Yagos Antiochos (Bodossaki Foundation) writes about the project that contributed to ensuring healthcare for marginalized prisoners.
Health without Barriers paved the way for prisoners’ unhindered access to healthcare.
In 1957, the United Nations (UN) defined the “Standard Minimum Rules for the Treatment of Prisoners,” which were updated in 2015 and renamed as the Nelson Mandela Rules (NMR). These rules address the fundamental right of people in prisons to health care, to unrestricted access to diagnosis and treatment as well as to the confidentiality of their medical files. Are the UN rules truly being upheld within the confines of Greek prisons, even after 66 long years since their adoption?
Giorgos Kalamitsis, President of the Hellenic Liver Patients Association “Prometheus”, describes the reality he has encountered in the past 7 years that the organisation has been active in prisons throughout the country. “When we started implementing our first project in 2017 which involved the diagnosis and integration of prisoners into the healthcare system, we identified the significant difficulties that exist in this particular field. Among these, we found that a very big obstacle to accessing healthcare services within prison was the fact that a percentage of prisoners did not have a Social Security Number (SSN), due to the absence of the necessary legislative documents. This practically meant that a large number of prisoners could neither have medical check-ups nor proceed with treatments for hepatitis B&C or any other health issue they were facing. Thus, we decided in collaboration with the organisation “Positive Voice” to design the “Health without Barriers” project, with the main objectives being to officially register those restrictions in 5 prison settings at the Greek periphery and to strengthen advocacy towards state institutions in order to bring policy change regarding prisoners’ rights, such as electronic medical records, Social Security Number issuance, telemedicine, medical data confidentiality etc.”
“Health without Barriers” started its implementation in April 2021, as one of the 119 projects managed by the Bodossaki Foundation in consortium with SolidarityNow, as the grant manager of the Active citizens fund programme for Greece. The €15 million Active citizens fund programme is funded by Iceland, Liechtenstein and Norway and is part of the European Economic Area (EEA) funding mechanism for the period 2014 – 2021, known as EEA Grants. The programme aims to strengthen and enhance the sustainability of civil society and to highlight its role in promoting democratic processes, enhancing citizens’ participation in public life and defending human rights.
The first step of the “Health without Barriers” project was to quantify the data on prisoners’ access to healthcare services. For this purpose, a scientific committee was set up which created questionnaires that were later answered by prisoners and employees in 5 prison settings. Specifically, those of Trikala, Chania, Malandrinos, Korydallos I and Chios.
The coordinator of the committee, Professor of Epidemiology and Medical Statistics at the Laboratory of Hygiene, Epidemiology and Medical Statistics at the Medical School of the University of Athens, Ms. Vana Sypsa, describes the approach: “First, you collect the data you need, then you analyse and utilize them in a final policy brief that can assist you in advocacy and in proposing institutional changes to the relevant authorities that will address the root causes of the problem. For the questionnaire, in addition to the participants’ information, such as age, country of origin, existence of a Social Security Number etc., we also included some standards of international organizations proposed for prison settings, allowing the data you collect to be comparable, for example, at a European level.”
The survey sample was quite large, with a total of 479 prisoners and 85 prison officers responding to the questionnaires. The results documented the pathologies in prisoners’ access to healthcare services and in the treatment of some infectious diseases, such as Hepatitis B and C, and HIV.
As Ms. Sypsa says, the survey “recorded that a large percentage had a history of intravenous drug use, a population in which the rate of hepatitis C infection is as high as 80%! Although the average length of detention for prisoners in the survey was 3.3 years, a significant period during which there are many opportunities for a person to be diagnosed with an infectious disease and given appropriate treatment, more often than not this had not been done. The absence of a Social Security Number or Temporary Social Security Number was identified as the main problem in accessing healthcare services, affecting 25% of the surveyed prisoners. In fact, among non-Greek citizens this percentage reached nearly 50%.”
Mrs. Ioanna Anastasopoulou, Director of the Nafplion prison setting, where activities of the “Health without Barriers” project were carried out, confirms the magnitude of the problem caused by the absence of Social Security Number: “Following an initiative of the Hellenic Liver Patients Association “Prometheus”, we proceeded to test the largest percentage of the population of the inmates of the Nafplion prison setting for Hepatitis C. Unfortunately, of the 84 who tested positive, only 17 were entitled to treatment. Why? Because they were the only ones lucky enough to have Social Security Number or Temporary Social Security Number. It’s so unfair when you consider that access to healthcare services for prisoners and non-detainees alike is an inalienable universal right, not a partial privilege.”
After completing the research and analyzing its results, meetings were held with the General Secretariat for Anti-Criminal Policy of the Ministry of Citizen Protection, where the challenges and potential solutions of the issue were presented in detail. As stated by the Secretary General, Mr. Konstantinos G. Papathanasiou, “In March 2021, following the encouragement and contact of Mr. Kalamitsis, President of the Hellenic Liver Patients Association “Prometheus” with us, a Memorandum of Cooperation was signed between the General Secretariat for Anti-Criminal Policy, the Hellenic Liver Patients Association “Prometheus” and the Greek Association of People Living with HIV “Positive Voice”, in order to implement the project “Health without Barriers”. The conclusions of the survey conducted within the framework of the project, contributed to a clearer assessment of the level of awareness and attitude of prisoners, patients and non-patients, as well as of prison officials, towards infectious diseases and highlighted the problems faced by incarcerated patients in their efforts to access healthcare services. Finally, the proposals put forward by the project promoters are align with the objectives already adopted by the General Secretariat, including the provision of a Temporary Social Security Number to prisoners who do not have a Social Security Number, to ensure they are not excluded from accessing healthcare services.”
The General Secretariat for Anti-Criminal Policy has submitted the legislative decree (Article 84 of Law 4985/2022) on the Temporary Number of Healthcare for Inmates and its use will start being implemented in all prison settings in the country from September onwards Eligible beneficiaries are domestic and foreign inmates in Greek prison settings who do not possess and do not meet the requirements for issuing a Social Security Number or a Temporary Number for Insurance and Healthcare of Foreigners, for the duration of their detention. This ensures vital healthcare life-saving medical intervention to thousands of prisoners who were previously excluded from it.
Active Citizens Fund – Greece, project “Health without Barriers”
