Loi de principes, Article 89). Continuity of care for prisoners is a major concern: there is no protocol to link medical follow-up before, during, and after incarcerated.

Prisoners’ medical records are stored on a different platform than the one used for people outside prisons. The medical record of someone entering prison is not transferred to the prison medical service.¹

The nursing staff is responsible for distributing medication, but sometimes it is done by guards or prisoners. In 48% of prisons visited by the KCE in 2016, this task was entrusted entirely to guards.¹ In Antwerp, Bruges, Saint Gilles, and Lantin, prisoners reported to the Monitoring Commissions that they did not always receive their medication on time or did not receive it at all.

The list of available medication is limited. Certain drugs are difficult to obtain (antibiotics, sedatives), and prisoners must sometimes take a different medication than the one they normally take. The labels are sometimes crossed-out and re-used for other patients, which can cause a breach of confidentiality.²

The Belgian section of the International Observatory of Prisons (OIP Belgique) denounced the cases of antipsychotic over-medication.³ Nearly 60% of prisoners found that they were prescribed at least one medication for anxiety in 2016.⁴.

The CPT reported that during the strikes of 2016, prisoners had more difficulty accessing medication and treatments, which led to more anxiety and stress, especially for people with mental health problems. Some people in the psychiatric annex of Jamioulx prison had their medication increased to deal with this situation.⁵

Medical transfers, which allow hospitalisation or outside consultations, are difficult to organise. Prison staff is not always available to do these transfers. There is a lack of hospital appointments, and the procedures are often cancelled or postponed.¹ In 2020, a prisoner in Saint-Gilles prison was not transferred in time and lost vision in one eye.²

Prisoners are always accompanied by prison guards for medical transfers.³ Some are handcuffed during the transfer and consultation. The procedures can be uncomfortable and embarrassing for prisoners, as they sometimes take place in front of guards.⁴ Some prefer to refuse treatment and wait to see a doctor after release.⁵

There are no studies of prevalent diseases.
Prisoners are seven times more affected by hepatitis C¹ and ten times more by tuberculosis ² than people on the outside.

Not all patients receive the appropriate treatment, such as those who are positive for hepatitis C.¹

There are some measures in place for the prevention of contagious diseases and epidemics.
Testing for infectious diseases is not always carried out and the methods are not standardised. According to a KCE study, the only routine testing done in 75% of prisons is for tuberculosis. Only six prisons in 2017 offered HIV and hepatitis tests when entering prison. Half of the facilities offer these tests to prisoners during their time in detention.¹
Patients with infectious and contagious diseases, such as tuberculosis or scabies, are isolated. Sometimes, officials may place in the same section prisoners with the same condition. They give practical reasons for doing so, such as managing their movements. These people are sometimes denied the right to work. During the COVID-19 pandemic, wearing a mask was mandatory for prisoners and staff. The CCSP reported that this measure was not always followed by staff in Jamioulx, Leuze-en-Hainaut, Marche-en-Famenne, Namur, Saint-Gilles and Saint-Hubert prisons.²

Actions regarding risk reduction are limited. There are only a few pilot projects in progress. The administration indicated that prisoners may obtain condoms and lubricant from medical services, as well as information on hepatitis C and the risks of infection (brochures, flyers).

People with mental health issues are over-represented in prison. The CPT reports that there is not enough psychiatric and psychological care, and that there is a marked lack of mental health professionals. In most prisons, a psychiatrist is present for a few days per week. In 2020, there were no psychiatrists present in Andenne, Arlon, and Berkendael (closed since November 2022) prisons.¹ Requests for outside support for treating mental disorders may, in some cases, entail a waiting time of up to one or two years.²

There are many cases of mental disorders in Ittre prison: severe depressions, suicidal states, breakdowns, poly-drug use. The administration gives priority to treating the most urgent cases. The others lack treatment and regular follow-ups.
Prisoners suffering from mental health problems can be placed in psychiatric annexes. These annexes are intended for relatively short detention periods, but, in practice, prisoners often stay there for between two and four years, pending a transfer decision to a specific facility. Psychiatric annexes accommodate, on a permanent basis, individuals undergoing mental health treatment when there are no specific facilities available to take them in.
Individuals with mental health problems are sometimes placed in confinement cells while waiting to be transferred, or when a prison does not have a psychiatric annex.³

Antwerp, Brussels, Gand, Haren, Jamioulx, Lantin, Louvain Secondaire, Mons and Namur prisons all have psychiatric annexes.
The broken windows in the psychiatric annex of Saint-Gilles prison have been replaced with plexiglass and plywood panels, which do not meet fire safety standards.⁴ During its 2021 visit, the CPT delegation met with prisoners who were living in very dirty cells, and who were demonstrably incapable of looking after their own personal hygiene or that of their cell.⁵

The European Court of Human Rights (ECHR) condemned Belgium several times for the poor management of their psychiatric annexes.[^echr] It found that the overcrowding and the lack of regular treatment constitute inhumane and degrading treatment. In 2016, the Court stated that the management of the psychiatric annexes represented a structural and systemic problem and asked the State to reduce the number of individuals they take in. Five years later, the European Court of Human Rights (ECHR) condemned Belgium following the complaint of five prisoners (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.

Offenders deemed to be not responsible for their actions are interned in specific facilities:

• social defence facilities (établissement de défense sociale, EDS), in Paifve, and social defence sections (sections de défense sociale, SDS), in Antwerp, Bruges, Merksplas and Turnhout
• forensic psychiatry centres, in Ghent and Antwerp
• civic hospitals

For more information on specific facilities, consult our thematic paper Belgium: walling up madness.

Each prison must have a psychosocial service consisting of psychiatric and psychology professionals. A team for additional care must be assigned to facilities with a psychiatric annex or a social defence section (SDS).¹

Guards take a course in narcotics during their basic training. It deals with the identification of drugs and their effects, as well as how to manage people with drug addictions. They can also register for continuing education on this topic.

In September 2017, the ECHR found a lack of training for guards in the case Tekin v. Belgium. One of the guards concerned had received no training whatsoever on how to deal with people with mental illness.

Points of contact for people with substance use disorders are available in the Flemish, Brussel, and Wallonia prisons. Specialised external teams visit the prisoners and work with them to determine the proper treatment and ensure they receive treatment when released.
There are two “drug-free” sections for prisoners who wish to stop using drugs in Hasselt and Bruges prisons. The person is placed in these sections at their request. They receive psychological support while withdrawing and can obtain methadone treatment.¹

In Ruiselede prison, the b-leave programme guides people with addictions towards withdrawal through sports and therapy.² A booklet on the health problems associated with narcotics is available for prisoners.

In Brussels, the Ambulatoire-Forest Association offers specialised psychosocial support for defendants who have problems with alcohol, drug, or medication consumption.