unbearable.. About suicide in places of detention in Egypt!
Contents
1- Executive Summary
2- Methodology
3. Introduction
4- Why are prisons a fertile environment for the emergence of mental disorders and the deterioration of the mental state of prisoners?
4.1 Living conditions in detention institutions and their impact on mental health:
4.2 Treatment of detainees in Egyptian prisons in general and its impact on mental health
4.3 Mental health impact of human rights violations against prisoners
4.3.1 Prohibition of visits
4.3.2 Intentional medical negligence and its impact on the mental health of detainees
4.3.3 Prolonged solitary confinement and its impact on the mental health of detainees
4.3.4 Prolonged pretrial detention and rotation on new cases and their impact on the mental health of pre-trial detainees
5- Forms of deterioration of the mental and psychological health of prisoners
5.1 At the level of the individual
5.1.1 Deliberate and systematic destruction of self-image, psychological defenses and capacities
5.1.2 Mental disorders and symptoms of prisoners in detention institutions
5.1.3 Self-harm – suicide: Why do detainees resort to self-harm?
5.1.4 Substance abuse in prisons.
5.1.5 Suicide attempts among detainees inside Egyptian prisons.
5.2 Prevalence of violence in prisons and how internal conflict in the prisoner’s external environment manifests itself at the level of his dealings with his surroundings
6- How psychological and mental disorders of prisoners are dealt with, starting from their presentation to the prosecution until their placement in prisons.
6.1 The role of the Public Prosecution in determining cases of acute mental disorder.
6.2 The medical examination.
6.3 How does the prison administration deal with cases of mental disorder
6.4 Prison Administration Handling of Suicide Attempts Among Detainees
7- Continued deterioration of the psychological state of prisoners after their release from prison
- Recommendations
8.1 With regard to prison conditions and human rights violations
8.2 With regard to the Public Prosecutor’s Office
8.3 With regard to mental health services in prisons
8.4 Regarding the management of suicides
1- Executive Summary
Prisons and places of detention are generally a fertile environment for the emergence of mental disorders among prisoners because they are institutions in which the prisoner is isolated from his social environment. In light of the lack of medical care in prisons and places of detention in Egypt as a result of insufficient awareness of mental illness, as well as violent treatment of prisoners with mental disorders and poor quality of health care inside prisons, the deterioration of prisoners’ mental health has become commonplace, leading them to attempt self-harm and end their lives.
Over the past years, a number of prisoners’ attempts to commit suicide inside places of detention have been documented, including Omar Adel, who ended his life after being arbitrarily detained in a disciplinary cell. Despite his mental and physical health problems, he was unable to remain alone or be held in the disciplinary ward where conditions are very bad. Although the victim explained this to the detaining officers and the prison doctor, he was ignored and accused of feigning illness. Three days later he ended his life.
Despite the continuous demands for the need to improve the conditions of prisoners inside places of detention, suicide attempts because of poor living conditions and mistreatment of prisoners inside prisons have not stopped, despite the announcement by the Ministry of Interior in December 2021 of the start of the trial operation of the Correction and Rehabilitation Center in Badr City as part of the plan to replace public prisons with correction and rehabilitation centers, and contrary to the continuous statements of Ministry of Interior officials that these centers will be the beginning of the solution to the crisis of poor detention conditions, but since the beginning of the transfer of prisoners to the Badr Prison Complex, there were reports of violations that include mistreating prisoners, subjecting them to psychological and physical abuse, preventing them from receiving visits from their families, as well as receiving or sending written messages to check on their families, and preventing the entry of blankets and clothes for detainees despite the low temperatures. Meat, chicken, eggs, fish and baked goods were also banned while prices in the canteen were excessively raised, in addition to preventing detainees from exposure to the sun and exercise, exposing the rooms to artificial light 24 hours a day, and installing surveillance cameras and searchlights directed at prisoners.
As a result of these conditions, a number of detainees announced in October 2022 their hunger strike. Prisoners in the Badr prison complex appealed to human rights and international organizations to quickly intervene to save them from what they described as a “slow death,” and then news circulated about suicide attempts for many of them in the Badr prison complex after they lost hope that their conditions in prison would improve or that they would be released.[1]
The prison administration faced the prisoners’ strike with violence and excessive use of force by taking escalatory measures against prisoners, including “stopping the periodic medicine dispensed to heart and diabetic patients, preventing the entry of medicines sent by families at a rate of once a month, in addition to a complete suspension of the “cafeteria” and “canteen” of the prison, and reducing the quantities of food dispensed to prisoners, which led to a deadly famine inside the prison, with the aim of “forcing them to submit to the administration’s demands to postpone their demands for family visits indefinitely.” The escalation between the prison administration and prisoners also amounted to “stopping medical services for detainees except in cases that are close to death or who have attempted suicide, and threatening detainees to disperse their objection by force, removing the blindfolds on the surveillance cameras inside the cells, and disconnecting the electricity from the cells except for emergency lamps only.”
In February 2023, a statement was leaked[2] from inside Badr 3 prison entitled “Badr 3 Uprising: Harvest of 10 Days of Events”, in which the detainees announced that they were subjected to a deadly famine, preventing medicines for the sick, the elderly and critical cases, and the frequency of suicides to reach 55 suicides within 10 days, whether by hanging, slashing wrists, or swallowing medicines, which prompted prisoners to open the electronic doors, cover surveillance cameras in rooms, and enter into a total strike in what detainees knew as the Badr prison uprising. The detainees announced that they would continue their uprising “until they obtain their legitimate rights and demands, foremost of which is allowing family visits, opening exercises, providing the required medical care, and improving living conditions.”
As a result of the use of excessive force by security forces, one prisoner suffered a severe heart attack that almost killed him and was treated hours later. While the detainee Hossam Abu Shorouk died after he hanged himself and the inmates could not save him, detainee, Mahmoud Al-Saidi, cut his throat before being detained in the medical center in critical condition. Two prisoners, Muhammad Turk Abu Yara and Awad Noman, slashed their wrists in an attempt to end their lives, and they were transferred to Badr Hospital, all of them in serious condition. Prison administration isolated suicides at the medical center located inside the Badr prison complex.[3]
In light of this, the report aims to shed light on the reasons why Egyptian prisons have turned, as a result of the constant use of violence, threats and attempts to control prisoners, into a fertile environment for the spread of mental disorders to the extent that it may threaten their lives and push them to death, whether inside places of detention or even after their release.
The report also addresses prison conditions as a key factor in affecting the psychological and mental health of detainees in detention institutions in Egypt on several levels: First, in terms of analyzing the general conditions in prisons, starting with the structure of prisons, living conditions, and the extent to which prisoners’ basic needs of food, drink and health care are met, as well as methods of dealing with detainees and mechanisms for imposing control and its impact on the mental health of detainees.
The report also discusses the stages of deterioration of the mental health of detainees, starting from the appearance of symptoms of mental illness such as severe psychological trauma, depression, severe anxiety and other mental disorders and their symptoms, to attempts at self-harm and suicide, with an explanation of the causes and factors that affect mental health, and the forms and symptoms of deterioration of mental health in detention institutions at the level of the individual and his surroundings.
The report also discusses the impact of negligence in dealing with cases of mental disorders, starting with presentation to the prosecution, as well as the poor handling of mental disorder inside Egyptian prisons, including violent treatment, cruelty and punishment, to preventing detainees from accessing psychiatric medications prescribed to them by doctors.
The report sheds light on suicide attempts inside prisons and how the prison administration deals with them, and its use of punishment for detainees who attempt suicide.
It also discusses the continued deterioration of the psychological state of detainees even after their release from prison, especially with their expectations that life will return to normal, only to be surprised by their inability to deal with the outside world and their sense of separation from society, especially after their long presence in prison, which may push some of them to suicide attempts after release.
The report concludes with several recommendations, including the obligation of the Public Prosecution not to detain people with severe mental disorders whose condition is exacerbated by staying in prison, and to take the necessary measures to transfer them to mental health facilities. The report recommends that prison administrations commit to conducting comprehensive physical and psychological medical examinations of detainees, improve health care conditions in prisons and provide psychiatrists in prisons and immediately cease all forms of abuse against people with mental disorders and ensure that detainees with mental disorders have access to on their psychiatric medications continuously and permanently. Also, to provide immediate and urgent medical care to any detainee who attempted suicide and transfer him to foreign hospitals urgently until his condition improves.
2- Methodology
Within the framework of this report, a number of direct interviews were conducted with doctors and former prisoners, where two interviews were conducted with two psychiatrists at the Nadeem Center who worked for many years to assist and rehabilitate victims of violence and torture inside places of detention and based on their experience with dozens of survivors. In addition, interviews were conducted with a number of people who spent varying periods of detention during the period from 2018 to 2021 in both men’s and women’s prisons in Cairo, Giza and Alexandria governorates.
In addition, the Egyptian Commission for Rights and Freedoms (ECRF) has documented a number of suicide attempts or suicide threats by prisoners over the past years. Several press sources, human rights reports, and statements from detainees’ families and lawyers were also reviewed about the deterioration of the psychological state of their families and clients, to the extent that their lives are at risk of suicide as a result of poor detention conditions.
International treaties and covenants on human rights and periodic reports of the United Nations on human rights with a focus on the rights of prisoners, reports of the United Nations General Assembly and reports of special rapporteurs regarding torture, ill-treatment and prolonged solitary confinement and their impact on the mental health of detainees were also reviewed, as well as the guide provided by Penal Reform International on mental health in prisons. This is in addition to the Egyptian Constitution, local laws and legislation, in addition to reviewing a research study on deteriorating mental health in detention institutions carried out in US prisons.
In the context of this report, all the names of former detainees whose testimonies contributed to the completion of this report were kept anonymous, in order to preserve their security and safety from any danger or security prosecution.
The report defines the term prisoners used to include primarily persons in pre-trial detention or deprived of their liberty following conviction by a court sentence. It also refers to all persons detained for any other reason in prison, and persons held in similar places of detention such as police stations.
Mental health professionals often describe mental disorders to include mental and psychological disorders, but some specialists tend to distinguish between them as different disorders that combine some common factors, most notably the direct impact on thought and mood.[4]
Mental illness may be an extension of a case of psychiatric suffering that has been delayed in treatment, for example, psychosis may arise as a result of a mental disorder such as episodes of severe depression or anxiety disorder.[5]
3. Introduction
World Health Organization (WHO) reports indicate that one in seven inmates in detention suffers from serious mental disorders, and this is higher among women in prisons who suffer from more complex mental disorders as a result of trauma resulting from past cases of violence.[6]The Guidelines for Mental Health in Prisons states[7] that according to psychiatric studies conducted in prisons, the rate of mental disorders is “very high” compared to outside places of detention. This is due to the fact that prisons, as places of isolation and detention, are a psychologically stressful environment as a result of the deprivation of liberty of detained individuals.
Deprivation of liberty in its basic form is the deprivation of freedom of movement, limiting the detainees’ contact with the outside world, including their families and friends, and in its other sub-forms that detainees experience on a daily basis, from clothing and food to their ability to own any personal property, and their constant exposure to searches, humiliation and insults by officers in prisons or even by other prisoners, which puts pressure on the mental health of prisoners to the extent that it frequently represents a danger to their lives.
The deterioration of mental health of detainees is a phenomenon inside Egyptian prisons, especially with the lack of the minimum level of medical care for mental health, such as the provision of psychiatrists to follow up on the psychological and mental state of detainees, the provision of medical drugs to treat mental and mental disorders, or the transfer of cases with acute disorders to specialized treatment institutions outside prison.
This report aims to engage with the mental health crisis inside Egyptian prisons by discussing and analyzing the causes and forms of its deterioration within detention institutions, and how these institutions represented by prison administrations deal with it and the consequent attempts of self-harm and suicide among prisoners.
4- Why are prisons a fertile environment for the emergence of mental disorders and the deterioration of the mental state of prisoners?
Prisons and places of detention are generally a fertile environment for the emergence of mental disorders and the deterioration of the mental state of prisoners due to the fact that they are institutions of isolation and detention. The prevalence of psychological and mental disorders within Egyptian detention institutions in particular increases as a result of the deterioration of the conditions of Egyptian prisons, both at the level of living and health conditions, and as a result of the violations suffered by prisoners such as beatings, torture, ill-treatment, solitary confinement without legal basis and for an unlimited period, prolonged pretrial detention and rotation, as well as prohibition of visits, and other practices that severely affect the mental health of prisoners, as well as neglect of providing medical and psychological care to prisoners.
In a study conducted by researcher Terry Coopers on the mental health of detainees in detention institutions in the United States of America, he reported that the prevalence of mental disorders among prisoners is very high, at least five times the prevalence rate among the general public.[8] This study was conducted on a representative group of prisons in the United States of America in 2015. The study discussed the mental health crisis behind bars, where many detainees in places of detention suffer from mental health disorders that require psychological treatment and medical intervention, whether these disorders arose while in prison or their mental condition deteriorated after being placed in prison. The study discussed the lack of mental health care services in prisons, and that the largest proportion of those with mental health disorders are exposed to medical neglect and failure to provide the medical services they need, as well as treating them with violence, which leads to further deterioration of their psychological state.
The extent to which prisoners’ mental health deteriorates varies based on several factors, including poor conditions in detention institutions, the extent to which prisoners are subjected to abuse during their detention, the extent to which these institutions lack mental health care services, and individual factors specific to prisoners themselves that determine the extent to which they are affected by these factors.
In an interview with Dr. Suzan Fayyad, a psychiatrist at the Nadeem Center for the Rehabilitation of Victims of Torture, to talk about places of detention and the extent of their impact on prisoners as places of isolation and detention, she says, “Prisons are indeed a very fertile environment for the emergence and exacerbation of mental illness, because they have the most severe types of pressures, and there are almost all the pressures known to us as psychiatrists – of course I am talking about Egyptian prisons in particular – prison itself even in any modern state is committed to human rights and health standards. The mere deprivation of liberty is a very big pressure, just isolation from contact with other human beings is immense, isolation from family and friends, from the work environment, from different social circles, isolation of this kind is fatal. Prisons in general restrict freedom and create a form of isolation and cause a kind of aggression on all psychological and social experiences that a person has formed, as it forces him to set aside all these experiences and start again to build completely different psychological and social experiences, and with completely new rules in prison. The law limits people’s freedom and isolates them from society, which should be the legal limit. In Egyptian prisons, this is not the ceiling at all, but rather the beginning of a series of unbelievable pressures inside the prison. This is because it violates on a daily and instant basis all the basic needs of the individual.”[9]
Negative experiences or destructive pressures on a detainee’s mental health begin from the moment of arrest, whether they are arrested from home, or randomly stopped on the street. In addition, some detainees were forcibly disappeared inside National Security headquarters or sections and then transferred to prisons in a long process of violence, threats, and intimidation.
In an interview, Dr. Mona Hamed, a doctor at the Nadeem Center for the Rehabilitation of Victims of Violence and Torture, said, “The pressure is so intense and unbearable when arrested, that the detainee’s entry into prison may be the moment of his release, especially if he is subjected to enforced disappearance or is in one of the National Security headquarters; so the moment he enters prison may seem to be the moment of his release by appearing after his enforced disappearance.“[10]
“Finally, I’m going out. I am the happiest person on earth. I will go to prison with all its cruelty, but I will get out of hell. When I left the building of the Omrania Police Station, I felt that I was going up from the bottom up, and I was smiling because I smell the air without barriers, and I only need to remove the blinders and “dogs” and stay in the ordinary prison forever!”[11]
A personal interview we conducted with a former detainee, who was subjected to enforced disappearance for more than two weeks inside a National Security center, talks about what he was subjected to during his disappearance, and the extent of his psychological impact during that period:
“I didn’t take any suicide step in my life other than in State Security, I had a keffiyeh, I went into the bathroom and sat looking for anything that would fit me to hang to like a gallows, but the only thing I found was on the same level as me while I was standing. This is the first and only time in my life that I have attempted suicide, I have always contemplated it as an idea, I have never taken a step towards it. I felt that if I had a choice between torture and death, I would choose death. The pain and suffering of torture would have been too much for me.”[12]
Prisoners inside Egyptian places of detention go through a series of living and health conditions that threaten their physical health, in addition to violent treatment based on humiliation and violation of their basic rights by prison authorities, which affects their mental health, in addition to negligence in providing the required mental health care to detainees, all of which contribute to the deterioration of the mental health of prisoners to a large extent.
4.1 Living conditions in detention institutions and their impact on mental health:
The general conditions in prisons include the design of prisons, the structure of cells, the availability of basic needs, in addition to the methods of dealing with prisoners, mechanisms for imposing control over them, and the violations to which they are subjected. These factors and circumstances contribute mainly to determining the extent of the mental health of detainees, especially if their detention is prolonged, starting with the narrow space of cells, and suffocating overcrowding, and their inability to breathe well, or get proper nutrition.
As a result of the widespread political arrest campaigns in the past years and the consequent increase in the number of prisoners in excess of the capacity of prisons, suffocating overcrowding has become the usual constant inside places of detention in Egypt, in addition to the way these prisons and cells themselves are built and designed, which are mostly built of tin and cement, without any ventilation holes except a small opening in the cell door and an air extractor that often does not work, which leads to an increase in the temperatures in the wards, especially in the summer. In this overcrowding, detainees almost always suffer from suffocation and difficulty breathing.
Detainees struggle to meet their basic needs for food, drink, and health care in places of detention. According to testimonies from former detainees, the food provided by the prison cannot be eaten, and in most cases, it is either moldy or frozen and inedible, and the water is unclean and causes skin problems and diseases.
In the case of Al-Qanater prison, we documented the deterioration of conditions inside the prison to the extent that the detainees were unable to use clean water, and they recorded the presence of an unknown substance in the water that causes hair loss and skin color change. The water itself is polluted and black in color and sometimes it has insects, and when women try to boil water, black lumps are deposited in the pot. This water is used in bathing only; still it causes changes in the skin color changes and hair loss and sometimes causes skin infections.[13]
Detainees are subjected to a number of violations at the levels of public health, with a former detainee in Qanater prison talking about being prevented from visiting and being physically harassed and subjected to indecent assault by the jailer during her search when she was placed in prison in 2018, which prompted her to try to end her life. In the text of her testimony, she says:
“They deported us to prison; this was the first time I saw the prison. A warden took me and told me to go for the search, I went in, and she took me to a bathroom at the end of the corridor and told me to strip. I took off everything except for the underwear; she told me to take off everything; I told her why and I tried to refuse. She searched like that, took me naked, and harassed me completely. She told me to lift my leg and put a plastic bag around her hand and entered her hand, she knew that I was married; she entered her hands from the front and from behind, I was in a state of complete collapse and crying.[14]
They took us to the ward of the newcomers. Of course, you are forbidden to talk to anyone or anyone to talk to you. We spent 11 days there and visiting is forbidden, you don’t have clothes, cigarettes, money, or anything. I had a visit after which they didn’t want to let them in; during the visit they gave them money they didn’t want to take, clothes, food, or anything at all. They took me to a ward with 3 levels of beds. Of course, the beds are not enough for the number of people, people sleep on the floor. I got on a bed without a mattress, a blanket on iron. You would just sit there and are forbidden to talk to anyone, and you do not have any money, and each one has 3 loaves of bread a day, and every week two cans of cheese and 4 eggs, and sometimes when they like to honor you they give you a tomato or potato, and of course not together. There is no food other than cheese and of course the worst cheese you will eat in your life; it is forbidden for anyone to talk to me, who talks to you from the criminal women will be displaced – I mean you will be thrown throw in the toilet – one of the political girls came and said I am inviting you for breakfast today. After twenty days I had soup and meat to eat. Then I began to reach the point that I needed salvation. I had a session with the prosecution and received another 15 days of detention. I returned to prison and felt that I was not going to get salvation, so I took the decision to commit suicide and began to implement it. There was a criminal prisoner next to me who had medicines, which I did not know the nature of. But at the moment of collapse, I took them all, I started to get tired. The girl understood that I took the meds because of the fatigue that I was in. They took me to the hospital and purged my stomach and then they returned me again to the ward.“[15]
Dr. Suzan Fayad talks about the violation of the basic needs of detainees and its impact on the deterioration of their mental health:
“The violation of the basic physical needs of a person is related to and directly affects the psychological state of a person. This is because the individual is one entity or one unit, the body, soul, and mind are elements of one component, and the psychological state is a product of these interactions with each other. If the basic needs of the body are repeatedly violated, this has a direct impact on the mental health of the detainee and may lead some to attempt suicide.”[16]
4.2 Treatment of detainees in Egyptian prisons in general and its impact on mental health:
Former detainees spoke in personal interviews about officers’ constant keenness to remind them that they are in prison through a number of violent mechanisms to impose control and intimidation, including cell searches, stripping, alienation, and discipline, in addition to humiliating, violent, and degrading treatment. Such conditions directly affect the mental health of detainees, especially since no psychological care is provided to them while they are in stressful and destructive conditions for mental health, in violation of the right to humane conditions of detention and freedom from torture and other cruel treatment, “Everyone deprived of his or her liberty has the right to be detained in conditions consistent with human dignity. No one shall be subjected to torture or other ill-treatment under any circumstances. States have a responsibility to take action to prevent the crime of torture[17].
1-Cell search
Cells are searched with extreme violence that may go so far as to smash everything in the cell and intimidate, humiliate, and strip inmates. A former detainee talks about the mechanisms officers use to spread fear and impose control in places of detention:
“They break into the cell very violently; you would be asleep and then find that the cell is being raided, you wake up with utmost violence, and you will see his righteousness, shouting, swearing, and so on. When they fail to find any violations, especially if they are looking for a phone, they resort to aggressive, insulting, and punitive behaviors to the greatest degree, even if their information is wrong and there is really no phone. They pour oil on the clothes and throw food on the ground, and they strip the prisoners of their clothes completely and sometimes they take prisoners to disciplinary cells, take remove their clothes and pressure them to speak if they want to know something.”[18]
2- Confiscating belongings
A former detainee in Tora Maximum Security Prison talks about the punishment of confiscating belongings:
“It is often a periodic punishment and not necessarily related to prisoners’ behavior, but it serves as a constant reminder to prisoners that they are in prison. They do not have the right to own property, or the right to tranquility. It is collective punishment, mostly periodic, and sometimes linked to conditions outside the prison, meaning if demonstrations and protests occur, they respond by punishing prisoners. Troops from the prison will take you out of the room, you will get out with your prison uniforms, 3 prison blankets and medicines. Then they confiscate all the belongings in the cell, including fans or blankets, books, kettle, shower curtains, and take all the belongings in the cell leaving it empty. The journey of suffering begins with the purchase of those needs from the beginning and new. There are needs that we used to take months to get to and in the end,they come to take it simply like this. This is psychologically very cruel. All your arrangements, all your attempts to adapt, are threatened without any justification.”[19]
3- Redistribution and deportation
“Redistribution” is a punishment that includes the distribution of prisoners to new cells, and in “deportation” detainees are distributed either to new cells or new prisons and is used as a form of punishment and abuse. One former detainee in Tora Maximum Security Prison said of the punishment of deportation:
“It’s a non-corporal punishment, but it’s very hurtful. The officer, for example, knew that this cell had a phone and did not know how to find it, or did not know how to plant an informer into the cell, or did not know how to penetrate it in some way, so he resorted to scattering prisoners anew. He distributes all the prisoners to other cells; you feel that you are being imprisoned from the beginning and again… As for this alienation, takes you and throws you in another cell or another prison, starting from the beginning all over again. The circles of safety and friendship that you built no longer exist. Or you go to a new prison and experience the violent “reception party” once more. For example, if a ward goes on strike, they will take two from each cell to alienate them and so on.”[20]
Dr. Suzan Fayad talks about the conditions inside prisons, especially with regard to the mechanisms of imposing control mentioned above and their impact on the mental health of prisoners, she says:
“Conditions in Egyptian prisons are very difficult, for example, the prison regulations still legalize the beating of detainees, and every once in a while, the prison administration carries out violent campaigns to ensure discipline and control inside prisons. This periodic and sudden violence from the prison administration is an additional factor to push cases towards psychological breakdown or mental illness. This is because even if a detainee experiences this violence once or the cell next to him experiences it, this obsession remains in his head. Here, detainees who have been subjected to this experience stand on the brink of severe anxiety, because they are already worried and exhausted by the general prison conditions, and when this continues for long periods, it turns into chronic anxiety and the detainee is released from prison in a state that continues even after his release. The overwhelming majority, if not all, come out mainly with chronic anxiety disorder, because the whole climate suggests anxiety, fear and terror and accompanies detainees for many years after their release from prison and may continue with them for the rest of their lives if the person was not treated.[21]
4- Discipline
The prison administration uses discipline as a means of ensuring control over prisoners by transferring prisoners to solitary discipline cells. In interviews with former detainees who spoke about disciplinary and procedural rooms, one former Tora Prison detainee said:
“Disciplinary cells: They are designed to harm, and the reasons are varied. They are normal cells, but nothing is allowed to enter with the prisoner, he does not even enter with soap, there is no exercise, there is no food from outside the prison, you stay in the cell indefinitely. Discipline is originally designed to physically and psychologically harm prisoners, often remaining an individual punishment. It is a cell of one meter by one meter and a half, there is no bathroom, no ventilation, no lighting, no blankets, and no exercise is allowed. People use bags or buckets for a toilet, and you are left like this; you sit there smelling the toilet – your excretions. You enter it with one loaf of bread a day and a bottle of water, and before you enter, you get humiliated and are subjected to violent psychological violence, and it is for anundetermined period.”[22]
Dr. Suzan Fayad also adds about disciplinary cells:
“I consider disciplinary cells to be a death rehearsal, I call it a death rehearsal; you enter, you might die, you may come out. A disciplinary cell is a cell very small cells made of concrete or tin in the walls, directly exposed to the sun. The temperature remains very high, higher than the normal temperature, which is already high, meaning if the temperature on the street is 40, then the cell remains 50 or 60. The cell is almost an oven, in which they sit with a bottle of water and a loaf of bread.”
As a result of these harsh conditions in the disciplinary rooms, 27-year-old Abdel Rahman Tariq, known as “Moka”, attempted suicide after being transferred to disciplinary detention in Tora Prison. The officer questioned his possession of a mobile charger, after which the security threw food coming to him from the visit, insulted him with words and treatment and prevented him from entering the visit – according to his family – and then he was transferred to the disciplinary cell for a day, which prompted him to attempt suicide by taking a variety of medications in order to end his life. Following his suicide attempt, Moka was taken to hospital by prison administration and rescued. According to his family – “After the last rotation, Moka’s psychological state collapsed, and he went on hunger strike for about 53 days because he was added to a new case.
In some cases, such conditions lead to death, such as in the case of Omar Adel, who has been held in pretrial detention since 2014 in Tora Prison – who died five days after being placed in a disciplinary cell as a result of the harsh conditions of detention inside the disciplinary rooms.
4.3 Mental health impact of human rights violations against prisoners
Prison is a correction and rehabilitation place. Prisons and places of detention shall be subject to judicial supervision, and anything that is contrary to human dignity or endangering one’s health is prohibited.” (Article 56 of the Egyptian Constitution)
According to the Egyptian constitution and international legislation, places of detention are inherently correctional and rehabilitation institutions, but there is a huge gap between what detention institutions are supposed to be and what is happening in reality as they include conditions that lead to the collapse of the physical and psychological health of detainees. Prisoners inside places of detention are subjected to a series of violations, with the aim of disturbing and abusing them. The ongoing practice of such violations against detainees is a major cause of deterioration in their mental health to the extent that it may threaten the lives of some depending on the extent of the violations committed against them.
Dr. Suzan Fayyad talks about the effects of violations practiced on political detainees for the purpose of abusing them:
“Abuse of political detainees is intentional and sustained, and the prison administration deliberately makes matters worse, with a strong desire to punish and abuse them where the violations against them multiply and are deliberate, and that is in addition to severe medical negligence, and banning their rights to visits and so on, leading to the collapse of the detainee’s mental health and may detainees are driven to try to end their lives. Suicide itself requires a very, very high degree of helplessness and hopelessness. There are insufficient studies on past suicide rates in prisons and current suicide rates, generally in prisons. But in the midst of past and current political arrests, we have seen multiple cases, and we have interviewed multiple cases of those who came out of prison and said they had considered suicide dozens of times or had already attempted suicide. “
4.3.1 Prohibition of visits
The ban on visits is one of the most important violations that affect the mental health of detainees because it affects their access to their basic needs of food, clothes and medicines, as well as their psychological needs from the support coming from their families and their sense of hope to join their families soon and also to check on their families. Denial of visits and communication with the outside world is a violation of a fundamental right, as the Standard Minimum Rules for the Treatment of Inmates state: “Prisoners shall be allowed visits, in addition to spousal visits, shall be applied without discrimination, women prisoners shall have the possibility to exercise this right on an equal basis with men, procedures and places shall be established to ensure fair and equal opportunity to avail themselves of this right, with due regard to safety and dignity. Inmates should be distributed to prisons as close to their place of residence as possible, and prisoners should be allowed to be visited by their lawyers without eavesdropping or censorship and in complete confidentiality.[23]
This prohibition also violates article 55 of the Egyptian constitution that “anyone who is arrested, imprisoned or whose freedom is restricted must be treated in a manner that preserves his dignity.”[24] The Law on the Organization of Community Correction and Rehabilitation Centers also stipulates the right of convicted persons or pretrial detainees to receive a visit twice a month, as well as the right of an inmate’s lawyer to meet with him in private, provided that a permit is obtained from the competent authority.[25]
The prison administration uses the ban on visits as a means of pressure and punishment for political detainees, sometimes to the extent of preventing the exchange of letters between them and their families. The activist Alaa Abdel Fattah was also detained in Tora Maximum Security Prison, where he was prevented from visiting, prevented from communicating with his family through letters, and denied visits containing hygiene tools, medicines, clothes, and letters. Alaa Abdel Fattah is currently detained in Wadi al-Natroun prison after pressure from his family to transfer him after the numerous abuses and arbitrariness he witnessed in Tora prison. The same thing happened with journalist Solafa Magdy during her pretrial detention in Qanater prison, where she was prevented from visitation without giving any reasons or even allowing her family to deposit money in prison in her name[26].
This abuse profoundly affects the mental health of detainees, especially if practiced for long periods of time. For example, poor detention conditions and denial of visits in the maximum-security Scorpion prison worsened to the extent that a number of detainees went on an open-ended hunger strike in August 2021. There have also been several suicide attempts among detainees due to harassment, denial of visits for four consecutive years and catastrophically poor prison conditions.[27]
This systematic abuse of political detainees has been deliberate and systematic and has been going on for many years, especially the denial of visits and the denial of detainees from communicating with the outside world and their families, which leads them to slowly collapse in prisons.
Blogger Mohamed Ibrahim, known as Oxygen, attempted suicide inside his solitary confinement in Tora Maximum Security Prison 2, due to arbitrary measures, preventing visits, and the intransigence of the prison administration in receiving any money placed for him in the prison secretariat. News of his family has been prevented since February 2020, that is, for more than a year and a half before he reached a state of despair that led him to attempt suicide on the first of August 2021, which his family learned from the renewal sessions for the rest of the detainees. In addition, the State Security Prosecution refused to issue permits to his lawyer to visit to determine his physical, mental, and psychological well-being.[28]
4.3.2 Intentional medical negligence and its impact on the mental health of detainees
According to testimonies from a number of former detainees in Tora and Qanater prisons, clinics in the prison are operating at double their capacity as a result of the severe overcrowding that prisons currently suffer from. As a result, a certain number of individuals are scheduled to leave each ward to be presented to the doctor, while the rest would have to wait for another day when the doctor is present, in addition to the sharp and humiliating treatment of prisoners and harassment at other times, in addition to not providing any privacy for prisoners during the medical examination.
In an interview with a former detainee in Tora Prison, in which he spoke about negligence in providing medical care inside the prison and its impact on mental health inside the prison, he says:
“The worst psychological experience ever in prison for me was going to the clinic and dealing with the officers in charge of the clinic. Your mistreatment as a new prisoner is organized and deliberate and you are subjected to physical and psychological violence from the first moment, and it is customary to shock the prisoner and keep him afraid and terrified of the place. You are subjected to violence in various forms, whether individually, in inspections, discipline and reasons, but the worst for me was the clinic. This has 3 reasons: – First, the pressure: – The inability of the clinic to deal with this number of people, so they resort to intimidating people away from the clinic. Second: – No psychological problems are considered reasons to go to the clinic; prison is really a very fertile environment for psychological and physical disorders, in people who are worried all the time about their health or have real psychological problems, and this is not understood at all and is treated as a trick or feigning by prisoners. The third and most important thing is the doctor officers. The MOI does not deal with them as real officers, so the only time they can exercise power is over prisoners. The process itself is highly humiliating in that it includes body searches at least twice, very long waiting periods, shouting and insults all the time, sexual harassment; both the behavior of the doctor or the procedure itself is harassing. I mean, for example, the chief of detectives was standing in the middle of the prison yard and saying search the genitals. Harassment takes place and there is no way to complain about it. For example, there was a police officer who was harassing me in a crude and continuous manner, and I knew I could not file a harassment complaint, and I said that he was taking a bribe.” [29]
In addition to generally poor health conditions inside prisons, deliberate medical negligence is used as a means of abusing political detainees. It can be said that medical negligence is the norm in Egyptian prisons, both intentional and unintentional. Prison authorities often use denial of medical care as a means of punishment and abuse towards political prisoners in particular, but in general, prison administrations do not care about the health of detainees and treat detainees as inferior.
According to testimonies of former detainees, prison administrations do not provide any real health care to prisoners, either in terms of physical or mental health. The prison doctor often prescribes the same medication – aspirin or antispasmodic for example – to all prisoners and to all symptoms alike. In addition, the prison administration is intransigent in receiving medicines coming on visits and prescribed by outside doctors, especially with political detainees, in violation of the right to health care recognized in article 12 of the International Covenant on Economic. Social and Cultural rights that “everyone is entitled to the enjoyment of the highest attainable standard of physical and mental health”[30] as well as in contravention of the Standard Minimum Rules for the Treatment of Inmates, which recognized the right of prisoners to receive health care and[31] everyone, including persons in detention, has the right to the highest attainable standard of physical and mental health. The State must assume responsibility for providing health care to prisoners, without discrimination on the basis of their legal status.
About the impact of negligence in the provision of health care on the psychological and mental health of prisoners Dr. Suzan Fayad says:
“Intentional medical negligence is a type of increased stress that puts a person in a very bad psychological state and puts them in a deep sense of humiliation. Prisoners are left in cells suffering from worsening symptoms of the disease, an illness that can resolve in two or three days can take up to two or three months to treat to the extent that the disease turns into a chronic disease. When we talk about medical negligence, it is considered torture and very violent psychological pressure on those who are going through it as well as on its viewers, and sometimes its impact on those who watch it more, because they feel helpless. In cases of death from very strong causes, such as a detainee who has a very violent heart attack, or a diabetic coma, his colleagues in the cell sit banging on the doors and no one asks about them; so the next day or perhaps the same day he will be dead and these are cases that have already happened, such as the case of Shadi Habash[32], who died as a result of medical negligence in prison. The physical pain, the sense of psychological humiliation, their lack of importance, and their exposure to direct aggression against their dignity and human rights to this degree, they have the feeling that they are worthless. This is, of course, essential in destroying their psychological state, and most likely this is intentional and deliberate.”[33]
4.3.3 Prolonged solitary confinement and its impact on the mental health of detainees
Solitary confinement is one of the penalties imposed on prisoners – according to the law – for a period not exceeding thirty days or placing the convicted person in a special high-security room for a period not exceeding six months by a decision of the Assistant Minister for the Community Protection Sector at the request of the prison warden and after taking the opinion of the prison doctor, and writing the minutes of the prisoner’s statements, investigating his defense and the testimony of witnesses, in cases specified in the regulation. The convict may not be transferred to the aforementioned room if he is under 18 years or over 60 years of age.[34] However, the Egyptian authorities deliberately abuse detainees on the basis of political cases by detaining them incommunicado, without committing a sinful act on their part, which requires punishment for solitary confinement, for long and indefinite periods in violation of the law, in which they are prohibited from exercise, from receiving reading materials, preventing visits in many cases, in addition to preventing the exchange of letters between them and their families. This is in violation of Rule 43 to 45 of the Standard Rules for the Treatment of Prisoners, which states that ” prolonged or indefinite pretrial detention is not permissible and recalls that solitary confinement under the Standard Rules is the imprisonment of prisoners for 22 hours or more a day without a means of meaningful contact with others.”
Prolonged solitary confinement refers to solitary confinement for more than fifteen consecutive days. Solitary confinement is used only as a measure of last resort, in exceptional cases and for the shortest possible time, and solitary confinement is prohibited for prisoners with disabilities, women and children.[35]
These conditions have a devastating impact on the mental health of detainees. In 2011, the UN Special Rapporteur on torture of the UN High Commissioner for Human Rights (OHCHR) called for the prohibition of solitary confinement of prisoners except in exceptional circumstances and for the shortest possible period with an absolute prohibition on its use on minors, children, women, and people with mental disabilities. In addition to criminalizing solitary confinement if it exceeds 15 days as torture due to some permanent mental damage after a few days in solitary confinement[36].
In the report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, submitted to the United Nations General Assembly at the sixty-sixth session, item 69 b of the provisional agenda, he discusses the effects of solitary confinement on the mental health of detainees, noting that an individual who is denied access to an adequate level of social stimulation is unable within a short period of time to maintain a reasonable level of mental health. In fact, just a few days of solitary confinement are enough for an individual’s mental activity to turn into an abnormal pattern of stupor and delirium.
The report also raised the point that the longer solitary confinement is held or the greater the uncertainty about the extent and length of that duration, the greater the risk of serious and irreversible harm to the prisoner. The report stated that with regard to the psychological and physiological effects of solitary confinement based on the research conducted, negative effects on mental health may occur after only a few days in solitary confinement, where solitary confinement causes violent mental disorders which is called “prison psychosis” and symptoms include anxiety, depression, anger, cognitive disorders, sensory perception abnormalities, pathological doubt, psychosis and self-harm.
The report also states that after experts examined the effect of solitary confinement, the minimal stimulation experienced by individuals during solitary confinement deteriorates their mental activity after only seven days.[37]
It is worth mentioning that these effects have been studied according to the minimum motivation, which is represented in exercising for an hour a day, visits, the introduction of reading materials and the exchange of letters, which is often prevented in Egyptian prisons, as in the case of Alaa Abdel Fattah, who remained in solitary confinement for nearly two years, and Dr. Abdel Moneim Aboul Fotouh who continues in solitary confinement[38] for 5 years from 2018 until now, despite his critical health condition as a result of poor detention conditions[39], and others held in solitary confinement for many years.
In a related context, the report stresses the worsening mental health of those held in solitary confinement to the extent that it puts them at risk of ending their lives and committing suicide. Political activist Alaa Abdel Fattah announced in the hearing to renew his detention on September 13, 2021, his ideas of getting rid of his life as a result of his desperation to improve the conditions of his solitary confinement in Maximum Security Prison 2 in Tora Prison Complex. Until then, he had spent two years in pretrial detention pending Case No. 1356 of 2019, where he was mostly prevented from visits, exchanging letters with his family, and preventing him from receiving reading materials such as books and newspapers, in addition to his repeated complaints of ill-treatment in prison.
According to his lawyer Khaled Ali, Alaa told the judge, “I am in a bad situation, and I can’t continue like this. I’m going to commit suicide, and tell my mother, Laila Soueif to prepare to receive condolences.”
Ali adds that after the session he told him:
I know that the new case will be referred to court.> I have been like this since 2011. I haven’t spent a whole year outside prison. if they want me dead, I shall commit suicide and get it over with.”
Alaa was arrested from Dokki Police Station on 29 September 2019, after serving his daily police probation period for five years, in addition to another five years spent in prison in the case of the Shura Council demonstration in 2014.[40]
4.3.4 Prolonged pretrial detention and rotation on new cases and their impact on the mental health of pre-trial detainees
Pretrial detention is a precautionary measure, which is applied in certain cases stipulated in the Code of Criminal Procedure in Article 134.[41] The fourth paragraph of article 143 stipulates that: “In all cases, the period of pretrial detention may not exceed one third of the maximum penalty of deprivation of liberty, not exceeding six months in misdemeanors, eighteen months in felonies and two years if the penalty prescribed for the crime is life imprisonment or the death penalty.[42]
In reality, however, the Egyptian government uses prolonged pretrial detention, which in some cases exceeded the absolute legal limit set out in the text of the aforementioned article. Pre-trial detention has been transformed from a precautionary measure into a punishment and a tool of abuse and punishment for political prisoners.
Speaking about the psychological effects of prolonged pretrial detention, Dr. Mona Hamed, a psychiatrist, says:
“We all have adaptive abilities, but how does the detainee adapt to something unknown in the first place, everything that brings the detainee to some degree of adaptation, collapses because there is a possibility that he will be released next time, will his imprisonment continue for several months, a year, two years, all this is very stressful for the detainee’s psyche and pushes him to gradually collapse.”[43]
After the Egyptian government witnessed widespread criticism over the use of prolonged pretrial detention, the Egyptian authorities resorted to the use of “recycling” pending new cases as a means of abusing political detainees. It is the re-detention of individuals detained pending cases of a political nature who have been issued release orders, on new cases on charges similar to those in which they were previously released on paper, in order to ensure the continuation of their illegal detention pending other cases[44]. This is contrary to the right of individuals to liberty and to be brought to trial promptly within a reasonable time or released, as provided for in article 9 of the International Covenant on Civil and Political Rights, article 14, paragraph 3, that “Every accused of a crime shall enjoy, on full equal footing, the minimum guarantees of which he shall be tried without undue delay.”[45]
In the same context, Dr. Suzan Fayad adds about the impact of recycling pending new cases after serving the maximum period of pretrial detention on the mental health of detainees, and its relationship to suicide in Egyptian prisons:
“After the detainees acknowledge the fact of imprisonment and all the daily grievances that accompany it, the detainee adapts on the basis that this situation is temporary, with a maximum period of two years, which is the maximum legal period of pretrial detention. After rotation, the detainee goes into severe shock, complete loss of hope and severe depressive illness or anxiety. In some cases, the person may be rotated a second and third time, in which case these are ideal conditions to destroy the detainee’s psychological ability to endure. Because his ability to adapt requires that he understand what’s going on or hold on to hope completely collapses. Some people stop feeling hopeful by preparing themselves for the fact that we are sitting for a long time and the possibility of this remains a solution, because attachment to hope every once in a while, is completely destructive in terms of psychological state. But mostly, especially with the feeling that in a state of open detention does not know when it will end, he enters a deep depressive state and a complete loss of hope, which may lead to despair and then suicide comes as a last resort to end this situation. Suicide is more closely related to the loss of hope than to life difficulties because people in general learn how to face life difficulties little by little, in addition to feeling that this situation is temporary, but after the shock of recycling pending a new case after spending two years in pretrial detention, it is a shock that is very difficult to absorb. Of course, we have seen a number of suicides, but the cases that we heard have thought about suicide or actually made attempts after the recycling shock, are too many cases and their parents are asking us for medical help because their parents are unable to deal with the shock.”[46]
In addition to the environmental factors in places of detention and the conditions to which prisoners are exposed, there are individual causes and factors that affect the extent of the mental health of detainees, which may push some of them to try to end their lives, especially in the case of a combination of individual factors in addition to environmental factors, such as having previous mental disorders or in the extent of support provided by the community surrounding them, whether in prison or outside prison, or in the extent of the violations they suffered.
All these factors combine to determine how well each individual responds psychologically and mentally to the stress they experience in prison. Everyone is affected by general conditions, stressors and traumatic conditions in prisons, but the extent to which each detainee is affected and how quickly his or her condition deteriorates to the point of suicide in some cases varies according to a number of factors that vary from individual to another.
In an interview with Dr. Mona Hamed about the reasons affecting the factors of mental imbalance or ill health of prisons, she talked about the impact of a group of factors on the detainee, such as age, gender, whether he has been previously detained, whether he has been subjected to previous violence, in addition to his personality, social, economic and political background, and other factors such as whether he was detained randomly or has a political background; all of these factors interact at the moment he is violated. She says:
“For example, if a detainee has a political affiliation or advocates for a particular cause or message and a person realizes that he may be at risk of detention because of his or her cause or political affiliation, this expectation may protect him or her to some extent than, for example, a person who has been detained from the street without causes. The reason for this is that the mind always asks a key question, “why”, why does this happen to me, and it makes a difference in a person’s reception of the event. The human mind always tries to understand the causes, and if the reason is understood, the suffering decreases, and if the reasons are not understood, the mind gets tired and when the mind gets tired, the detainee feels more pain, and wonders why this is happening to me, when this will end, what to do, how to act now, and so on, questions that put the detainee in a vicious circle of thought. Also, support is an essential factor in mental health, whether spiritual support or community support. Detainees with a religious background have support coming from their spiritual feelings, and that the detainee, for example, will be rewarded well or that God is with him; this feeling gives some reassurance and comfort to the detainee. The mental health of detainees is also directly and very strongly affected by social support, both from other detainees and from friends. If a detainee is able to reach a detainee in the revenue cells – where the detainees are present for 11 days or longer without visits, food, or money – and sends him support, whether material or moral, this will bring peace to the person. For a detainee to see familiar faces, someone who reassures and respects him, exchanges conversations and jokes greatly affects the person’s feeling. As terrible and horrible as the abuse may be, and the officers treat him with contempt, degradation, and cruelty, if he finds people to support him and treat him with respect, this affects his psyche very positively.
In addition, a person with physical or mental health problems is more likely to be affected than a healthy person. All these factors intervene at the same moment to determine a person’s psychological and mental reaction to stressful conditions in prison.[47]
5- Forms of deterioration of the mental and psychological health of prisoners
Manifestations of deterioration of the psychological and mental health of detainees are represented on several levels, including the emotional level of the detainee, which is reflected in a range of psychological symptoms such as acute anxiety, severe depression, panic attacks, self-deflation, self-harm, and drug addiction. It also affects his perception of events in his surroundings and his dealings with his surroundings, whether inside or outside prison, which may be represented in the emergence of violent and aggressive behaviors towards others.
5.1 At the level of the individual
5.1.1 Deliberate and systematic destruction of self-image, psychological defenses, and capacities
A former detainee says
“All my adaptive and survival defenses collapsed, and I couldn’t repair them, replace them or create new defenses. I couldn’t do anything but wait, I was in a state of constant waiting, the only thing I was doing was just waiting for the end of the day. The end of the day seemed very far away, so I used to start every day while waiting for my end, every day that starts I sit and wait for its end. I had no idea how one could continue in prison.”[48]
The mental health of detainees gradually deteriorates, from the moment of arrest and the fear associated with the arrest process, in addition to the violence and threats used by officers, through periods of enforced disappearance inside National Security headquarters and police stations, to detention in a prison.
It is not only about the fear or panic resulting from the threat of torture, murder, the detention of their families, poor prison conditions and the failure to meet their basic needs, but also about the deterioration of their self-image and their slow and continuous destruction as well as their feeling of extreme helplessness either to help themselves or their detained friends who are subjected to violence, torture or death in wards or in disciplinary cells. All these factors combine to break down their psychological defenses day after day, to the extent that it pushes them to end all this and attempt suicide. This is confirmed by the Guidelines for Mental Health in Prisons[49], which states that suicide is often one of the most common causes of death in correctional institutions, as a result of the combination of all these factors to cause unbearable pressure on the detainee, which leads him to end his life.
In an interview with a former detainee in Tora prison about his time in prison, he said:
“It is necessarily known that the very idea of imprisonment affects the psychological state, all the effects are boiled down to the constant concern to reshape your perception of yourself, so that your perception of yourself becomes trivial, slighter and more despicable than you imagined or knew about yourself. One had perceptions about himself that he had rights, that he had human consideration, that he had human dignity, and so on from impressions to the person being formed about himself. Prison is careful to destroy these concepts; you have no dignity, no human consideration, no rights, no care, you are literally on your own and you do not have a will. This puts the prisoner in a state of fatal conflict with himself, should I surrender to their narrative about myself, I really have no rights and nothing and surrender to this situation and never resist and be punished.
This conflict takes you into three circles, acquiescence or surrender, suppression and that you remain careful to adhere to your concept of yourself but suppress these reactions in order to be able to survive, or the third case that you can’t check the control of the loop – an infinite circle of abuse and punishment. One of the police secretaries always said the sea of harm is wide, in an indication that anything that can harm you in greater needs and in greater and more harm and you will not be saved. I see that no matter how much a person tries to defend his impression of himself and resists being disciplined and reconstituted in the other, no matter how conscious one is, no matter how solid and strong he is, he will undoubtedly be affected by this process.”
And continues.
“For example, you are insulted by someone directly face-to-face and you have learned to suppress your feelings in order to be polite – punished by moving him to the disciplinary cell – although this is something to adapt, it affects you to the greatest extent. You accept insults, for example, by generating feelings and impressions, one does not like to know that he has the ability to get it like this, that he is insulted and wanted. It has complications that when one is insulted by a colleague in prison or later in normal life, he is forced to have a frank discussion with himself. Either he returns the insult, or you split yourself or swallow it and remains subject to humiliation by anyone, or you overreact in a vindictive way to compensate for the fact that you are not able to defend yourself. The amount of feelings that are generated by the person and me is a very delicate and detailed process, slow and continuous, you all the time acquire negative and hateful meanings and feelings and you will never be able all the time to deal with them or treat them, a laborious process to the farthest extent.
War directly remains about the formation of your concept of yourself, of the Ego – the ego – of your belongings, regardless of whether this ego is justified or unjustified and appropriate for you or not. However, you are in constant attack on the ego in every detail, either you give it up and lose yourself completely and remain a human being without dignity, or you strengthen your ego (because if you do not see yourself representing a human value, you will not be able to withstand) the prisoners’ selves are inflated in some way or try to amplify their egos to survive direct attacks. If you go out to normal life by needing to form this ego again, what personal and what is not personal, what is insult and what is normal, what is dignity and what is normal joking, you will still lose your connection with reality and its mechanisms, and you are required to start from the beginning and new. Of course, there is still an arduous journey with a lot of flopping, losing many relationships and losing yourself.”[50]
5.1.2 Mental disorders and symptoms of prisoners in detention institutions
Penal Reform International’s Guidelines on Mental Health in Prisons speak of the [51]emergence of multiple types of symptoms of mental illness as a result of being in detention institutions, which may often require urgent medical intervention, especially if it poses a threat to the life of the detainee or others. The Mental Health Guidelines in Prisons categorized common symptoms into disruptive and aggressive behaviors, calm, sadness or withdrawal, lack of self-care, sharp changes in mood or behavior, preparation for suicide, suicide and self-harm, sleep problems, acute fear and anxiety, depression, severe panic attacks, irritability, and disconnection from others.
Talking about the symptoms of mental illness that appear on the majority of detainees inside Egyptian prisons, regardless of the severity of symptoms and the individual abilities of each detainee in dealing with them, Dr. Suzan Fayad says:
“All known types of expected and well-known psychological effects, such as acute anxiety, which may turn into chronic anxiety, or severe depression, which may lead to suicide attempt, whether inside prison or after the detainee is discharged and unable to integrate into normal life again, or post-traumatic stress disorder. In some cases, mental disorders lead to symptoms of mental illness, such as psychotic depression. The symptoms of these disorders are very severe, experienced by the detainee on a daily basis, a sense of constant tension, a sense of extreme fear. Recalling memories of events in the form of an intrusive image in a post-traumatic stress disorder (PTSD) in which a physical response occurs, such as a person screaming or falling to the ground believing that he is going through the same experience again, especially in acute experiences such as torture. Feeling very sad, feeling empty, feeling worthless, deep feelings of guilt that can turn into a pathological and chronic guilt that lasts for many years. Feeling unable to communicate with others. Feeling unable to interact with external events or others completely, some describe feeling as if they are a robot, or a moving machine and that there is a distance between him and those around him, feeling of lack of self-awareness or knowledge, does not feel himself, in addition to continuous dreams and nightmares that are of a high degree of severity or severe insomnia or difficulty in continuing to sleep and an unusual feeling of lack of familiarity and alienation, all of these symptoms may push detainees to commit suicide, whether inside the prison or even after they get out of it.”
5.1.3 Self-harm – suicide: Why do detainees resort to self-harm?
The guideline provided by Penal Reform International also indicates that correctional institutions must be wary of self-harm and suicide behaviors, as they are common behaviors in prisons that lead to death, and that staff in correctional institutions should pay attention to self-injuring behaviors, initiate meaningful conversations with the prisoner, ensure that appropriate supervision and continuous human communication are provided, in addition to paying attention to any tools that may be used in self-harm or suicide[52].
Through a number of interviews conducted with a number of former detainees, the phenomenon of self-harm in prisons for various reasons has been documented, as some use it as an alternative to harming others and bring out feelings of anger and oppression on themselves. Or they are angry with themselves for not being able to respond to the insult and violence to which they are subjected, as some criminals use to avoid punishment or discipline.
In an interview with a former detainee, he confirmed that this behavior is prevalent in prison and is sometimes considered a way to discharge negative emotions and charges of anger, whether clearly such as self-injury or in the form of destructive behaviors such as severe drug consumption or tattooing the body with unsanitary and potentially contaminated tools “such as needle pricking.” In addition, self-harm may be a means and a method of objection. He says:
“We hear and see that criminals sew their mouths as a kind of objection, making deliberate injuries to himself in order to avoid deportation or transfer in what is known as alienation or because the prosecution will release him to prison if he is subjected to great harm from the prison administration. We heard and saw other methods, such as “fecal syringes” injected under the skin so that the objector could get an infection and be discharged to the hospital if he was sick, or to postpone his transfer to another prison. He also shaved his eyebrows because the prosecution considers this torture, and some people slit their testicles so that they can go to the hospital if they feel tired and sick and when they commit this behavior, they are transferred to the hospital.”[53]
Asked about the reasons that lead detainees to harm themselves, Dr. Mona Hamed adds.
“Pressure, all the pressures we talked about earlier affect the psychological and mental state of the prisoner, his sense of self and the mechanisms for dealing with the intense emotions he experiences in prison. Many criminals may use the means of harming themselves or others because this is part of their background or previous culture. In addition to factors such as drug use in prisons, self-injurious behavior, may hurt themselves and suffer withdrawal symptoms. Some self-harm is committed as a means of putting pressure on the prison administration or as an attempt to discharge negative emotions. Some people hurt themselves in order to “feel”. In a form of reaction to trauma or harsh circumstances, a person may feel he is freezing, freezing on all levels and losing his feeling. In other words, he feels nothing, he doesn’t feel his body, he doesn’t feel himself – Where am I? and who am I? and so on. After some time, the “insensitivity” is very painful in itself. There are people who hurt themselves in order to feel or try to alert themselves and stay prepared for the coming danger or try to remember certain things. Some people have this happen to them as a result of the “why” question. Some illogically come up with the idea that “I deserve, I deserve because, for example, I hit my mother or brothers, or because I did anything in my life that requires me to be exposed to this. I mean, I am a person who once beat my little brother, I deserve it; of course, this beating was terrifying, a kind of torture. I mean, he was beating his little brother, and he pledges that when he is released, he would never beat him again. It is not necessarily at all that the person is aware of the cause, he may commit the behavior while unaware of the reason. He feels guilty and the feeling of pathological guilt is a symptom of many psychological symptoms such as depression and others, so “I hurt myself, because I am guilty.”[54]
5.1.4 Substance abuse in prisons.
The Mental Health Guidelines in Prisons states that a mentally ill detainee suffers from a number of vulnerability aspects, including substance abuse and dependence. In an interview with a former detainee about the high rates of substance abuse in prisons as a way to escape harsh prison conditions, he said:
“Of course, the rate of drug use inside prisons for criminals in particular, if available, in my opinion is not less than 99% if one does not want to say 100%. In conditions like prison conditions, it is essential for survival, not luxury. Criminal detainees in particular go through a struggle in which they expose themselves to significant risks such as extending their prison term, discipline, etc., and other risks for using their bodies as a means of smuggling, such as swallowing, lifting, and suspending. In my opinion, I would see this as a struggle for survival, if we were talking about a detainee who is subjected to conditions that cannot be adapted to, without literature to support him in the case of criminal detainees, or family support, or institutional, partisan or societal support he receives. On the contrary, he is all the time rejected and socially rejected outside the prison framework. In this case, drugs become a necessity for survival, and not only that, but they also have an economic dimension in prison, not only psychological.
Drugs are central to the prison economy for criminals, in addition to cigarettes, which are the official currency of the prison. Detainees from economically less privileged environments, who have no family support or visits, or who have been transferred from distant prisons for long periods. In addition to their families suffering from poverty and unable to meet the prison requirements, which are very expensive, all of them are economically dependent on drugs. Of course, other than the drugs themselves, you are dealing all the time with detainees who have strong withdrawal symptoms, which affects the extent of violence and aggressive behaviors in prisons, problems about money, about betrayals, withdrawal symptoms that lead to self-harm, especially since the prices of drugs in prison are many times more expensive than their price outside, as is everything else in prison.”[55]
Dr. Mona Hamed adds:
“Of course, the rates of substance use by detainees are on the rise as a result of the harsh and intolerable conditions to which they are exposed.”
Regarding the impact on the psychological and mental health of detainees, she says:
“Of course, they are harmful substances and have an impact on the mental health of the detainee if not in the short term, then in the long term. “Whether the substance itself or the symptoms of its withdrawal, all contribute to the deterioration of the mental health of detainees.”
5.1.5 Suicide attempts among detainees inside Egyptian prisons.
“Don’t ask me about my youth that I lost. And ask the beautiful country that has grown with hatred. How did it discard me? Who am I? I was killed by a jailer”
(From a suicide letter by a former detainee, 2018[56]).
In a testimony of a former detainee about her attempt to commit suicide after being tortured and ill-treated, as well as the denial of family visits, which contributed to the deterioration of her psychological state, and she was already suffering from post-traumatic stress disorder before her detention, she says:
“I was arrested in 2017 for covering the events of Warraq, I was dealt with very violently, I went at first to Abdeen station, the chief of detectives at the time told the police secretary to slap me and suspend her. At first, I said they would handcuff me and that is all. They scared me, then I found they suspended me and there was nothing left for me but to complain, so the prison governor came and slapped me. They preferred to hit me while I was unable to move. There was an 18- or 19-year-old boy with me, he started crying and then he told me what happened because I lost consciousness. He said, “They were coming down on you, your body was cold and rigid, and sweat came down from all sides, the department was terrified, but it took a quarter of an hour until you began to exhale. Today, I have a great fever, praise be to God, our Lord blessed me with good girls in the ward, the security told them to beat me, but they agreed with me that when we hear him coming, they will pretend to do as he told but that they will spare me.
Before my suicide attempt there was a new warden who was checking the cells. There were many writings on the wall such as “the revolution is a justice that will triumph over injustice”. He read it and asked who wrote this. Then he turned and found something else: down with all traitors, military, remnants of the old regime and the brotherhood. He turned to abuse me, and I protested so he held me and kept slapping me. I was trying to push away his hand, so he pulled me from my hair. I pulled at his shirt. I swear I was so badly beaten, the men standing around were crying from what happening to me. They kept beating me until they tired. There was even an officer who tried to defend me and was trying to cover my mouth so that I stop talking or answer back to the warden. That day I was injured in my head, one of my teeth broke, I had tendon tears in my hands and feet and my body was covered with bruises. He left me when he felt exhausted. He asked for a glass of water because he was drained and he threatened to charge me of possession of drugs. I told him I was a political prisoner, and nobody will believe you and everyone knows I am a political prisoner. He transferred me to the cell in the police station’s reception room. They tried to persuade him not to, but he insisted. The girls helped me to my feet because I could hardly walk. That was the second time I would spend the feast in prison. My daughter was only 2 and half years old. I couldn’t believe that again I shall not be with her. There were some meds prescribed for me. I decided to end my life and took three strips of the tablets. I was hardly conscious when I heard them scream “we need an ambulance”. The warden said we shall not take her to hospital, treat her here. They made me drink slated water and I vomited. Then they took me back to the cell and nobody took me to hospital. [57]
In an interview with another detainee who was previously detained inside al-Qanater prison, she says:
“I asked the chief of detectives to return me to a political ward because I was alienated, I told him I want to return a political ward because I am tired and the girls there know my condition, as all those with me in the current ward were Islamists; they refused. Nobody cared about me for 5 months, it was a kind of punishment and intransigence with me, until my mental state deteriorated very much, and I started thinking about hurting myself and attempting suicide. I told him if you don’t take me to a political cell, I will kill myself. I told him that I will electrocute myself with the water heater. Or go to the toilet and cut my wrists with one of the tiles on the floor. I was serious because I had reached the maximum of psychological collapse after torture, beatings, and alienation” [58]
One former detainee also recounted her suffering while held in a solitary cell:
“During this time, I was in the cell completely alone, with nothing to distract me, it took a huge effort to get lost. I spent long days not talking, and on other days I was talking to myself because I needed to hear my voice. In the sixth renewal of my detention, I reached the stage of nervous breakdown that I feared, I collapsed nervously and preferred to scream and throw everything in the cell and throw it at the door until my wrist cracked. On another day I tried to commit suicide, I broke my family’s watch, I cut my hand in an attempt to end my life, and then I stitched the wound in the prison hospital.”[59]
According to the Mental Health Guidelines in Prisons on the Mental Health of Women in Prisons, documented information from different countries of the world indicates that women in prisons have in many cases been subjected to domestic violence or sexual assault prior to their imprisonment. In fact, a woman in prison is more likely to actually have a mental disorder than her male counterpart. Moreover, most women are mothers and their separation from their children as well as from the rest of the family has a violent negative impact on their mental health (adapted from Bangkok Rules 12-13).[60]
The Egyptian Network for Human Rights had documented the suicide attempt by Abdullah Boumediene Nasrallah, 15 years, in Ramadan 2020 by taking a large number of pills with the aim of ending his life, especially after the intransigence of the National Security Agency in Al-Arish in North Sinai in implementing a release order issued for him.[61] Khaled Hassan, who holds dual Egyptian and American citizenship, attempted suicide inside his cell in Tora Prison in July 2019 by cutting his wrist and taking a large amount of high blood pressure pills, and prison authorities transferred him to Tora Prison Reception Hospital after prisoners found him unconscious in the cell.[62]
5.2 Prevalence of violence in prisons and how internal conflict in the prisoner’s external environment manifests itself at the level of his dealings with his surroundings
Some manifestations of deteriorating psychological and mental health of detainees are violent and aggressive behaviors in their dealings with others in their surroundings, in a conscious or unconscious attempt to discharge feelings of humiliation and anger.
Dr. Mona Hamed points out that there is what is known as the circle of oppression, in an attempt to define the impact of detainees’ interaction with the symptoms of mental health disorder and its relationship to violence as a result:
“The detainee is subjected to violence, beatings or severe insults, which makes him feel immense anger. Here he has two solutions: either direct this anger towards himself, which leads to depression, or direct it outward, and the detainee begins to assault his colleagues. Some had a way of endurance by focusing on memorizing everything they had been exposed to, memorizing faces and names for the purpose of revenge one day. Some have nothing to do with violence at all, but they are held with violent detainees. Of course, they are affected by this, because if a person is non-violent and has violence surrounding him, violence will become a form of adaptation so that he can adapt and survive inside the prison.[63]
On the prevalence of the phenomenon of violence in prisons, a former detainee adds:
“The rates of use of violence are very high in the case of criminal detainees, with advanced and very severe stages of violence amounting to violent beatings or causing severe wounds. However, in the case of political detainees, they have different literature that regulates their relationship with each other, so the impact of violence is limited. There is no room in a political cell for detainees to beat each other, but indeed with criminal detainees violence develops to very severe degrees, but this violence is contained in the wards of political detainees.[64]
6– How psychological and mental disorders of prisoners are dealt with, starting from their presentation to the prosecution until their placement in prisons.
6.1 The role of the Public Prosecution in determining cases of acute mental disorder.
Persons who are found not to be criminally responsible or subsequently diagnosed with intellectual disabilities and/or severe mental health problems whose presence in prison aggravates their condition may never be placed in prison, and arrangements shall be made for their transfer to mental health facilities as soon as possible.
(Rule 109 of the United Nations Standard Minimum Rules for the Treatment of Prisoners.)
The Public Prosecution is the competent authority to institute public proceedings and initiate its procedures before the authorities and courts, and it is the competent authority to investigate criminal cases with the accused, which determines after the investigation whether the accused will be held in pretrial detention or released. In addition, if the prosecution finds the accused suffering from a mental disorder, the law allows the investigating judge or the summary judge to request the Public Prosecution or the court before to examine the state of mental disorder of the accused, and that the accused be placed, if he is in remand detention, under observation in one of the designated government mental health facilities for a period or periods not exceeding a total of 45 days after hearing the statements of the Public Prosecution and the defendant’s lawyer, if he has a lawyer. If the accused is not in pre-trial detention, he may be ordered to be placed under observation elsewhere.[65]
However, the reality of the matter is that the prosecution does not play this role at times, especially in cases of a political nature, as the Egyptian Commission for Rights and Freedoms documented during the events of September 20, 2019, the prosecution’s investigation of a young man with mental delay, on charges of spreading false news. A lawyer at the Egyptian Commission for Rights and Freedoms reported that he attended with a 20-year-old young man with special needs, suffering from mental retardation and slurred speech, and this appeared from the first moment he spoke during the investigation, and the Commission’s lawyer demanded that he be presented to the forensic medicine to prove this. During his arrest he was dragged in the street and beaten resulting in a knee injury. He had no political affiliations and did not participate in any demonstrations. The investigator was unable to take a coherent sentence from him as a result of the disability he suffers, and despite that, the prosecution decided to detain him for 15 days pending the case.[66]
With regard to the responsibility and role of the prosecution in dealing with people with mental disorders, Dr. Mona Hamed adds:
“The prosecution must have a role in this regard, and if the person in question happens to have his lawyer, he will probably have papers and prescriptions. In the absence of a lawyer, the investigation consists of questions and answers, so there is certainly a degree of discrimination, whether this person understood the question, whether the answer has anything to do with the question. Very simple details related to human communication make it easy to determine whether the person before me understands me or not. He answers a question that he understands or not, his behavior, his appearance, how to look at him, all these needs appear clearly. If in doubt he should be referred to forensic psychiatry and this is available and possible, but this does not happen. There are people in prison who clearly suffer from a mental disorder but have not been seen by any specialist. They are usually only referred if the prison staff fear for themselves and feel that the person can cause calamity in prison. The referral here is to protect prison staff rather than provide a needed professional help.”
“Some families communicate with me to explain the condition of their relatives, as I write medications. Of course, this is not the best way to reach a diagnosis, but it is the second-best possible thing to do. Of course, I remain in a state of shock, not understanding how the disorder has not been noticed by the prosecution, or during the investigations, that he is not responsible for his actions. The description that parents describe is a description of a person who is not responsible for his actions at all. The prosecution does not know how to deal with these people, and so he renews their detention instead of sending them to hospital or providing medical care. Some of them have mental retardation, some of them have epilepsy, and some of them suffer from a psychotic disorder, some of them fell ill in prison, and others entered prison while already suffering from these conditions. In fact, it is completely incomprehensible how they passed through all the stages of from the prosecution to their inclusion in prisons, passing through medical examination and renewing their detention.” [67]
6.2 The medical examination.
The medical examination at before entering prison is an essential step to determine the physical and psychological needs of the detainee during his stay in prison, [68] but some detention institutions consider this a mere formality, the main purpose of which is to reveal any ill-treatment or torture experienced by the detainee before entering prison, or any old injuries so as not to be accused later of having cause it. This examination is to protect the prison administration rather than to determine the health needs of the detainee, whether physical or psychological.
Asked if the medical examination during prison included a psychiatric examination, one former detainee said:
“They don’t ask any questions about mental disorders at all, they only ask if you have any chronic diseases and not any psychological need.”
Dr. Suzan Fayad adds:
“Upon entering prison, detainees are examined superficially, blood pressure or pulse are not measured, urine analysis, chest x-rays and so on are not done. This is supposed to be a medical examination, but all this does not happen, not to mention a psychiatric examination in the first place.”[69]
6.3 How does the prison administration deal with cases of mental disorder
WHO reports indicate that the rate of psychological ill-health among prisoners is significantly higher and disproportionate to its prevalence in other places. One in every 7 inmates suffers serious mental disorder. As for women prisoners they suffer psychological disorders that are more severe and complicated, probably related to traumas of violence they suffered prior to their imprisonment[70].
The physical health of detainees inside prisons is neglected, either as a form of abuse against them, or as a result of the lack of a health system inside prisons, and the prison administration’s lack of interest in treating detainees. Negligence with regard to mental health is even worse, as prisoners are accused of feigning illness, and their complaints are ignored based on ignorance of the nature of mental illness, reinforced by society’s view of mental illness as a whole.
According to testimonies of a number of former detainees, whether women or men, the dealings of officers and police secretaries with those suffering from mental illness are extremely harsh and violent, and the matter reaches the extent of severe beating and violence. Sometimes they are prevented from accessing the psychiatric medications prescribed to them by doctors in order to abuse them, which may drive patients to commit suicide to get rid of this torment.
The Egyptian Commission for Rights and Freedoms had documented the suicide attempt of Osama Murad, who had committed suicide by cutting his throat on April 22, 2019, in Ward A of Tora Reception Prison during noon prayers. The prisoners went to the noon prayer while Osama went to the bathroom to end his life in order to get rid of the torment and severe depression that afflicted him in prison. His family documented that he did not suffer from any psychological condition and never thought about suicide before his detention, but the physical and psychological abuse he was subjected to pushed him to the brink of psychological collapse. Security forces had arrested him on May 27, 2015, and forcibly disappeared him for 10 days, until he appeared pending Case No. 186 of 2014 and sentenced him to 10 years in prison, on charges of joining a terrorist group.
Osama moved between more than 5 different prisons, spent 7 months in the center of Tanta and then turned to the reception of Tora for 9 months. At this time, he was in a relatively stable psychological state and was giving literacy classes to illiterate prisoners. He was transferred back to Minya prison, where he began to deteriorate psychologically as a result of physical and psychological abuse. He and six others were held separately from the rest of the prisoners, where they were monitored inside the prison with cameras and headphones at all times. He was subjected to ill-treatment and arbitrary restrictions during family visits, as he received visits from his family in the section of prisoners on death row, and the visits were monitored through cameras in addition to the permanent presence of security personnel. According to his wife, he sat with them during the visit surrounded by terror and was silent most of the time out of fear. After spending 3 months in Minya prison, he began to show symptoms of mental illness and he suffered from severe depression and then suffered a state of psychological collapse that caused him to enter into states of agitation and screaming and was presented to a doctor who prescribed him special medicines for the treatment of depression and sedative drugs, and he continued for a while until the Tora Reception Prison administration prevented the entry of medicine for him.
The Commission’s lawyer submitted a communication bearing No. 44 of 2019 Maadi petitions, registered with No. 3497 of 2019 Administrative Maadi, by investigating the aforementioned facts, interrogating the warden of Tora Reception Prison, and the Chief of Investigations of Tora Reception Prison from preventing the entry of his medicines, and investigating the Chief of Investigations of Tora Prison to investigate the incident of assaulting him by beating and cursing, which led to the deterioration of his psychological condition, and his attempt to commit suicide. He requested his transfer to a mental hospital, in order to evaluate his psychological state and putting him under observation for fear of his life or committing suicide again.[71] However, the Maadi District Prosecution, which filed the complaint on June 3, 2019, without investigating the incident.
As for how the authorities and the prison administration deal with cases of prisoners suffering from mental disorders inside the prison and whether this treatment differs if the prisoner has a medical history before entering the prison, a former detainee in Tora Prison adds:
“It depends on the nature of the disorder, in the sense that we had two basic models in the ward, one of which entered the prison with a history of mental disorder, but it remained stable for a while before it relapsed. The other person was completely healthy and then he was punished and went to a disciplinary cell and came back completely deranged; he would even throw his daughter during the visit or beat his mother or throw food on the floor of the ward and so on. The first person, who relapsed in prison, had a good sense of humor and was treated relatively nicely. The second person went into sharp tantrums and cursed the ministry of interior and was often subjected to more punishment or beatings. In addition, the prison administration does not treat anyone, meaning either someone from his family knows his illness and they give him medicine, or he is left as he is. The prison administration itself does not care or provide any medicines. If his family brings him medicines, they intervene if there is no intention to disturb or punish him. At some point, they banned psychiatric drugs in the whole prison as a punishment for the whole prison, and it was a period of tension, and they banned all psychiatric drugs from reaching prisoners.”[72]
Dr. Mona Hamed also points out the danger of preventing the entry of psychiatric drugs for prisoners with a history of mental illness:
“In the case of dealing with mental disorders and medical neglect of mental health in prisons, we must mention detainees who were already being treated psychologically and prescribed certain psychiatric medications and who regularly took their psychiatric medications. Once they are denied medication and treatment, there will be very severe withdrawal symptoms, and no one will ask about them and no one will believe them. In most cases, as long as he is a mental patient who does not harm the authority, whether he hurts his colleagues, hurts himself, or withdraws on himself, such as stopping eating or bathing, or going through severe panic attacks, they do not care. Abuse must be done in order for a reaction to occur, in people who remain completely out of control, attacking the jailer or officers, in this case they start to intervene. Even if the prison administration, for example, allows the drugs to enter, the administration often takes the medicine and gives it to the patient tablet by tablet, or decides – on their own – to give the patient half the prescribed dose or to give him the meds every other day; a completely catastrophic behavior that has nothing to do with psychiatry and has catastrophic effects on the patient and may worsen his condition.”[73]
A former political prisoner says:
“With criminal prisoners, there is no such thing as being tired psychologically in the first place, you will be taken away and kept in a toilet and the jailer will beat you. In the case of political prisoners, if the situation is difficult, he will have to see a doctor after external pressure, because they fear reactions from family and friends. In most cases, they don’t agree to allow entry of psychiatric treatment unless the doctor agrees, and most likely he won’t. I spent 4 months in prison until the doctor agreed to give me the treatment and it was a big struggle. If you turn to the doctor, it is the same treatment for all people, usually tranquillizers or hypnotics that cause fatigue and in some cases cause hallucinations.”[74]
6.4 Prison Administration Handling of Suicide Attempts Among Detainees
According to testimonies by former detainees about how the prison administration deals with suicide attempts inside prison, they stressed that the principle of punishment is the most common tool in dealing with prisoners trying to end their lives.
A former detainee in Tora Prison confirms this way of treatment, to which he was a witness, saying:
“By punishment, the prison administration punishes the detainee who tries to commit suicide and locks him in disciplinary cells. It was known in the prison that the MOI and the prison administration punished anyone who attempted to commit suicide. As long as criminal suspicion is ruled out and the person commits suicide, nothing will happen after that. “We heard about someone who committed suicide in a disciplinary cell, and nothing happened to the Interior Ministry or the officers themselves.”[75]
A former detainee also adds that:
“Dealing with criminal prisoners is a little different from political prisoners; with criminals they will be locked in a toilet and punished, but with political prisoners they worry a little about suicides because of the media coverage that will happen.”[76]
Dr. Mona Hamed emphasizes the negligence in the way prison administration officials deal with suicides inside prisons:
“Prison administrations generally have a degree of fear for themselves to be held responsible for the suicide, but there is a very long distance between awareness of the situation and responsibility. From the attempts of the detainee’s colleagues to draw the attention of the officers by knocking on the doors of the wards without response, to the stage of going to the clinic and then bringing a doctor if any, time here is a very important for rescuing the detainee. But I don’t think there’s a real interest in suicide, no different from letting any detainee suffer from kidney failure, heart attack or stroke. All of them are left until their condition deteriorates to a serious stage, and I do not think that suicide is an exception because there is a general state of disregard for human lives. In the case of suicide attempts or violent self-harm, some kind of treatment or care is provided, but the quality or speed depends on the prison administration and varies from prison to prison. Later, if the detainee is rescued, no psychological support or any subsequent assistance is provided to the detainee. Security personnel or officers may sympathize with the situation and treat the detainee exceptionally, but there are no systematic steps towards this, such as regular psychiatrists, rehabilitation, or termination of their detention in order to preserve their lives, especially those held in pretrial detention.”[77]
7- Continued deterioration of the psychological state of prisoners after their release from prison
The psychological state of prisoners continues to deteriorate even after the end of the prison period and return to normal life, as the psychological state of some of them worsens after leaving prison, in view of their recognition of their inability to deal with the outside society. This is in addition to the feeling of separation and inability to absorb the nature of life outside the prison walls, which pushes them to enter a new cycle of attempts to adapt to the outside society, which requires energy and effort that they are often unable to exert.
In addition, a number of former detainees reported feeling a sense of lack of belonging, as if no one understood what they went through inside the prison, and none of their old friends who had not gone through the prison experience could communicate with them on a deep psychological level. As well there is guilt in telling prison tales, which can generate a constant feeling of discomfort.
Symptoms of post-traumatic stress disorder appear with detainees on a daily and permanent basis. Feelings of intense and constant stress and fear increase. Symptoms of post-traumatic stress disorder appear in the form of intrusive symptoms where the person feels the same event again, in addition to feeling sad, empty, worthless and a constant feeling of self-awareness represented by the collapse of a person’s self-image and lack of knowledge of it as a result of the destruction of that image inside prisons. There is also a deep sense of guilt, which often turns into pathological guilt. In addition to the feeling of helplessness that haunts the person, whether as a result of events he went through inside the prison in which he was unable to help his colleagues, or even a feeling that he has won his freedom and still has friends inside whom he cannot help.
There are also the persistent dreams and nightmares, which are of high intensity, severe insomnia and difficulty in continuing to sleep. Some mentioned that he would wake up sometimes not remembering whether he was still in prison or had already been released, and whether his release was a dream or a reality. These symptoms have led some freed detainees to attempt suicide after being released from prison.
Dr. Suzanne Fayyad confirms from the fact that she met a number of released pretrial detainees who were colleagues of Omar Adel, who died in the disciplinary cell, and several days before that he kept calling, screaming and banging on the door of the cell until he died, that many of them felt feelings of severe guilt and severe helplessness that continued with them after their release, to the extent that they thought about suicide even after their release. The majority of them regularly visit National Security and are even unable to express their feelings on social media so as not to be detained again. She says these feelings are very difficult to absorb, handle, accept, or even imagine the idea that these memories are what will remain in their heads for the rest of their lives. Even if the depression ends, the constant feeling of guilt and helplessness does not end.[78]
At the level of daily life, it does not improve at all, as a former detainee talks about the effects that a prisoner suffers after his release from prison:
“In prison, no matter how much a person tries to resist being disciplined and remodeled, no matter how conscious he is of this process, no matter how hard and strong the person is, he must be affected by this process. Many of these effects remain indirect, for example, the idea of limited space, you are not aware that you do not have the right to get out, you do not have the right to move. For example, when I went out, I could have sat in the room for 12 hours not moving, and then I ask myself, why am I sitting all this here and thinking to myself that I can move? Or like the idea that you don’t own, and you don’t have the right to own anything, when you get out of prison you still have property, but you don’t feel that you own it or that it is yours. The feeling that you are not in control of your life and that someone else is in control of your life and deals with you that you are his property, you have been accustomed for a very long time that you are not in control of your life, you are not the one who feeds yourself and you do not even have the ability to move. All this you cannot recover from easily, even when you get out of prison to recover meanings, this is a very, very difficult process, you have finally lost your connection to reality. Unconsciously, losing the conditional connection between rent and housing, collecting money to eat, being reintegrated into normal life is still very difficult. Because you’ve practiced this slowly, continuously, sustainably, like taming an animal in prison, the idea that a person can normalize again with real life is never easy.”[79]
In addition, a person’s identity is destroyed while in prison and this is done systematically, deliberately, and sustainably throughout the detainee’s stay in prison. Dr. Mona Hamed explains the effects of imprisonment on the level of the individual identity of the detainee. She says that some officers are trained in the smallest details in terms of destroying the detainee’s individual identity and destroying his sense of self, and trained in how to understand the functioning of the human mind, for example actions such as calling a prisoner by a number instead of his name, or that everyone wears worn uniforms, everyone is clean-headed, eats the same food; this the detainee’s mind translates into the idea of “then I am without identity”, or identity disappears completely; this leads to the appearance of symptoms such as severe depression, a sense of loss and loss of self-connection, and this may push him to self-harm, addiction or suicide, even after his release from prison.
A former detainee adds about her psychological state after her release from prison:
“I came home with a destroyed psyche, I started following up with a psychiatrist, I was diagnosed with severe depression, post-traumatic stress disorder from prison trauma such as torture, beatings, harassment and severe suicidal tendencies. I can’t sit in any gatherings; if I hear the sound of a police car I have a nervous breakdown and I start screaming. Any loud voice I imagine that they are coming to catch me again. If someone touches me, I have a very severe panic attack. I think of what happened, I can’t pass in front of a police station or from a place where there are police. I took a very large number of medicines and tranquilizers; 3 months after I got out I tried to commit suicide, I cut the arteries of my hands. I couldn’t sleep, I couldn’t sleep at night, I slept during the day, I was convinced that they would break the door on me at any time and take me, I couldn’t live with this amount of fear and nervous breakdown, I cut off the arteries of my hands in an attempt to end my life. Then I entered a psychiatric hospital trying to get treatment, and I stayed for a very long time after I in our house, thinking that I was in prison. Now that I celebrate that I have been a year out of year, I started to improve a little bit, but my mental state is still bad in general.”[80]
Another detainee also emphasizes the continuing psychological effects after the end of her prison term:
“In fact, and strangely, the first time I left the department, I felt that everything started now, cohesion or steadfastness began to go so that I could feel all the psychological effects at once, 5 days after I left, I drank a caustic substance, and for the next 6 months after I left the poison, I attempted 7 suicides. I was a depressed patient before I went to prison, I was treated with medication, and until the present moment the doctor increases my medication, dose and strength of the active substance. In addition to that, I entered a hospital last January, I felt that I could not save my life, the only solution I saw was that I throw myself out of the window. Post-traumatic disorder in my case was very bad and very violent. Once while I was in the sanatorium, I was healthy, everything was white, I thought of myself in prison, and I got a violent panic attack and collapsed. In addition to that I got a case of obsessive-compulsive disorder, all the time I saw images of my card, any sudden sound any movement that underwent me, every time I heard the sound of an ambulance, I thought that I would be arrested. Until now, I am still treated, I went to 7 doctors over the course of a year, and every little while someone tries medicines in your brain, many months I do not get out of my house because I do not know how to deal with the world, when I hear the sound of the ambulance during the day, I get nervous. I feel unfamiliar needs and needs that I do not even understand.”
Dr. Suzan Fayad adds about the psychological effects that prisoners face after their release:
“Coming out of prison, they are persons who have been literally harmed, if the detainee committed a crime, it is one crime, he was not unemployed and psychologically disturbed and did not know what to do in his life. The detainee comes out of prison with a broken psyche and feels that he is without an entity, and societal conditions will destroy his psyche even more. With an army of unemployed people coming out of prison, too many divorces, cases of domestic violence, very severe cases of social violence. If we talk about society, there are many detainees who were not politicized at all, knew nothing about extremism, did not know the meaning of terrorism and then were held in cells with ISIS groups, for example. He did not have the opportunity to think or choose, but it was the result of luck according to his distribution to any cell, so that groups of extremists emerge to society, and not only that, but also are motivated as a result of the violence they were subjected to inside the prison. Prisons in Egypt are counterproductive. Some will break their psyche and stop political work as the Egyptian government wants, but the majority came out much worse than they entered, with no profession to maintain, no savings, no family to maintain, as ties were severed while in prison and all this is broken, so who do you protect? Who are you protecting?”[81]
Recommendations
8.1 With regard to prison conditions and human rights violations
- Improve the structure of prison construction and living conditions in relation to the number of detainees in the cell, provide healthy food with sufficient nutritional value to maintain the health of detainees, provide clean water and observe infrastructure repairs so that prisoners have access to clean water continuously.
- Improving the conditions of disciplinary cells, as they are considered a serious danger to the lives of detainees due to the structure of their design, which caused the death of a number of detainees, and allowing them to have several bottles of water and healthy meals of nutritional value. In addition, the detainee is allowed an hour of exercise a day, and they are allowed to use toilets instead of using a bucket.
- Comply with Article No. 38 of the Law No. 396 of 1956 Organizing Community Reform and Rehabilitation Centers in accordance with its latest amendments regarding the provisions of visiting and correspondence, and immediately stop adopting a punitive approach with political detainees by preventing family visits, preventing the exchange of letters between them and their families, and allowing their families to leave funds in the prison’s secretariats.
- Immediately stop using prolonged solitary confinement as a means of harassing political opponents.
- Improving the level of services provided in prison clinics in terms of the permanent availability of an emergency doctor in prisons and the availability of different types of medicines according to each organic disease, and in the absence of appropriate therapeutic medicine, the patient is transferred to external hospitals for treatment promptly in a way that preserves his human dignity and life.
8.2 With regard to the Public Prosecutor’s Office
- The Public Prosecution should commit to its role and not detain people with intellectual disabilities or severe mental health problems whose presence in prison aggravates their condition and take the necessary measures to transfer them to mental health facilities.
- The Public Prosecution and the judiciary shall abide by the provisions of the fourth paragraph of Article 143 of the Code of Criminal Procedure No. 150 of 1950, in accordance with its latest amendments, and not to rotate defendants based on investigations by the Investigation Department or National Security, especially in cases of a political nature, whose term of serving their sentences has expired, or who have been released in other cases, or who are held in pretrial detention.
8.3 With regard to mental health services in prisons
- The need to raise awareness of mental illnesses and ways to deal with them as a disease such as an organic disease that has causes and symptoms and requires urgent and specialized medical intervention, given the threat that some mental disorders may pose a threat to the life of the detainee or the lives of other inmates, as well as the application of regulations and laws regarding medical examination and periodic examination.
- Include the psychiatric examination in the medical examination at the beginning of the detainees’ admission to prisons in order to identify any mental disorders suffered by the detainee and indicate the prisoners’ medical history, and include this in their medical files, while identifying their medication needs and ensuring that they receive them.
- Provide a permanent psychiatrist or psychological support team in each prison to monitor the psychological state of detainees and conduct periodic conversations with detainees to determine their psychological and mental health and determine their needs for psychological support or medical intervention.
- Ensure the availability of psychiatric medications needed by people with mental disorders, whether in prison clinics or through family visits. Do not prevent a detainee with a psychiatric disorder from receiving medication or withdraw them from him to punish him or for any other reason, as this poses a serious danger to the life and mental health of the detainee to the extent that he may commit suicide or harm himself or others.
- In the case of severe mental or mental disorders that may endanger the life of the detainee or other inmates, the detainee shall be transferred to external hospitals for appropriate treatment as in the case of an organic disease.
- Immediately cease all forms of ill-treatment against people with mental disorders, such as physical assault by beatings, violence, displacement, , handcuffing and locking them in toilets – and all forms of ill-treatment received by people with mental disorders in prisons and dealing with them in a manner appropriate to their condition and in accordance with the provisions of international treaties and laws to preserve their rights to treatment, to the provision of appropriate health care for their condition, their right to humane treatment and to their enjoyment of human dignity.
8.4 Regarding the management of suicides
- Dealing seriously with the threat of suicide or self-harm, presenting the detainee to the psychiatrist immediately to assess the extent of his psychological deterioration, modifying, increasing, or changing his medication doses, whether with the doctor is affiliated with the prison or an external doctor, and allowing people with mental disorders to communicate with their psychiatrists in case they follow up with an external psychiatrist periodically.
- The presence of an emergency doctor on a permanent basis – morning and evening – in the prison with a medical team trained in emergency cases, to determine the manner in which the suicide occurred and to immediately examine the pressure and pulse to determine the extent of the detainee’s condition.
- Immediate intervention to save and aid the life of the detainee and the availability of the necessary tools for this in each clinic and hospital attached to the prison or transfer them urgently to external hospitals while ensuring the availability of an ambulance close to each prison for rapid intervention to save the life of the detainee and ensure prompt transportation to an outside health facility.
- Transfer any detainee who attempted suicide in prisons to external hospitals for a period of time to ensure appropriate psychiatric treatment, medication, and care.
[1]Committee for Justice, Monitoring Gross Violations in the Badr Prison Complex with Demands to Change the Culture of the Egyptian Authorities in Dealing with Detainees, 22 February 23, available at: https://shorturl.at/nFHOX
[2] Al-Shehab Center for Human Rights, Al-Shehab Center Facebook homepage, statement from inside Badr prison regarding the widespread violations there, February 23, 2013, available at: https://www.facebook.com/elshehab.ngo/posts/3385960385010199
[3]Akhbar Al-Ghad, a fourth message from Badr 3 prison in Egypt we are exposed to a deadly famine, 9 March 2023, available at: https://shorturl.at/qvyEG
[4]The difference between mental health and mental illness, ADDCOUNCIL, January 2021. Availablevia:-https://redirect.is/7qhamb6
[5] The complete guide on the difference between mental health and mental illness, Al-Amal Psychiatric Hospital, is available at: https://redirect.is/br4bbbw
[6]Mental Health in Prisons, A Brief Guideline for Prison Workers, Penal Reform International, London, 2018. Available through: https://cdn.penalreform.org/wp-content/uploads/2018/05/Mental-Health-in-prison-Arabic.pdf
[7] Mental health in prisons, a brief guide for prison workers, previous reference.
[8] Prison Insanity: A Mental Health Crisis Behind Bars, A Study on the Impact of the Penal System and Penal Institutions in the USA on the Mental Health of Prisoners, Terry Coopers, 2015. Available at: https://www.hindawi.org/books/15807486
[9] Interview with Dr. Suzanne Fayyad, Psychiatrist at El Nadeem Center for the Rehabilitation of Victims of Violence and Torture, about the phenomenon of suicide in Egyptian prisons, August 2021.
[10] Interview with Dr. Mona Hamed, Physician at the Nadeem Center for Victims of Violence and Torture, on the phenomenon of suicide in Egyptian prisons, July 2021
[11]“here you have to forget your old name now”, Ahmed Jamal Ziada, Raseef22, August 12, 2021. Available via:-https://bit.ly/37g79IK
[12] Interview with a former prisoner in Tora Prison, about the phenomenon of suicide in Egyptian prisons, July 2021.
[13]“Stations for Humiliation: Report on Gender Violations Against Women with Non-Stereotypical Gender Identities in the Criminal Justice System,” Egyptian Commission for Rights and Freedoms, June 26, 20102021. Available at: https://rb.gy/mcljgj
[14]Lawyers of the Egyptian Commission for Rights and Freedoms filed a complaint with the head of the Qanater charity prosecution about the rape of the victim in al-Qanater prison by the guard in charge of the search, called Hanem.
[15] Interview with a former detainee at al-Qanater prison, July 2021.
[16]Interview with Dr. Suzanne Fayyad, Psychiatrist at El Nadeem Center for the Rehabilitation of Victims of Violence and Torture, on the phenomenon of suicide in Egyptian prisons, August 2021
[17]The text of Article II of the Convention against Torture, available at
Next: https://www.ohchr.org/ar/professionalinterest/pages/cat.aspx
[18] Interview with a former detainee in Tora Prison about the phenomenon of suicide in Egyptian prisons, July 2021.
[19]Interview with a former detainee in Tora Prison, about the phenomenon of suicide in Egyptian prisons, July 2021.
[20] Interview with a former detainee in Tora Prison, about the phenomenon of suicide in Egyptian prisons, July 2021.
[21]Interview with Dr. Suzan Fayyad, previous reference.
[22] Interview with a former detainee in Tora Prison, about the phenomenon of suicide in Egyptian prisons, July 2021.
[23] Rule 58 to rule 63 of the United Nations Model Rules for the Treatment of Inmates op. cit.
[24] See the text of Article 55 of the Egyptian Constitution
[25] See articles 38 to 42 of the Law No. 396 of 1956 regulating community reform and rehabilitation centers.
[26]More than once: Preventing the entry of visits by Alaa Abdel Fattah and journalist Solafa Magdy from medicines and supplies, Darb, April 2020, available through: – https://bit.ly/3i7HW5K
[27]Egyptian Network for Human Rights, Suicide attempts and hunger strike in Scorpion Prison, 11 August 2021. Available via: https://rassd.com/501895.htm
[28]Windows, for the Arab Network for Human Rights, blogger Mohamed Oxygen attempts suicide in solitary confinement in Tora Prison, August 2, 2021. Available via:-https://bit.ly/3td6jVY
[29]Interview with a former detainee in Tora Maximum Security Prison, about suicide in Egyptian prisons, July 2021
[30]The text of article 12 of the International Covenant on Economic, Social and Cultural Rights, available on the United Nations website, is available at: https://www.ohchr.org/ar/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights
[31]Rule 24 of the Standard Minimum Rules for the Treatment of Prisoners, “The State shall be responsible for the provision of health care to prisoners. Inmates should have access to the same standard of health care as in the community and should have the right to access essential health services free of charge without discrimination on the basis of their legal status.”
[32]Statement by the Egyptian Public Prosecution regarding the completion of investigations into the death of Shadi Habash on their Facebook page, May 5, 2020, available at: https://www.facebook.com/ppo.gov.eg/photos/a.2579366742171212/2957187124389170/?type=3
[33]Interview with Dr. Susan Fayyad, previous reference
[34] Articles 43 to 48 of the Law No. 396 of 1956 regulating community reform and rehabilitation centers.
[35]Rules 43 to 45 of the Standard Minimum Rules for the Treatment of Prisoners, available on the United Nations website, last visited on February 20, 2022 via the following link: https://www.un.org/ar/events/mandeladay/mandela_rules.shtml
[36]UN News, “Solitary confinement should be banned in most cases, UN expert says”, 18 October 2011, available at:https://news.un.org/en/story/2011/10/392012-solitary-confinement-should-be-banned-most-cases-un-expert-says
[37]United Nations, General Assembly, sixty-sixth session, item 69 of the provisional agenda, Promotion and protection of human rights, human rights questions, torture and other cruel, inhuman or degrading treatment or punishment, pp https://undocs.org/pdf?symbol=ar/A/66/268. 20-p. 25.
[38] Arabi Post, spent two years in pretrial detention and authorities transferred Alaa Abdel Fattah and other activists to court, October 16, 2021. Available via: – https://rb.gy/y8vul2
[39] The New Arab, Abdel Moneim Aboul Fotouh refrains from visiting, 13 March 2022. Available through: https://bit.ly/3t94adB
[40]Khaled Ali: Alaa Abdel Fattah’s life is in danger after his psychological condition deteriorated due to his ill-treatment in prison, Mada Misr, 14 September 2021. Available through: https://bit.ly/3CIP4yD
[41] See Article 134 of the Code of Criminal Procedure No. 150 of 1950 and its amendments in 2020, which is that the incident is a felony or misdemeanor punishable by imprisonment for one year. The evidence is sufficient or that the accused was arrested in flagrante delicto, or in case of fear of the escape of the accused, or fear of damage to the interest of the investigation, whether by influencing the victim or witnesses, tampering with evidence or evidence, or making agreements with the rest of the perpetrators to change the truth. or serious breach Security and public order resulting from the gravity of the crime or if he does not have a fixed place of residence in Egypt and the crime is a felony or misdemeanor punishable by imprisonment, available at: https://manshurat.org/node/14676
[42] See Article 143 of the Code of Criminal Procedure No. 150 of 1950 and its amendments of 2020
[43] Interview with Dr. Mona Hamed, previous reference.
[44]Until further notice. Recycling or Methods of Circumvention by the Authorities of Judicial Decisions to Re-Hold Political Prisoners”, Egyptian Commission for Rights and Freedoms, 22 June 2020. Available via: –https://rb.gy/oroov4
[45]Articles 9 and 14 of the International Covenant on Civil and Political Rights, published on the United Nations website, last visited on February 20, 2022, available at: https://www.ohchr.org/AR/ProfessionalInterest/Pages/CCPR.aspx
[46]Interview with Dr. Suzan Fayyad, previous reference.
[47] Interview with Dr. Mona Hamed, previous reference.
[48]Interview with a former detainee in Tora Prison about the phenomenon of suicide in Egyptian prisons, July 2021.
[49]Mental Health in Prisons: A Brief Guideline for Prison Workers, op. cit.
[50]Interview with a former detainee at Tora Maximum Security Prison about suicide in Egyptian prisons, July 2021.
[51]Mental Health in Prisons: A Brief Guideline for Prison Workers, op. cit.
[52] Mental Health in Prisons, A Brief Manual for Prison Workers, op. cit.
[53] Interview with a former detainee about suicide in Egyptian prisons, July 2021.
[54]Interview, Dr. Mona Hamed, previous reference.
[55]Interview with a former detainee in Tora Prison, op. cit.
[56]Interview with a former detainee at al-Qanater prison, August 2021.
[57]Interview with a former detainee in the Abdeen police station about the phenomenon of suicide in Egyptian prisons, July 2021.
[58] Interview with a former detainee at al-Qanater prison about suicide in Egyptian prisons, July 2021.
[59] Interview with a former detainee on suicide in Egyptian prisons, September 2021.
[60]Guidelines for Mental Health in Prisons, a brief guide for prison workers, previous reference.
[61]Documenting the suicide attempt of the child Abdullah Abu Madian inside the National Security in Al-Arish, Windows, March 22, 2021. Available via:-
[62] Suicide prisons, death haunts the grievances of Egypt, the new Arab, 9 August 2021. Available via:-
[63]Interview with Dr. Mona Hamed, previous reference.
[64] Interview with a detainee in Tora Prison, op. cit.
[65]Article 338 of the Code of Criminal Procedure No. 150 of 1950, as amended.
[66] The Egyptian Commission for Rights and Freedoms, stories from the heart of the investigation with the September 20 detainees. State Security “investigated a young man with mental retardation, another 16-year-old child, and a third “illiterate” who is not fluent in writing and reading on charges of “spreading false news”, available at: –https://rb.gy/hcl5kc
[67]Interview with, Dr. Mona Hamed, previous reference.
[68]Article 27 of the Regulations of Community Reform and Rehabilitation Centers issued by the Minister of Interior Decree No. 79 of 1961. Which states: The doctor must examine each inmate immediately upon his placement in the correction and rehabilitation center, provided that this is not later than the next morning and prove his health condition and the work he can do, and he must also clinic sick inmates daily and the clinic of each inmate who complains of the disease, and order the transfer of the patient to the hospital of the correction and rehabilitation center, and he must also visit every inmate held in solitary confinement daily and that each inmate of non-such persons return once a week to The least to stand on his condition in terms of health and hygiene.
[69] Interview with, Dr. Suzanne Fayyad, previous reference.
[70]الصحة النفسية في السجون، دليل إرشادي موجز للعاملين في السجون مرجع سابق.
[71] Deep wound: On the physical and psychological effects of torture, cruel, inhuman or degrading treatment, prolonged solitary confinement and deliberate medical negligence, Egyptian Commission for Rights and Freedoms, 27 June 2020 Available at:- https://rb.gy/gqpqtf
[72] Interview with a former detainee in Tora Prison about the phenomenon of suicide in Egyptian prisons, previous reference.
[73]Interview with Dr. Mona Hamed, previous reference.
[74] From a personal interview with a former detainee in Al-Qanater prison, Al-Qanater previous reference.July 2021.
[75]Interview with a former detainee at Tora Prison, previous reference.
[76] Interview with a former detainee at Damanhour prison about the phenomenon of suicide in Egyptian prisons, July 2021.
[77] Interview with Dr. Mona Hamed, previous reference.
[78] Interview with Dr. Suzanne Fayyad, previous reference.
[79]From a personal interview with a former detainee in Tora Prison, July 2021, previous reference.
[80] From an interview with a former detainee, op. cit.
[81] Susan Fayyad, op. cit.
