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Working in a prison in Myanmar: Médecins Sans Frontières’ experience working in Insein prison
Jean-Marc Biquet

Working in a prison for a humanitarian organisation is not easy, particularly because of the specific characteristics of such places. Médecins Sans Frontières’ experience working in Insein prison illustrates the difficulties of achieving objectives both in terms of results (long term provision of appropriate and full medical care to patients) and working conditions (minimal manipulation, indiscriminate access to patients, etc.).

There is not a lot of literature about humanitarian action in prisons, which tends to imply that it is not very common: not all NGOs who want to work in prisons are able to and, in theory, information about what happens inside is not available to the public.
The situation is paradoxical, with prisoners among the least susceptible to be provided with external aid when this is needed. Excluded from society for what they have done or what they think, prisoners’ well-being is totally dependent on the goodwill of the authorities. If there is a disastrous health situation, this is often the result of voluntary negligence: security is the main, if not only, preoccupation of the authorities. Providing basic services such as food, hygiene, health and protecting prisoners’ rights, in a way that guarantees dignity, is of secondary importance, as was reported by Manfred Nowak in 2010 (who was the UN Special Rapporteur on torture at the time), after four years spent visiting a large number of prisons throughout the world [1].
One of the reasons that there are so few assistance projects in prisons is no doubt the difficulties linked to the conditions in which action can take place: what can be done in a prison depends completely on the authorities and this is either imposed by them or is the object of very tough negotiations. Indeed, all the problems which can exist in any humanitarian project can also exist in prison, but more intensely than elsewhere (risks of manipulation, of collusion, of a lack of implication by the beneficiaries, violation of independence and impartiality, security problems, etc.).

Médecins Sans Frontières (MSF) has some experience of working in prisons bringing vital assistance to inmates in response to a medical emergency (cholera, famine, etc.). Sometimes the organisation takes the initiative of proposing a healthcare programme for inmates with a chronic disease who have not had access to full healthcare from the authorities in charge (tuberculosis, AIDS, etc.) [2]. These cases involve longer-term programmes to deal with these public health problems.
MSF’s experience in Myanmar is an example of this type of situation and the difficulties of achieving objectives both in terms of results (patients being provided with appropriate and full healthcare in the long term) and working conditions (minimal manipulation, indiscriminate access to patients in need…).

[1] “…I got a fairly comprehensive impression of the conditions of detention around the world. In many countries I was simply shocked by the way human beings are treated in detention. As soon as they are behind bars, detainees lose most of their human rights and often are simply forgotten by the outside world” Extract from the Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment” of 5/2/2010, p. 61. It can be consulted at the following address: http://www2.ohchr.org/english/issues/torture/rapporteur/index.htm

[2] BIQUET J.-M. “Humanitarian work in prisons: the experience of Médecins Sans Frontières” in Humanitarian Aid on the Move, April 2014, pp. 12-15. Available at: http://www.urd.org/IMG/pdf/URD_HEM_13_EN.pdf

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