Exercising the right to the highest attainable standard of physical and mental health remains unreachable for millions worldwide. This is especially true for vulnerable populations, including those in closed institutions, prisoners, and drug users. Therefore, the UN Human Rights Council established the mandate of the Special Rapporteur on the right to the highest attainable standard of physical and mental health (UN Special Rapporteur on health issues).
The mandate aims to collect information on the realization of the right to health and develop dialogue on cooperation opportunities with relevant stakeholders, including governments, the UN (especially WHO and UNAIDS), NGOs, and financial institutions. Hence, it is logical to send a joint statement to the UN Special Rapporteur on health issues from several NGOs working directly with the most vulnerable social groups. In anticipation of the Special Rapporteur's report on harm reduction for sustainable peace and development, UnMode, Harm Reduction International (HRI), and the European Prison Litigation Network (EPLN) submitted such a statement highlighting issues identified through their practical work.
In the statement, we focused on two significant issues with realizing the right to health. One issue arose for the first time due to the full-scale Russian invasion of Ukraine and its disproportionate impact on detainees, harm reduction services, and other essential medical services.
Local organizations confirmed that about 2,000 individuals detained in prisons in Kherson and Mykolaiv regions of Ukraine were illegally transferred by Russian troops to Russia in November 2022, violating international law, human rights, and humanitarian law. No information about their whereabouts, health conditions, or detention conditions was provided by the Russian side. Detainees, already vulnerable, now face exacerbated conditions due to the uncertainty of their legal status and complete disregard for their rights by the aggressor state.
Some illegally transferred detainees were "lucky" and were released after serving their terms (set by Ukrainian courts) and managed to leave Russia. These individuals became the primary source of information about the fate of the transferred Ukrainian detainees. According to their testimonies, all transferred (read - stolen) detainees were subjected to cruel treatment or torture during transportation to Russia. This degrading treatment continued in Russian prisons, where detainees were isolated from the general prison population, deprived of outside contact, lacked access to clean water, medical care, and were kept in unsanitary conditions. The most challenging conditions were faced by detainees requiring continuous medical care, those with HIV, hepatitis, and active tuberculosis, due to both the general negative attitude of the Russian prison administration and the absence of personal medical records with diagnoses, medical histories, and treatment recommendations.
After release, former detainees are placed in so-called Temporary Detention Centers for Foreign Citizens (CVDIG), as they "have no legal grounds to stay in Russia." Most often, they also lack valid identity documents, making it extremely difficult for them to leave Russia, leading to potentially indefinite detention in CVDIG. None of these centers have adequate medical equipment, medications, or qualified medical personnel, putting those requiring continuous medical care on the brink of survival.
This vividly illustrates the particular vulnerability of Ukrainian detainees stolen by Russia, in conditions of at best indifferent attitudes from prison administrations and extremely limited support from civil society institutions. Facing such a situation for the first time, we have to invent methods and ways to resolve it on the go. Our organizations make every effort to restore and realize the right to health for Ukrainian detainees illegally transferred to Russia. However, the situation is complicated by the absence of official communication channels, Russian censorship, and active obstruction of our activities by Russian authorities. Under such conditions, the UN remains perhaps the only lever of pressure on the Russian administration, providing a chance to address this issue and a basis for cautious optimism.
The second issue highlighted in the joint statement is more general and systemic, related to the impact of imprisonment on the availability, quality, and affordability - including price - of essential medicines and medical services. The analysis and need to highlight this issue are also based on our practical work.
Our experience shows that punitive policies towards drug users and limited access to quality harm reduction services in prisons negatively affect the health of detainees and can lead to severe consequences, including death. Prisons represent a high-risk environment for disease transmission due to a combination of factors, including overcrowding, limited access to clean water and quality food, poor sanitary conditions, inadequate or absent medical care, and cruel treatment of detainees. Although harm reduction is available to some extent in some prisons, detainees face various barriers to accessing services, including stigmatization and discrimination from prison staff and other detainees.
Often, access to OST (opioid substitution therapy) is merely declarative. In Albania, Latvia, Montenegro, and Serbia, people cannot start OST while in prison. It is only available if they were on OST before imprisonment. A study conducted in Moldova in 2021 showed that the lack of prison and medical staff is a barrier to accessing healthcare services, compounded by the lack of knowledge about harm reduction among existing staff. Methadone is considered a drug by prison staff. In Russia, any use of methadone is prohibited by law for any purpose.
Remarkably, during the implementation of separate, independent projects, our organizations encountered similar problems and difficulties and reached almost identical conclusions about ways and means to resolve them. This commonality of views allowed for the creation of a joint statement.
Joint initiatives also help attract international community attention and stimulate important measures. The interaction between civil society and the UN is key to achieving sustainable and equitable solutions in health and human rights.
The statement text can be found via the following link:
Please click the link for the full text of the statement.