NPM overview

Facts and figures

Recommendations

Body searches 

• Take steps to properly carry out the search of the cells and personal belongings of women deprived of their liberty by female officers. 

Access to mental healthcare 

• When providing psychiatric care and medical services to women deprived of liberty, the Prison Administration must ensure to obtain their written informed consent. In the event that the person submits a request to refuse or stop treatment, the necessity of initiating involuntary treatment should be carefully reviewed and discussed in accordance with applicable laws.

Pregnant women 

• Provide for necessary conditions for the separation of pregnant women from other

Detention issues

Ensuring the rights of women deprived of their freedom within the criminal justice system is of paramount importance. This issue is particularly sensitive because they require special treatment. Women in detention are especially vulnerable to risks such as victimisation, sexual violence, inadequate access to gender and age-specific healthcare, and a lack of stable contact with family members. In this context, it is essential to recognize that women face unique challenges while incarcerated. These challenges require a focus on their specific needs, including:

• Access to necessary medical services, particularly those tailored to their gender and age.
• Psychological support to help them cope with trauma, mental health issues, and the emotional strain of incarceration. + Adequate conditions of detention that prioritize safety, hygiene, and respect for dignity.
• Opportunities for education and employment to promote rehabilitation and reintegration into society. Addressing these special needs is critical to ensuring that women in detention are treated humanely and fairly, with their rights fully respected.

Personal hygiene and sanitary facilities

Bathing and maintaining personal hygiene are crucial for the physical and mental well-being of persons deprived of their liberty, including women. Given the specific hygiene needs of women, it is essential to ensure that they are provided with adequate facilities and opportunities to shower frequently. Proper hygiene conditions contribute to their overall health and dignity while in detention. 

During private conversations with prison administration and inmates, NPM representatives observed that individuals in solitary confinement are only allowed to bathe once a week, typically on Fridays. Inmates expressed their grievances to the Human Rights Defender, stating that bathing is strictly scheduled for certain days of the week. If an inmate is unable to bathe on the designated day due to illness or other reasons, they are not allowed to make up for the missed bath and must wait until the following Friday. This rigid schedule leads to frustration and discomfort for women deprived of their liberty, as they are denied access to essential hygiene on other days. 

In connection with the mentioned, the NPM expresses deep concerns and urges to follow the European Prison Rules (rules 19.4 and 19.7) and, taking into account the climatic features and thermal conditions of the region, to create adequate opportunities for showering or bathing. Moreover, if possible, it recommends to organise it every day, at least twice a week (if necessary, more often), based on the goal of maintaining general hygiene. At the same time, it is necessary to provide special measures that take into account the specific hygienic needs of women.

Cell searches

During 2023, women detained in the "Abovyan" penitentiary institution submitted complaints regarding cell searches conducted by male staff members. Women expressed concerns that, during these searches, male correctional officers had access to their personal belongings, including clothing, underwear, feminine hygiene products, and intimate accessories, which they found to be humiliating.

Furthermore, women deprived of liberty reported that, on some occasions, the officers did not handle personal belongings with sufficient care. Personal items were reportedly thrown on the floor, bed, or shelves, leading to contamination and damage to their possessions.

The NPM urges the penitentiary administration to implement gender-sensitive protocols for cell searches. Searches should be conducted exclusively by female staff members to safeguard the privacy, dignity, and emotional well-being of women deprived of liberty. In addition, correctional staff should undergo specific training to ensure that personal belongings, particularly intimate items like clothing and hygiene products, are handled with respect and care during searches. Mishandling of such items is unacceptable and contributes to the humiliation and distress of detainees. Clear guidelines on how to handle belongings during searches should be developed and enforced accordingly.

Access to mental healthcare

According to Article 16, Part 1, of the Law "On Medical Assistance and Services to the Population," written consent from an individual is a mandatory requirement for any medical intervention. However, exceptions are outlined in Article 24 of the same law, which allows for medical interventions without written consent in circumstances where there is a threat to human life or in the case of diseases that pose a risk to public health or the environment, as determined by the Government in accordance with the law.

A psychiatrist is involved in the department's work, treating individuals with mental health conditions only after obtaining their initial consent. However, document reviews reveal that when a person deprived of liberty provides a written refusal of treatment or verbally refuses to take regular medication, the possibility of interrupting or stopping treatment, or initiating an involuntary treatment procedure, is neither discussed nor considered. Additionally, no informed written consent is obtained from the individual for resuming treatment after they have refused or completed the drug treatment prescribed by the psychiatrist.

Thus, the process of properly obtaining informed consent from individuals deprived of their liberty who have mental health conditions, as well as the oversight of its implementation, is not adequately maintained. This lack of proper consent procedures raises concerns about compliance with legal and ethical standards regarding the treatment of individuals in situations of vulnerability in detention.

In correctional facilities, medical interventions continue to be performed on individuals deprived of their liberty without obtaining their written informed consent, which is impermissible and constitutes a violation of the law and applicable standards. Therefore, it is necessary to: 

• Ensure protection of medical confidentiality for persons deprived of liberty, in accordance with the legislation's defined requirements.
• Perform medical interventions in penitentiary institutions only after obtaining the written informed consent of the individuals deprived of liberty.

Risk of self-harm and suicide

In accordance with the applicable legal norms,2 the assessment of the risk of suicide and self-harm must be conducted by the responsible duty officer (or, if unavailable, an appointed person) immediately after the person is transferred to the penitentiary, but no later than within 24 hours. Furthermore, if an average or higher level of risk of suicide or self-harm is identified during this initial assessment, a psychologist (or, in their absence, a social worker) must perform a more in-depth evaluation of the risk of suicide and self-harm within 48 hours.3

All persons deprived of their liberty must receive social, psychological, and legal support from the moment they are admitted to a penal institution.4 The implementation of appropriate psychological interventions is particularly crucial during the initial phase of incarceration, when the individual is in the quarantine department. Psychological consultations during this period are essential for helping individuals adapt to the penitentiary environment and for assessing the risk of suicide or self-harm. If necessary, preventive measures should be taken based on these assessments to ensure the safety and well-being of the person.

Women in special situations of vulnerability

Pregnant women

According to the Government Decision No. 1543-N1 of 3 August 2006, “detainees and convicts who are pregnant or accompanied by a child under the age of three are housed in detention facilities or correctional institutions in a manner that minimizes their contact with other detainees or convicts”.5

Government's Decision N 543-N of 13 April 13 2023, outline certain aspects of the detention conditions for pregnant women, women with a child under the age of three, and underage detainees in penitentiary institutions.6 However, these provisions do not adequately address the creation of an environment tailored to their specific need.

Abovyan Penitentiary does not provide for special conditions for pregnant women or women with children under the age of three. During the monitoring visit7 of the Abovyan penitentiary in March 2022, the NPM had found that there were three women with children under the age of three, two of which were held in solitary confinement facilities and one in the general area. In addition, similar to the general conditions of the prison, the mentioned areas did not have adequate conditions.

The NPM strongly recommends that pregnant women be housed separately from the general inmate population. This separation will ensure that they are protected from any potential risks posed by other inmates and can access the specialised care and support they require during pregnancy.

NPM overview

Facts and figures

Detention Issues

a. Legal and regulatory framework

Burkina Faso has enacted laws and regulations governing and defining the rights of persons deprived of their liberty, including women, and protecting them from torture. These include the following texts:

• The Constitution of 02 June 1991 (article 03) 
• Penal Code of 2018 amended in 2019 
• Code of Criminal Procedure of 2019;
• Law No. 010-2017/AN of 10 April 2017 on the prison system in Burkina Faso
• Order No. 2018-094 MJDHPC/CAB on the internal regulations of prisons in Burkina Faso

b. General observations

Some of the rights of women deprived of liberty  are effective in Burkina Faso, although the government still has some way to go. These include compliance with time limits for pre-trial detention, the right to freedom of religion, and the absence of torture and similar practices against women deprived of their liberty.

However,  the separation of women detainees  by status, the right to health and the right to food are insufficiently implemented. Burkina Faso does not have a prison exclusively for women, but there are detention units for women in the general prisons. Improvements in detention conditions are more visible in these wards than in the others. The CNDH's findings also show that pre-trial detention periods for women are generally respected. However, difficulties persist in certain aspects of women's detention, such as the absence of gender-sensitive internal regulations, the shortage of women staff in the prison security guard (GSP), the lack of resources to meet health, hygiene and training needs, and the absence of crèches for newborn babies. 

Women deprived of their liberty generally come from disadvantaged social backgrounds and cannot read or write. This has an impact on their ability to familiarise themselves with the rules and regulations of places of detention, let alone exercise their rights.

Physical and psychological violence

Following interviews with women deprived of liberty and prison officials, the CNDH has noted cases of women who were victims of physical and/or moral or psychological abuse, most of which involved incidents between fellow prisoners. 

Contact with the outside world

The data collected by the CNDH revealed that, in general, women detained in prisons receive visits from their  relatives or parents. In addition, some establishments have television and radio sets for women deprived of liberty. In others, there are no such facilities, but women who have the means are allowed to have television or radio sets for their information and entertainment.

However, it should be pointed out that none of the prisons visited by the CNDH receive any newspapers or magazines from the State. Nor do women, like other persons deprived of liberty, receive "correspondence kits".

Furthermore, although visits are permitted, it is important to point out that no prison has conjugal cells to facilitate conjugal visits for legally married women. However, a criminal conviction (deprivation of liberty) must not lead to the loss of all the detainee’s other rights.

Access to healthcare

Women’s right to health care in remand and correctional facilities is insufficiently implemented. The CNDH's findings show that health services in some prisons are only partially operational or have closed down altogether due to a shortage of pharmaceutical products and medical staff. This state of affairs has weakened health provision, with the result that the most serious cases of illness are transferred to regional hospitals. 

Accommodation and food

According to the NPM’s findings  on site, women in prisons are provided with separate facilities from men and do their own cooking in their quarters. Given that women are generally few in number, their conditions appear to be much better than those of men. Nonetheless, these conditions remain unsatisfactory, given that women detainees or their families have to pay for certain food-related expenses, such as condiments and certain grains like rice.

The CNDH's findings show that almost all the women's cells have good ventilation, lighting and running drinking water. 

Sanitary facilities and personal hygiene

The observations made, corroborated by the interviews, show that women prisoners receive soap and sometimes bleach to clean their cells and to keep their bodies clean. With regard to the provision of dignity kits, consisting of intimate hygiene products, interviews with women showed that they sometimes receive them, depending on their availability, from the stewardship department.

Life in prison: regime and activities

a. Sports and cultural activities

The findings of the CNDH show that there is no sports field or specific sports discipline for women detainees. However, women  can go walking for those who wish to do so, and this becomes compulsory for those whose health requires it. 

As far as cultural activities are concerned, overcrowding and a lack of financial and logistical resources mean that most prisons in Burkina Faso do not organise such activities for detainees, even for women. However, in some establishments, certain civil society organisations do initiate socio-cultural activities for the benefit of the detainees. Apart from this, no specific cultural activities are organised for women detainees.

b. Religion

During its monitoring of places of deprivation of liberty, the CNDH noted that the right to freely practise one's religion within prisons was a reality for women detainees. The team noted the existence of places of worship. Ministers of religion (Muslim, Catholic and Protestant) also provide spiritual, material and psychological assistance to women deprived of their liberty.

c. Education and work

The data collected shows that women in some prisons benefit from a literacy programme at least once or twice a week. This programme is generally provided by the social action department in two languages, namely French, and a local language. However, most prisons do not have a library. 

Production units and workshops for socio-professional reintegration have been developed in all the prisons to encourage work placement and apprenticeship for women detainees. However, it is important to emphasise that these units and workshops are encountering enormous difficulties that are having a negative impact on their operation and productivity. 

NPM Overview

Facts and figures

Recommendations

Body searches

• Preferably use alternative detection methods and tools such as ultrasound examinations, scanners, security gates, metal detectors, etc. 

• Ensure that search operations, in particular full strip searches, and their results are recorded by systematically keeping a strip-search register, which includes the identity of the person carrying out the strip search, the identity of the person being searched, the reasons for the search and any results obtained.

Access to healthcare

• Ensure that the Medical Entry Form is used in all prisons.

• Implement stricter measures to ensure that all necessary information is correctly entered into the medical records when detainees are admitted, in particular by providing regular training for medical staff and raising awareness about the importance of traceability.

• Create monitoring systems to ensure that each medical file is examined, checked and assessed by the facility's doctor.

• Allocate additional resources to remedy any discrepancies in correctly entering information on medical forms.

Mental health

• Improve the programmes that promote and improve the mental health of detainees, and programmes that prevent suicide and self-harm.

Detention Issues

At the time of writing[1], the Kingdom of Morocco's National Mechanism for the Prevention of Torture (CNDH/MNP) is finalising its thematic report on the situation and treatment of women and girls deprived of their liberty in prisons. The CNDH/MNP chose to focus on women in prisons because of the particular characteristics of this population and the need to conduct an in-depth analysis to identify any reforms or measures that could guarantee better protection of their rights. This thematic report covers all 43 prisons where women and minors are detained, across the 12 regions of Morocco. Interviews were conducted by the CNDH/MNP with each of the women and girls detained. The following information constitutes some of the preliminary conclusions of this work. 

The report, which will be finalised, is mainly intended to document the conditions in which women are detained in an exhaustive manner and to develop a rigorous and systematic assessment that would serve as a basis for feasible and actionable recommendations.

Body searches

1. Legal and regulatory framework

In Morocco, strip searches are governed by the provisions of articles 68 and 78 of law no. 23-98. This law only allows prisoners and visitors to be searched by a person of their own sex and in conditions that preserve their dignity, while guaranteeing effective control.

2. In practice

The NPM's visits to prisons housing women prisoners revealed that they are systematically searched in the following situations, in accordance with Articles 68 and 78 of Law no. 23-98[2]: when they enter the facility; before and after any visiting room or family visits; before and after any extraction; before any transfer; and at the end of any daily activity. The staff interviewed also stated that stripping detainees during body searches takes place in two stages (they undress the upper part of the body, then put their clothes back on before they undress the lower part of the body).

Apart from cell searches, which are recorded in dedicated registers, strip searches are not recorded in registers. This lack of procedure and traceability of body searches makes it impossible to control and standardise the proper conduct of strip searches, which are certainly necessary for security, but there is a potential risk of it leading to ill-treatment and/or traumatic experiences for the women detainees.

According to the testimonies gathered, strip searches of female detainees are conducted exclusively by female staff and out of the presence and sight of staff of the opposite sex, in accordance with the provisions of Article 68 of Law 23-98 and the standards of the Nelson Mandela (52) and Bangkok (19) Rules. 

The Délégation générale de l'administration pénitentiaire et de la réinsertion (DGAPR) has indicated that for strip searches of detainees, in case of a transfer or in case of an extraction before the court and to the hospital, prisons have a register that tracks this operation and this in accordance with the Délégué Général's memo no. 48/2015. The DGAPR also indicates that for strip searches after the detainees’ daily activities, such a register would cause a considerable delay in the course of these daily activities. 

The DGAPR has indicated that all prisons have walk-through metal detectors and hand-held metal detectors in sufficient quantities. Hand-held metal detectors are distributed to all units, including the women's unit. However, the DGAPR believes that the alternatives available to it only allow for the detection of metals and not illegal substances such as drugs and hallucinogenic tablets. As a result, detection equipment cannot replace the body search required by law.

Solitary confinement, isolation

a. Legal and regulatory framework

Solitary confinement is applied either as a security measure, or for health reasons, such as contagious diseases (art. 31-32 Law 23-98), or as a precaution (preventive isolation) for 48 hours before the disciplinary commission is held (art. 58 Law 23-98), or by order of the investigating judge (art. 75 Law 23-98) or at the request of the detainees themselves if the reasons they give are justified (art. 31 Law 23-98).

b. In practice

The DGAPR has indicated that solitary confinement has 2 distinct components: solitary confinement for medical reasons and solitary confinement for other reasons (notably security, placement in a disciplinary cell, etc.). It is up to the doctor to decide whether solitary confinement is appropriate for health reasons (contagious diseases, mentally disturbed detainees who present a danger to others). Medical monitoring (and its frequency) is provided by the doctor in each case. The end of this measure is also determined by the doctor, depending on the detainee's medical condition.

With regard to solitary confinement for other reasons, the doctor gives his opinion whether it should be ended for health reasons (their medical condition is incompatible with this measure). The doctor is required to visit prisoners 3 times a week for security isolation and at least 2 times a week for disciplinary isolation. He may, however, give his opinion to terminate the measure whenever he feels that the medical condition has become incompatible with this measure.

The doctor is only asked to give his opinion on extending the isolation for security reasons, in accordance with paragraph 5 of article 32, as the duration of disciplinary isolation is well defined. 

As far as mental health conditions are concerned, solitary confinement is applied on a case-by-case basis according to the opinion of the hospital's attending psychiatrist, recorded in the patient's medical file. Some psychiatrists recommend solitary confinement for a specific period of time under close medical and security supervision (especially if the detainee poses a danger to others). The solitary confinement of detainees is recorded in an isolation control register. 

According to the staff interviewed in the facilities visited, pregnant women, breastfeeding women or women accompanied by babies/young children and/or who have recently given birth, the elderly, the chronically ill, people suffering from mental health conditions and minors are not subject to the isolation regime. 

Any prisoner who considers himself to be under threat may request to be placed in preventive isolation for their own protection. Persons placed in isolation for their own protection may, however, appeal against decisions relating to their placement. They may submit complaints or grievances to this effect to the Director, the Regional Director, the DGAPR, the judicial authorities or the CNDH. In addition, their situation may be reassessed on the advice of the psychologist and doctor.

Use of means of restraint

a. Legal and regulatory framework

The only legal bases that set out the conditions and procedures for the use of means of restraint or coercion are those set out in article 62 of law no. 23-98. This article lists handcuffs, shackles and straitjackets among the means of coercion that may be used.

b. In practice

Interviews with female prison staff did not indicate the existence of an internal procedure for the use of means of restraint. Despite the wide range of means of coercion authorised by law, the practice followed by the prisons visited is limited to handcuffing (arms in front).

In this context, the DGAPR has indicated that it has a very limited number of hand and foot restraints, and they are only used for the category of very dangerous male detainees and in very limited situations, and under no circumstances are these restraints used for women detainees.

According to the testimonies of the staff interviewed, means of restraint are not applied to all categories of detainees. In fact, pregnant women, women in labour and/or immediately after childbirth are not subjected to it.

Access to healthcare

The privacy and confidentiality of detainees' medical examinations are guaranteed[3] in 82% of the prisons visited by the NPM. In this respect, the DGAPR indicated that healthcare management in prisons requires the involvement of several actors, which makes confidentiality difficult.

The NPM noted a shortage of medical and nursing staff in several of the prisons visited. The DGAPR indicated that prisons without permanent doctors are covered by agreements with doctors from the public or private sector, by the mobility missions of DGAPR doctors conducting consultations and by telemedicine. The DGAPR has also indicated that it is continuing to recruit nurses to meet the challenges and improve the quality of care and services for detainees. 

Medical consultations for women take place in dedicated medical and dental offices and are performed by a woman doctor or dentist whenever they are available. In prisons where only male medical or dental staff are available, consultations are systematically conducted in the presence of women nurses or women civil servants. In accordance with Mandela Rule 24.1, all women prisoners who are ill are entitled to free medical consultations both in prison and in public hospitals, as well as free medication. Prisoners who require specialist treatment or surgery are transferred to public hospitals in accordance with Mandela Regulation 27.1. Except for urgent cases, which go through a flexible and fast-track system, detainees who need to be transferred to a hospital follow the ordinary procedure, which requires them to go through the appointment platform, but delays have been reported. This affects the treatment of detainees with chronic illnesses. 

Pregnancy monitoring for women detainees, which is conducted by the Ministry of Health and Social Protection, is conducted in accordance with the Ministry's recommendations in 76% of cases[4]. No matter how far along the pregnancy is, each new detainee is asked to provide her previous medical records, and if not, everything is taken care of at the prison. All pregnant women who gave birth while in prison received the full range of pregnancy monitoring services.

In accordance with Bangkok Rule 14, 67, some of the establishments visited have an HIV prevention programme that takes into account the prevention of mother-to-child transmission. However, inmates do not systematically benefit from preventive health measures, which are particularly important for women, such as screening for gynaecological cancers. In the absence of a permanent programme, screening is performed during campaigns organised in only 25% of prisons in 2023. 

STI/HIV/HCV screening is offered systematically to all detainees during the medical examination upon admission, during routine consultations and during awareness and screening campaigns. STI/HIV services are integrated into the regular activities of the Prison Health Units. Voluntary HIV screening complies with the WHO's 5 "C" rules and is carried out in accordance with the Guidelines on HIV screening in Prisons, the subject of an agreement signed in February 2017 between the DGAPR, the CNDH and the MSPS. Juvenile detainees benefit from awareness-raising on HIV and Sexual and Reproductive Health (voluntary HIV testing depends on the consent of the guardian). Tests for STIs (HIV, viral hepatitis B and C, and syphilis) are systematically offered to pregnant women and performed during the first days of incarceration. If tests are not available in prison health units or MSPS facilities, they will use private laboratories. 

The NPM was informed that in 2024 the DGAPR had initiated a CAP (Knowledge, Attitudes and Practices) study to identify and determine the best services needed for the different categories of women, in particular pregnant women, women with children and elderly women. The DGAPR has also indicated that it organises annual recruitment competitions for nursing, medical and dental staff, with a substantial number of budgeted posts. The low attractiveness of prison work and the heavy medical workload have an impact on the number of doctors.

Initial medical examination

This examination, which represents the detainees' first contact with the prison healthcare system, is intended to gather information on their socio-economic status, clinical history and data, physical condition on admission, medical and surgical history, drug habits, psychiatric treatment with prescription, serological screening (HIV, HBV, HCV), search for signs of tuberculosis and their overall condition on admission, according to the form designed and implemented by the DGAPR. 

If the patient is a woman detainee, additional information is collected regarding late menstruation, a current pregnancy and whether the pregnancy was monitored prior to incarceration, if any check-ups were performed, as well as the number of children accompanying her, their age and sex.

The purpose of the initial medical examination of the detainee is to ensure continuity of care in the event of previous treatment, and to detect any contagious or progressive illness that would require isolation or in-house care.

Mental health

The NPM found that 67% of the health services in the prisons visited had psychologists but neither psychiatrists nor nurses qualified in psychiatry. It also noted problems with training programmes for health staff in mental health care, it detected difficult situations for women and assessing the mental health needs of women detainees.

The initial medical examination form gives instructions that the questionnaire to identify the risk of suicide/attempted suicide/harm to the person’s physical integrity must be systematically completed in the event of: unkempt appearance or clothing; agitation; history of psychiatric treatment; history of suicide attempt; history or scar of self-mutilation; no answer to the question whether life is worth living; chronic toxic habits involving tobacco, alcohol, cannabis, glue or thinners; the use of cocaine, heroin; taking psychotropic prescription medications. 

The CNDH/MNP team noted that this questionnaire is not systematically completed by detainees with a history of chronic toxic habits involving tobacco or alcohol, psychotropic drugs, attempted suicide or self-harm, or scarring, sometimes due to the use of an old format that does not provide instructions on situations that require an assessment to determine the risk of suicide or physical harm.

The DGAPR has indicated that a new Medical Entry Form and a questionnaire to identify the risk of suicide or self-harm has been drawn up, along with a prevention manual. A data collection matrix has also been developed to complement the support materials and tools already in place, which will be used to generate recommendations and multi-participatory actions with the other DGAPR departments (socio-cultural, security, etc.) in order to reduce the risks as much as possible. This is done in tandem with medical treatment and other supportive measures (socio-cultural, security and creating a protective environment). The implementation of this package of preventive services is still experiencing some difficulties in being properly applied in all prisons, given the constraints in terms of human resources and the existing means.

All detainees suffering from mental health problems are treated by MSPS psychiatrists and receive all the medication (psychotropic drugs) they need free of charge. In 84% of the prisons visited, the health services do not offer a specialised treatment programme for women addicted to drugs, as recommended by Mandela Rule 24. In all prisons, and in accordance with Bangkok Rule 41, women in need of mental healthcare are housed in non-restrictive areas and receive appropriate treatment, and the use of restraints or sedative medication is not routinely used, in accordance with Mandela Rule 49.

The DGAPR has indicated that, given the shortage of psychiatrists nationwide and the unattractiveness of working in prisons, it is difficult to sign agreements with psychiatrists. However, all detainees requiring psychiatric treatment are sent to hospitals and receive support services from DGAPR psychologists. As part of the agreement to strengthen healthcare provision for prisoners, the MSPS is regularly asked to include prison doctors and nurses in the ongoing mental health training sessions it organises for its staff, and several doctors and nurses have benefited from modules designed to improve their mental health care skills.

With regard to the treatment of addictive disorders, the DGAPR has indicated that, in partnership with the MSPS, it has set up 10 addiction units in prisons, 6 of which provide continued opiate substitution treatment with methadone for prisoners who were already enrolled in this programme before their incarceration and who were being monitored at MSPS addiction centres. The addiction units in prisons also provide a package of services including RdR (Harm Reduction) and psychological support. Specialised theoretical and practical addiction training, particularly in substitution treatment for hard drugs, was provided for medical and nursing staff in prisons with addiction units dispensing methadone. Similarly, more than 20 prison doctors have received a university diploma in Addictionology.

In all prisons, women detainees who are put on psychotropic drugs are either suffering from a proven psychiatric disorder or an addiction disorder and in all cases are monitored by psychiatrists at MSPS hospitals. The DGAPR added that women who require continued methadone treatment and who are enrolled in the MSPS opiate substitution programme before their incarceration receive this treatment in the prison’s addiction unit, with the possibility of transferring from one prison to another that offers this service. They also receive regular follow-up at MSPS addiction centres and harm reduction services, in addition to psychological support in prisons. Detainees addicted to substances other than opioids are regularly monitored by psychiatrists at MSPS facilities, and psychotropic medication is regularly administered in hourly doses by female nursing staff.

Life in prison: regime and activities

The CNDH/MNP was informed during interviews with women detainees that women have fewer opportunities for paid work than men. Although the work assigned to women detainees is not appalling, it does not contribute sufficiently to their vocational training. In addition, they lack opportunities to acquire skills in production units, which would facilitate their reintegration after release.

The vocational training activities offered to women detainees are fewer and more varied than those for male detainees. They are generally limited to hairdressing, cutting and sewing. The DGAPR states that access to vocational training depends primarily on the wishes of the women concerned and secondly on meeting the conditions and prerequisites set by the departments concerned.

Women in Special Situations of Vulnerability

Women with their children in prison

Alternatives to detention

Morocco has adopted draft law[5] no. 43.22 on alternative sentences, which aims to improve the Moroccan justice system and overcome the problem of prison overcrowding. The new law no. 43.22 on alternative penalties provides for four alternative penalties for offences punishable by up to five years' imprisonment, namely community service, electronic surveillance, restrictions on certain rights or imposing certain control, therapeutic or rehabilitation measures, and daily fines.

Control measures such as hospitalisation or rehabilitation are also provided for. However, alternative sanctions are not applicable in cases of terrorism, money laundering, trafficking in organs or psychotropic substances. Nor do they apply to the sexual exploitation of children or people with disabilities, corruption, embezzlement, misappropriation of funds, breach of trust or misappropriation of public funds.
 

Facts and Figures

United Kingdom (England, Wales, Northern Ireland, Scotland)

England and Wales

Recommendations

Body searches

• Prison services should use the available technology and move permanently away from routine body searching to intelligence-led searching only.

Use of means of restraint

• Prison services across the UK should replicate restraint techniques which do not induce pain. 

Access to mental heallthcare

• There is an urgent need for joint action with the Department of Health so that prison is not the default setting for women whose primary problem is mental health condition.

• A high security mental health provision for women should be established in Scotland. 

• Justice systems should mainstream the Inspire model of probation supervision and establish a small women’s custodial facility using a therapeutic model.

• More thought needs to be put into how to support women experiencing extreme mental health conditions, and staff need more comprehensive training.

Detention issues

Body searches

Body searching of women can be routine (when entering visits, going between sections of the prison, etc.), intelligence led, or random. Practice varies greatly across UK prisons. Searching is systemic across the estate, and most establishments will have a local searching strategy that defines the circumstances and modalities of body searches for women. There is varied practice across the four nations also in terms of alternative searching methods. Some establishments utilise a BOSS chair which can detect objects concealed in body cavities. 

Full searches will always be conducted out of sight of men and by women. Rub down searches may sometimes be conducted by men, or in sight of men. Invasive body searches are either strictly forbidden or carried out only in exceptional circumstances, by a trained and authorised medical professional. Record keeping of body searches is generally good. 

Body scanners are used in Scotland as an additional, rather than alternative search to body searching. The continued use of routine body searching of women after a visit and in-cell searches is a significant concern in Scotland. In this regard, an intelligence-based or risk-assessed approach would be better to minimise potential for re-traumatising those who have been affected by previous abuse. Routine body searching at HMP and YOI Stirling and at Lilias and Bella Community Custody Units continues to undermine the trauma-informed approach outlined in the SPS Strategy for Women in Custody. Routine body searching is potentially retraumatising and degrading, but the Scottish Prison Service showed little understanding that it was inconsistent with the Strategy. 

Solitary confinement, isolation

The use of official segregation units is strictly regulated across the UK, although the adequacy of safeguards varies. Solitary confinement is not prohibited for girls, pregnant or nursing women, women with young children or women with psychosocial disabilities. 

Women with severe mental health conditions are often found in solitary confinement units in not-suitable settings. Findings across the NPM show women with very high mental health needs, acutely unwell and who should be in hospital, held in solitary confinement. The more severe or complex a woman’s mental health condition, the longer she is likely to stay in the segregation unit as there are still long delays in transfers to secure mental health units. In Scotland, there are no secure mental health beds for women, so women who need them are transferred across the border, far from their families, if there is availability for them at all. 

Additionally, some women are segregated on wing or self-isolate in their cells, which leads to very serious mental health issues and is less well regulated. Record keeping for formal segregation is good, but documentation on isolation on wing is not. Across the estate, women continue to have too little time out of their cell. 

The condition of cells used for solitary confinement varies across the prison estate. Bleak cells that are not fit for purpose are not uncommon. While some are better than others, they are not an environment anyone should spend a long period of time in. 

Findings from the NPM revealed that some segregation units in England were bleak, with little access for women to a meaningful regime or therapeutic support, but Foston Hall had made progress in improving conditions and had reduced its use for women who self-harmed. Elsewhere, weak oversight and monitoring meant it was not always possible to see justification for the prolonged segregation of a small number of women, some of whom were at risk of self-harm. 

In 2021, at Eastwood Park women’s prison (England) a prisoner with an acquired brain injury was continuously segregated for 1,202 days. This case was escalated to both senior officials and the prisons minister, but a solution is yet to be found: she has now been in solitary confinement for nearly three years. 

In Scotland, some officers working with women in segregation reported receiving training in trauma and therapeutic approaches, personality disorders and mental health. Generally, however, most officers at the Separation and Reintegration Unit (SRU) had received very little, if any, mental health training, with some feeling under‑prepared for SRU work as a result (across the whole prison estate). People in prison who have been segregated in their own cells, and especially women at HMP Greenock and HMP YOI Grampian, report less positive relationships with staff. The design of the Separation and Reintegration Unit at HMP and YOI Stirling meant that women were located within sight and hearing of the neighbouring community,  which compromises women’s right to privacy. 

In Northern Ireland, a shared Care and Supervision Unit (CSU) for young men and women at Hydebank Wood when inspected in 2022 was out of step with the Nelson Mandela Rules as it did not provide “entirely separate” facilities for women. Women were removed immediately from the shared CSU and were segregated within Ash House and later in Beech house while plans for a bespoke CSU were developed. A new, separate CSU for women was opened in September 2022 which reflected consideration of entry and movement through the unit, materials, furnishings, colour and therapeutic spaces. The unit is calm and spacious and includes a communal multi-purpose space. 

Use of means of restraint 

Self-harm rates have increased, and the NPM is concerned about the lack of active care to prevent women entering a crisis. Instead, staff use physical force to stop self-harming behaviour. Use of force is not always only used as a last resort and there is a lack of guidance or training from HM Prison and Probation Service to help staff deal with such situations. 

Detention procedures regulate the use of physical and medical restraint. Restraints for pregnant women, women in labour, women giving birth and after birth are not prohibited, but they are rarely used in practice. 

Record keeping on use of restraint is broadly good, though CCTV recording is not always available, and body-worn cameras are not used in Scotland. In Scotland at HMP and YOI Stirling, a new technique for restraint which does not induce pain, is in use, and inspectors hope it will be rolled out across other establishments. At Foston Hall (England), with some of the highest use of force in the women’s estate, body-worn footage was available in fewer than half the incidents in some months, which means incidents cannot be scrutinised for necessity and proportionality.

Access to healthcare

While healthcare provision is generally good, delivery is sometimes hindered by a lack of staff. In 2023, the Prisons and Probation Ombudsman raised concerns over the deaths of two babies in women’s prisons in England. These concerns have been carefully considered by the prisons and have been responded to appropriately. 

The Independent Monitoring Board at HMP/YOI Styal reported particularly serious problems with women receiving the right medication at the right time, which adversely affected the daily lives of these women, including their access to education and work.

Mental health

Some women in prisons across the UK are acutely unwell and should be in hospital instead of prison. In some women’s prisons, over half the population was on a mental health caseload in 2021, and mental health services in prisons struggled to cope. Self-harm is nine times higher in the women’s prison estate than the men’s estate in England and Wales. Some women with acute mental health conditions are still sent to prison by the courts as an alleged ‘place of safety’ or for their ‘own protection’. There is an urgent need for joint action with the Department of Health, so that prison is not the default setting for people whose primary problem is mental health condition.

Initial medical screening on first admission to prison includes determination of mental healthcare needs, including post-traumatic stress disorder and risk of suicide and self-harm. Regular assessment of mental healthcare needs does not occur as a matter of course, but during risk episodes occurring. Good multidisciplinary support was provided to the most vulnerable at each women’s prison in England, but there was an over-reliance on use of assessment, care in custody and teamwork (ACCT) case management, with too little attention to preventing women getting into crisis in the first place.

In women’s prisons in England, despite commitments to remove courts’ power to use prison as a “place of safety” (under the Mental Health Act 1983) or to remand people to prison for their own protection under mental health grounds under the Bail Act 1976, the number of women deprived of their liberty under these provisions has actually increased in some prisons. 

A lack of secure community mental health beds leads to women being detained for their safety in an inappropriate environment for their mental health needs, with some women held in segregation or on wings without adequate treatment and support. Due to the high level of need, inpatient and specialist units in women’s prisons – where they exist – are often full, and women needing admission to secure mental health hospitals are not transferred quickly enough. The high level of care and supervision needed to support women with particularly complex needs who account for many of the increasing incidents of self-harm in prisons, is exacerbating staff shortages. At New Hall, some women with highly complex needs lived on a designated unit that had a positive and therapeutic ethos. At Eastwood Park, the unit to accommodate some acutely mentally unwell women was in a very poor condition and provided far too little support and care.

Across all four nations, women in prison with very serious mental health conditions are not receiving appropriate treatment. In Scotland, despite many years of repeated recommendations, there is no high security hospital for women, which means they must be transferred to England. The result is that women in episodes of severe mental distress are transferred many hours south of the border, if a bed is made available. In Scotland’s Community Custody Units, when women arrive after clinical staff have left for the day, are placed on observation with 15-minute intervals between contact by operational staff who do not have clinical expertise and have to wait until the next day to be assessed by a health professional. 

In Scotland, a new design at HMP and YOI Stirling has become operational, where women are assessed before transfer to other prisons. HMP and YOI Stirling offers modern accommodation in a campus design, and a trauma-informed ethos provide a therapeutic environment for women. Staff are caring and compassionate, especially in the unit housing the women with the most complex support needs. Women currently stay at HMP and YOI Stirling for only short periods of time, before being transferred to much older prisons with worse quality accommodation, which does not make best use of the much-needed therapeutic environment at the centre. Women cannot fully benefit from this resource when spending such short periods in it. 

Contact with the outside world

Relationships with children and family are central to the care of women in prison, but many women are held far from their family homes. The conversion of the women’s unit in Edinburgh prison into a unit for high-secure men means that many women have been moved to different areas of the country, far from their communities. There are no women’s prisons in Wales, meaning that Welsh women in prison are detained in England. 

Support for women to maintain relationships with their children and families was slow to recover after the pandemic, though some sites offered good support to women and their children through mother and baby units. A 2024 inspection of Peterborough prison found that only a third of women said there were able to see family or friends more than once in the previous month. However, staff and prisoners received training through a “Mothering Justice” course on understanding mothers in custody, and a family engagement team provided individual help to women and communicated with children’s services, making links between women and, for example, schools, so that mothers could virtually attend parents’ evenings and ready school reports. No parenting or antenatal classes were available in the Mother and Baby Unit, but mothers in the unit could mentor expectant mothers and offer support. At East Sutton Park and Askham Grange, release on temporary licence was used extensively to enable women to spend time with their family, which was a positive initiative. 

Accommodation and food

Findings from the NPM revealed that, while living conditions were generally reasonable, some shared cells are cramped. In England, prison food was often unpopular and, disappointingly, there were limited or no opportunities for women to prepare or cook their own food at any of the three prisons. Women found the range of items they were able to buy was too limited and did not meet their needs. Just 52% said the shop/canteen sold the things they needed.

Heating and ventilation were common problems in prisons in England, with prisoners either facing extreme cold or heat – which was especially challenging for menopausal women.

Resettlement

Remanded women cannot always access even very basic resettlement help. In some prisons they are excluded from services that are available to sentenced prisoners, such as housing assessments or debt advice. Too many women left prison without a sustainable place to live or homeless.

In England, prisons face too many barriers to providing good resettlement support, providing disjointed, complicated services that couldn’t address practical needs like access to bank accounts or national insurance numbers. Suitable accommodation is often not found until very close to women’s release dates, which creates uncertainty and prevents other necessary services, like medication or mental health treatment, being arranged reliably. Staff shortages lead to delays and reduce the chance of meaningful support during sentences. However, work to reduce reoffending was properly focused and the quality of offender management was reasonably good in inspection in 2022-23. Importantly, the impact of trauma and abuse was increasingly taken into account with good support offered in England.

Women in special situations of vulnerability

In 2022-23, work to promote fair treatment for different groups of women in prison in England had stalled or declined at all sites inspected. Datasets used by leaders were too narrow, and consultations with prisoners too infrequent, to allow leaders to build understanding of the needs of women with additional protected characteristics.

Women belonging to ethnic minorities 

The report Towards Race Equality in 2022 reported concerning examples of unequal treatment received by black women especially. Respondents to surveys gave examples of racism and direct discrimination based on race, including by prison staff. Black, Asian and minority ethnic women also reported indirect discrimination and unfair treatment in adjudications, access to employment and release on temporary licence. Staff equality and diversity training seemed inadequate and inconsistently delivered across the women’s prison estate. There was not always adequate translation for women prisoners who did not speak English as a first language.

Alternatives to detention

In England, it is particularly disappointing that it is proposed to build 500 more prison places for women, rather than investing in small and transitional units, as recommended 15 years ago in the Corston Report. In England, the open prison Askham Grange was only at 73% of its capacity, even though there were plenty of suitably assessed women in the closed estate.

In Northern Ireland, a review of how women in conflict with the law were treated found good promotion of a gender-sensitive ethos, but the need for improving gender responsivity in the criminal justice system. Recommendations were outstanding to mainstream the Inspire model of probation supervision and establish a small women’s custodial facility using a therapeutic model.

It was not possible to tell in any formalised or strategic manner the extent to which criminal justice measures had been responsive to females’ offending risks and needs. Lack of resources, and women’s relatively low numbers in prison and within the criminal justice system, meant women’s risks and needs were somewhat less prioritised. Criminal justice professionals worked with existing, mostly generic, and at times male oriented, out-of-court and community measures to operate where possible in a gender-responsive way. 

Probation Board for Northern Ireland staff had established a female only Community Service Squad, Youth Justice Agency and Probation Board staff had sought out gender appropriate services in local areas, and Police Officers worked with community organisations to help de-escalate situations involving women often homeless, living with addiction and in crisis. 

Early intervention, out of court and diversionary measures would have benefitted from gender-specific options or clear operational standards to ensure generic measures were tailored in a gender-responsive way. 

Other relevant NPM information on women in prison

NPM Overview

Facts and figures7

Recommendations

Contact with the outside world

• Consider avoiding as much as possible the application of sanctions regarding the right to receive visits, which may have a negative impact on the process of reintegration of women deprived of liberty.

Life in prison: regime and activities 

• Organise more initiation, qualification, requalification, improvement and specialisation courses for women detainees.

• Take the necessary steps to conclude service contracts with companies, to provide work opportunities for women deprived of liberty while serving their sentence.

Sanitary facilities and personal hygiene

• Set up accommodation rooms with properly equipped sanitary facilities for people with disabilities, in accordance with the provisions of Art. 1, para. (6) from the Annex to the Order of the Ministry of Justice no. 2772/C/2017.

Prison staff 

• Increase the number of staff in the operative, medical and social reintegration sectors in women’s prisons

• Provide training and certificate to supervisory agents in the provision of first aid, through trainers of the General Inspectorate for Emergency Situations - IGSU.

Overcrowding 

• Address the problem of overcrowding in prisons during some periods, in accordance with the provisions of art. 1, para. (3) from the Annex to the Order of the Ministry of Justice no. 2772/C/2017 for the approval of the mandatory minimum norms regarding the accommodation of persons deprived of liberty. 

Detention issues

Accommodation and food

Body searches

a. Legal and regulatory framework

The procedure for conducting searches of persons deprived of liberty is described in the Regulation on the safety of places of detention subordinated to the National Prison Administration, approved by Order of the Minister of Justice no. 4800/2018.

Detailed records of body searches are mentioned in the Regulation on the safety of places of detention under the National Prison Administration, approved by Order of the Minister of Justice no. 4800/2018 and in Government Decision no. 157/2016 for the approval of the Regulation for the application of Law no. 254/2013. 

b. In practice

According to the documentation verified during NPM visits and the interviews conducted with women detainees, there is no indication that body searches of women are carried out systematically without an individual assessment. 

Body searches of women detainees and visitors are carried out by women staff as required by law. During body searches, the privacy and dignity is respected according to the relevant legal provisions. The NPM is not aware of any complaints from persons deprived of their liberty regarding the way body searches are carried out. 

Invasive body searches are performed only in exceptional circumstances, by a trained and authorized medical professional, according to legal provisions. In situations where, during the searches, there are indications that prohibited objects are hidden, both the control of the body cavities and that of the bandaged wounds, prostheses and plaster casts is carried out by the specialised medical staff.

Solitary confinement, isolation

The use of isolation is strictly regulated and appropriate protective measures are provided according to legal provisions.9 Isolation is prohibited - and is not used in practice - for girls, pregnant and nursing women, women in prison with their young children and women with psychosocial disabilities. 

During its monitoring work, the NPM found that the disciplinary sanction of solitary confinement was applied only in case of committing a serious, repeated disciplinary offense. The sanction did not apply to pregnant women or women with their children up to one year old in prison, in accordance with the relevant legal provisions.

There is no indication that solitary confinement is routinely and disproportionately used against women or certain categories of women. There are situations in which women are placed in isolation for their own protection according to Government Decision no. 157/2016 for the approval of the Regulation for the application of Law no. 254/2013. The conditions of the cells used for isolation are appropriate and meet the legal provisions.

Means of restraint

During its visits to prisons, the NPM found that pregnant women and women with serious health conditions were exempted from the use means of restraint, according to the relevant legal provisions. In case of negative events in which women detainees are involved, they were resolved through dialogue, with the provision of specialised assistance from medical, psychological and social professionals.

Means of restraint are also prohibited for women during labour, childbirth and after birth,  and not used in practice. There are no indications that restraints are used against women or certain categories of women in a disproportionate or discriminatory manner.

Women in special situations of vulnerability

An initial assessment of vulnerability is carried out by a commission established according to the legal provisions, on the occasion of the individualization and establishment of the execution regime, based on the criteria set by law. During the execution of sentences, when  one of the possible situations of vulnerability intervenes, the appointed commission meets and analyses the situation of the prisoner in order to assess the vulnerability. In 2023, in the penitentiary units that accommodated women serving a sentence, 25 inmates were included in this category. 

Pregnant and nursing women and women with children in prison

Pregnant women, women who give birth during the detention period and those who have children under the age of one year under their care do not carry out work activities in a toxic or harmful environment, cannot extend their working day beyond 8 hours and are provided with the necessary food, including for children, according to the legal norms in force.

The administration of the place of detention ensures the necessary conditions so that the mother, at her request, can take care of her child in appropriate conditions, until the child is one year old. Children under the care of mothers deprived of liberty are provided with vaccinations, according to the National Program of Immunizations.

Medical assistance and the monitoring of the child's physical and psychomotor development through periodic evaluations are carried out by a family doctor or paediatrician from the public health network, in compliance with the provisions of the framework contract that regulates the conditions for the provision of medical assistance, medicines and medical devices in the framework of the social health insurance system and the methodological rules for its application.

During one of the visits made by the NPM to women’s section of the Craiova Penitentiary, two inmates were pregnant, one of them with twins. These were recorded at the medical office, were monitored monthly and, starting from the 6th month of pregnancy, they were transferred to the profile section of the Bucharest - Rahova Penitentiary Hospital, for the supervision of the pregnancy and the provision of specialised medical assistance. 

At the level of all places of detention for women, spaces designed for visiting mothers with children are set up. During 2023, 261 visits for relatives were granted at the mother and child spaces set up at the level of penitentiary units.

Other Relevant NPM information on women in prison

NPM overview

Facts and figures

Recommendations

Solitary confinement

• The measure of solitary confinement should be applied only in extreme situations, taking into account the needs of the person and providing sufficient guarantees to respect her right to a due process.

Mental health

• To increase the number of staff, especially the number of psychologists and social workers.

• A screening program for women with mental health conditions in the penitentiary system should be established on a regular basis and not only applied when a person enters prison.

Detention issues

Solitary confinement 

1. Legal and regulatory framework

Under the Bulgarian law, solitary confinement is the most severe disciplinary punishment in prison. Therefore, the procedure and conditions, including the offense to which it can be applied, should be clearly specified in the law.

A person can only be isolated in a penal cell for serious or systematic violations of prison rules. According to the Bulgarian law, solitary confinement in a penal cell can be imposed for a maximum period of 14 days for adult prisoner and 3 days for juvenile prisoner.

If a convicted person has two or more punishments of solitary confinement and none of them has been served, the stay in a penal cell may be extended up to 20 days, but not more than the total number of days with which he or she is punished.

Upon admission and release from a penal cell, a mandatory search shall be conducted on the prisoner. During their stay in a penal cell, persons deprived of liberty shall not have any right to use food deliveries.

The conditions in the penal cell and the items which the convicts may keep shall be determined by the rule for application of the law. The penal cells shall be located in high security areas, ensuring isolation from the rest of the premises.

Rooms arranged as punishment cells shall meet all hygiene and health requirements - they shall be free from moisture, have direct access to daylight, be well locked, heated, have ventilation facilities and a secure bed. 

Solitary confinement can only be imposed by written order of the competent authority.  The order for disciplinary punishment of solitary confinement in a penal cell is subject of appeal before the Administrative court within three days of its announcement.

Prisoners isolated in a penal cell shall be visited by a medical specialist every working day. The medical examination shall be carried out on site, unless the case requires otherwise. By request of the prisoners the medical examination shall be carried immediately.

The undertaken medical examinations shall be certified in the relevant written documents, which shall be attached to the medical file of the convicted person.

2. The use of solitary confinement in practice

According to the information provided by the women’s prison, the number of women held in solitary confinement as disciplinary punishment has decreased over the past few years, which is considered as a positive trend. 

However, despite the safeguards introduced in the law and the possibility to appeal the measure, it should be noted that the risk of violating the right to due process is high. In this regard, it is worth noting that, even if the measure is appealed, the court's assessment is usually formal and based on documents submitted by the prison administration. Furthermore, prisoners cannot always afford a lawyer or provide enough witnesses for their case. 

Another problem at legislative level is that appealing against the measure does not stop its execution. That means that, if the court delays in issuing its decision, and the prisoner's appeal proves to be justified, the person will have suffered an unlawfully imposed measure. In such a case, the only defence left is to sue for compensation for non-pecuniary damage resulting from the execution of an unlawful act. 

Solitary confinement has a number of negative effects on women detainees, making it necessary to provide them with additional and effective rehabilitation support. Isolation in women can lead to high levels of depression, contributing to feelings of doom and a sense of loss of perspective in life. 

Possible measures to support women detainees include expanding opportunities for voluntary work and involving them in rehabilitation activities, minimising the negative effects of isolation by involving them in cultural, informational and sporting activities, and enhancing the professional competences of prison staff in order to adequately respond to the individual needs of each woman.

Access to mental healthcare

Healthcare for persons deprived of liberty with mental health conditions in Bulgaria is subject to special regulation which establishes the conditions and procedures of healthcare in correctional facilities. In general, findings from the NPM revealed several shortcomings in relation to healthcare in prison, such as: poor quality; lack of medical professionals; neglect of detainees' complaints, untimely referral of detainees to external specialists for diagnosis and treatment, and poor sanitary and hygiene conditions.

Healthcare of detainees with mental health conditions is provided in the medical centre of all prisons in Bulgaria and in the Specialized Hospital for active treatment at the prison in Lovech (SHAT). If necessary, healthcare for detainees may also be provided in other healthcare facilities. 

Тhere are two units in the Specialised Hospital at Lovech’s prison: one unit for men, with a capacity of 40 beds, and one unit for women, with total capacity of 10 beds. In addition to this, there is a stationary unit in every prison where persons with mental health conditions are placed until they are transferred to the Specialized Hospital.

The person deprived of liberty shall be informed about the offered healthcare services and all medical activities shall be carried out after the person has given their informed consent. Any additional healthcare service beyond the offered volume of healthcare may be provided at the patient's request and their own expense, at prices set by the health establishment. Medical, financial and statistical records shall be kept and stored at the Hospital. Every detainee with mental health conditions shall be prescribed, free of charge, the necessary medication for their treatment upon discharge from the hospital. Inmates from all over the country are admitted for treatment in the Specialised Hospital. 

One of the main recommendations by the NPM over the years has been that all prisons must employ a specialist psychiatrist to monitor prisoners with mental health conditions. From December 2022, psychiatrists in prisons are on civil contracts. 

According to the most recent data, one psychologist works with about 200 prisoners and one social worker with 100 prisoners The NPM has repeatedly recommended to increase the number of staff, especially the number of psychologists and social workers. However, so far authorities have not taken measures to implement this recommendation, alleging lack of funds for salaries.

According to the Bulgarian legislation, the initial training of prison’s staff shall include health-related information on: 

• the external signs of emergency conditions and the actions of staff in the event of the need for somatic emergency care and psychiatric emergency care;

• signs of withdrawal states in alcohol and/or drug dependence and initial actions to manage them;

• characteristic features of mental health conditions, suicidal attitudes and ways to prevent self-harm;

• involvement of non-medical professionals in the design of programmes for persons with addictions (alcohol and/or drug). Consultants from other medical facilities may be brought in to assist in the healthcare of detainees.

In case of suspected mental health condition of a person deprived of liberty, the inspector-psychologist, in cooperation with a psychiatrist at the prison medical centre or an external psychiatrist, shall conduct clinical-psychological and psychiatric examinations to clarify the diagnosis. Detainees with alcohol and/or drug dependencies or at risk of suicide shall be supervised by the psychiatrist, who, together with the inspector-psychologist and the inspector for social activities and educational work, shall draw up a program for their treatment.

On admission to a prison, detainees shall be placed in a reception ward for a period of 14 days to one month, and juveniles shall also be supervised by a tutor, a doctor and a psychologist. After the initial medical examination, detainees are consulted by a psychiatrist and a psychologist, who necessarily give an opinion on:

• the detainee's mental health state and their characteristics, such as suicidal tendencies, self-harm and aggressive behaviour;

• the symptoms of drug and/or alcohol dependence and the measures to be taken during the sentence.

Findings from the NPM revealed, over the years, the high percentage of women detainees with mental health conditions or who later develop them while in prison. In October 2019, during an inspection carried out at the women’s prison, it was found that 42 women had mental health conditions.  

In this regard, the NPM recommended that a screening program for persons with mental health conditions in the penitentiary system should be established on a regular basis and not only applied when a person enters prison. This recommendation has not yet been approved by the Ministry of Health.

Contact with the outside world

According to the Execution of Penalties and Detention Act, visits shall be carried at least twice in a month. Besides that, the convicted persons have the right of correspondence and phone calls. The allowed time for a visit is up to 60 minutes by order of the Chief Director of the Chief Directorate for Execution of Penalties.

The distance of Sliven Prison (307 km away from the capital Sofia) and other populated areas inevitably creates obstacles for regular visits. It is therefore recommended to consider extending the visiting hours for women serving their sentences far away from their permanent addresses. Another measure which could be taken to ensure the right to have contact with family and the outside world is to grant home leave to women who have good behaviour. 

Other relevant NPM information on women in prison

NPM overview

Facts and figures

Recommendations

Solitary confinement

• Prison should ensure that all women inmates who are not in solitary confinement can spend at least eight hours outside their cell every day and take part in meaningful activities, including at weekends.

• Prisons should ensure that women inmates who are at greater risk of suicide and self-harm are met with knowledge-based preventive measures, such as increased human contact, care, and meaningful activities. Solitary confinement should never be used to prevent self-harm and suicide.

• The local health units in prisons should ensure the daily supervision and follow-up of women inmates in solitary confinement. Health units should also ensure that it has a comprehensive overview of completed supervisions of such inmates.

Use of means of restraint

• The use of restraint beds in prisons should be abolished, considering the high risk of inhuman and degrading treatment associated with the measure.

   

Body searches

• Prisons should ensure that male staff are not present during body searches performed on women inmates.

Healthcare

• The local health units should ensure that inmates have access to a woman doctor.

Detention issues

Through numerous prison visits and in its 2016 thematic report on women in prison, the NPM has expressed its concern that women inmates in high-security prisons are collectively afforded inferior conditions compared to men. Additionally, the proportion of women inmates with mental health conditions rose considerably during the period 2010 – 2019.

In March 2023, the NPM conducted an unannounced visit to a high-security prison exclusively dedicated to women - Bredtveit Prison - and the Zulu East wing at Ullersmo Prison. The visit took place because of increasing concerns regarding conditions at Bredtveit Prison and the transfer of female inmates to Ullersmo men’s Prison in January 2023 as an emergency measure due to many serious incidents of violence and self-harm. The visit revealed that the inmates at Bredtveit Prison were living under critical and even life-threatening conditions. The seriousness of the situation and the need for urgent measures led the NPM to notify the Ministry of Justice and Public Security of the conditions in a letter dated 23 March 2023.

Body searches

In Norway, body searches may be performed under the Execution of Sentences Act.21 Until 2021, body searches were performed as strip searches without any clear legal requirements of concrete risk assessments by prison staff. As a result, these measures were applied routinely, on both women and men inmates, upon admission to prison, in connection with movement and transfers out of prison, and before and after visits.

The practice of routine strip searches without risk assessments has been consistently criticized by the NPM after its prison visits. This led, firstly, to gradual changes in the modalities of how body searches are performed, including for women. Secondly, NPM recommendations were later picked up in the case law of the Norwegian Supreme Court, which in several judgments has held that routine strip searches in prison amount to ill-treatment contrary to article 3 of the European Convention on Human Rights (ECHR).

Men staff are very rarely present during body searches. In cases where this has happened, as far as the NPM has been able to ascertain, the male officer has had his back turned or stood outside a door kept ajar.

Body cavity searches may be performed under Section 29 of the Execution of Sentences Act. A medical opinion shall be obtained and taken into account when considering whether this measure shall be implemented. The procedure may only be carried out by health service personnel.

Solitary confinement

1. Legal and regulatory framework

Generally, the applicable national legal framework that authorizes the use of solitary confinement as an administrative measure is set out in the Execution of Sentences Act, Section 37. A stricter form of solitary confinement - in security cells without any furniture - is provided for under Section 38 of the same act. Moreover, the use of restraint beds is also allowed under Section 38. The Courts may also impose solitary confinement on prisoners on remand to prevent the destruction of evidence if the legal requirements in the Criminal Procedures Act Section 186a are met.

No legal rules or regulations exist that explicitly prohibit the use of solitary confinement for women in particularly vulnerable situations, such as pregnancy. However, there are stricter legal requirements to subject inmates under the age of 18 (including girls) to solitary confinement.

Solitary confinement may also be imposed as a control measure when necessary to maintain ‘peace, order and security’. This legal requirement leaves a lot of leeway to prisons and does not reflect that solitary confinement must only be used in exceptional cases. By law, ongoing assessments must be made of whether or not the use of solitary confinement is necessary, and the stay must be brought to an end as soon as this is no longer the case.

Norwegian legislation allows for prolonged solitary confinement for up to a year at a time, contrary to human rights standards. The Ministry of Justice and Public Security has recently proposed several legal amendments to the provisions on the administrative use of solitary confinement as an attempt to address these shortcomings.

2. The use of solitary confinement in practice

While the use of Court-ordered solitary confinement has decreased in the last decades, the use of solitary confinement as an administrative measure remains.22 In recent years, official statistics from the Correctional Services on the use of solitary confinement in security cells and on the use of restraint beds suggest that women inmates are disproportionately affected by these measures.

The NPM’s visit conducted in March 2023 revealed serious failings at Bredtveit Prison, the Norwegian Correctional Service’s regional office and within the prison health service. During the period 2018–2022, the prison recorded a doubling of women inmates being placed in solitary confinement in their cell (from 36 inmates in 2018 to 77 in 2022). Since 2018, the prison has more than doubled the number of inmates it has placed in security cells, (from 27 decisions in 2018 to 92 in 2022). A security cell in Norway is a bare cell with only a plastic mattress and a squat toilet. Food and water are pushed in through a hatch at floor level and no washing facilities are provided for the inmates. Most of the communication between the inmate and staff takes place through small hatches or plexiglass. While in a security cell, inmates are deprived of virtually all control over their own lives, to a far greater extent than that which follows from the imprisonment itself. 

Most of the decisions concerning placement in security cells that were reviewed by the NPM did not fulfill the applicable statutory requirements. Many cases indicated poor conflict prevention, and threats or violent acts that could have been foreseen. Examples include stress and worry in connection with impending court hearings or frustration over inactivity and a lack of association with other inmates, which in turn contributed to further escalation which was then dealt with by placing the inmate in a security cell.

The prison’s efforts to fulfil the requirement of ongoing assessments consistently appeared to be very inadequate. The NPM observed numerous examples of decisions being made in the afternoon to place an inmate in a security cell until the following day. In some cases, the inmate was described as being calm when the decision was made and there was no information in the documentation to indicate that the inmate needed to remain in the security cell.

3. Health-related risks of solitary confinement

In Norway, the prison health service is run by the municipal authorities as primary health care  provider, even if the services are localised within the prison. Some prisons also have the regional specialist health services present. What is known as ‘the import model’, where the health service is independent of the Correctional Service, supports the medical personnel’s independence of the Correctional Service. The import model is intended to ensure that medical personnel never partake in administrative decisions on sanctions or in enforcing sanctions. 

Findings from the NPM visit conducted in March 2023 revealed that efforts made by the prison to prevent the adverse health effects of solitary confinement were also inadequate. The NPM found virtually no documentation that indicated that inmates who had been in solitary confinement (placed in isolation in their own or a reinforced cell) had been offered the opportunity to engage in social contact, which met the minimum requirement of two hours of meaningful human contact per day. The NPM also found no examples of inmates in security cells being given the opportunity to get out into the open air, even when their stay in a security cell lasted several days. 

There was a dedicated resource team at the prison that was responsible for preventing solitary confinement damage by following up on and activating individual inmates. This resource team was doing an important job, but it had very limited capacity and was therefore unable to meet the needs of inmates in solitary confinement at the prison. 

The visit and subsequent review of documentation revealed that the prison had failed to comply with the requirement that solitary confinement must only be used in extraordinary cases, as a last resort and for as short a period as possible. It appeared that the prison consistently had a low level of understanding of both the considerable health risks linked to solitary confinement and the legal limits of its use. The Norwegian Correctional Service’s eastern regional office, which is responsible for the execution of sentences at Bredtveit, also appears to have failed to identify these shortcomings. 

The follow-up of inmates in solitary confinement by the municipal healthcare department at Bredtveit prison was found to be inadequate. The department did not independently consider the health-related consequences of using solitary confinement and security cells for individual inmates. They also had no general overview of how long inmates spent in solitary confinement or the reason for the solitary confinement, not even in cases where the solitary confinement was justified through suicide risk. The NPM found no systematic recording of injuries suffered by inmates while they were in solitary confinement. The municipal healthcare department also lacked procedures for supervision in connection with exclusion and the use of security cells. There was no evidence to suggest that they carry out daily supervision of inmates who had been excluded from interaction with other inmates, even though the Directorate of Health’s guidance stipulates that such supervision must be carried out.

Means of restraint 

In Norway, the use of restraint beds is regulated by the Execution of Sentences Act Section 38. The Act provides for the use of restraint beds, security cells and other approved measures of restraint, in all situations covered by Section 38. 

The NPM’s thematic report ‘Use of restraint beds in Norwegian prisons’ (2020), showed that over 30% of cases of inmates being placed in restraints in the period 2013–2018 concerned women. This included some of the longest periods spent in restraints. Additionally, the decisions analysed showed that women inmates who had been placed in restraint beds, more often had been restrained several times, compared to men inmates in restraint beds. Five of the seven inmates who had been put in restraint beds four times or more were women. The NPM’s visit conducted in March 2023 revealed that, in many cases, the inmate was carried from the third floor to the security wing, which forms a ground-floor extension, wearing handcuffs. 

Contact with the outside world

Legal and regulatory framework

Visits in Norwegian prisons are regulated by the Execution of Sentences Act Section 31. According to the Guidelines to the Act, visits shall normally take place in a dedicated visiting room, and it is up to the prison to decide, based on local conditions, how often an inmate can receive visitors and on which days visits can be received. As far as practically possible, inmates should be allowed at least one visit per week, lasting at least one hour.

Contact with family: the situation in practice

Because very few prisons in Norway receive women inmates, women risk being detained in prisons far away from their homes. This means that it will be difficult for some inmates to receive visits from family, particularly their children. This is especially the case for children who are too young to travel alone and children who do not live in the same country as their mother. Being detained far away from their family makes contact by telephone particularly important. However, this is limited to only 20 minutes for all inmates.23  If there are special reasons and capacity allows, extended phone time can be granted. However, presently, this remains at the discretion of the local prisons.

Women in special situations of vulnerability

Women with disabilities

Women inmates with mental health conditions are particularly vulnerable to experience solitary confinement, restraints, and use of force because of inadequate efforts to ensure a healthy prison environment tailored to their needs. Between 2018 and 2022, Bredtveit Prison recorded a twenty-fold increase in self-harm incidents. Despite this, the prison had no system in place for identifying and following up the risk of self-harm and suicide, both upon admission and during the stay in prison. The prison largely dealt with self-harm and indications of suicide risk by solitary confinement and the use of force. A review of decisions made concerning the use of security cells during a sample period showed that 16 out of a total of 23 decisions were taken because of concerns about self-harm and suicide risk. 

The NPM encountered inappropriate and routine escalation of intrusive measures: from isolation in the inmate’s regular cell to placement in a security cell and, in some cases, the use of a restraint bed. The use of solitary confinement and force may reduce the likelihood that inmates at risk share information about their mental health and suicidal thoughts with the staff. There was also a lack of awareness of how the prison’s own operation, detention conditions, and use of solitary confinement impact all its inmates and could increase the risk of mental health conditions, self-harm, and suicide.

Foreign women

Foreign women are a in a situation of heightened vulnerability as they are far away from their homes, and family. Language problems can result in inmates being poorly mapped on arrival and in their special needs not being identified. This could place foreign women in a vulnerable situation with an increased risk of isolation. Contact with their family is therefore very important to this group of inmates. Yet, it has emerged during several of the NPM’s visits that women who had children in another country found it difficult to maintain good contact with their children. 

According to the Regulations to the Execution of Sentences Act, telephone calls shall normally be paid by the inmates themselves. The NPM has been informed by foreign inmates at several prisons that financial limitations make it difficult to make international calls since they are more expensive than domestic telephone calls in Norway. In addition, the Regulations limit telephone calls in high-security prisons to a total duration of 20 minutes per week, provided capacity allows (as described above). At the local level, extended phone time can be granted if there are special reasons and capacity allows.

Other relevant NPM information on women in prison

NPM overview

Facts and Figures

Recommendations

Body searches

• Body searches should only be carried out in the presence of two prison guards of the same gender as the searched person.

• Body searches should generally be conducted in a way that the person being subjected to the search only undresses one part of the body at a time. 

• Body searches with removal of clothes shall be documented in writing due to the intensity of the infringement. The staff shall record the purpose and the specific circumstances of the body search in order to ensure subsequent reviewability and preclude abuses.

Accommodation and food

• In general, women’s sections shall be run as shared accommodation.

• Women should only be held in closed detention in justified individual cases.

Life in prison: regime and activities

• The range of occupational opportunities for women detainees should be expanded. Women detainees should have the opportunity to get to know various employment types in different companies.

• It is highly recommended to ensure that men and women detainees work together in the prisons’ own companies.

Sanitary facilities and personal hygiene

• It is necessary to ensure that the increased need for hygiene of women detainees are taken into account, especially during their menstruation.

• During their menstrual cycle, women should have the opportunity to take a shower every day without having to ask for it.

• The range for sanitary articles available to women detainees should include tampons (in different sizes).

Pregnant and nursing women

• Pregnant women must get the same medical exams which pregnant women outside prison  have access to, i.e. regular preventive health check-ups offered to them within the so-called “mother-child-booklet”. 

• Pregnant women should give birth outside the correctional institution, i.e. in a regular hospital, and should have access to a midwife or a female prison staff with experience in childbirth while in prison, prior and after the birth of their child. 

Older women

• Prisons must ensure that the detention rooms are equipped for older women with disabilities, that medical and nursing care is provided and that the staff is adequately trained.

Detention issues

The Austrian NPM has focused its attention on the situation of women in prison since the beginning of its activities in 2012. Findings revealed that women in prison were discriminated against in many areas, especially due to their small number in prison, including with regard to employment. Their employment rate was lower compared to men, and the activities were mostly limited to cleaning or simple tasks, which can be compared to household chores, such as ironing. 

The Austrian Federal Ministry of Justice followed up on the NPM’s recommendations and, in 2016, it adopted a decree on the “Minimum standards for women in Austrian correctional institutions”, setting the standards for the accommodation and treatment of women in remand and in penitentiary institutions. 

Body searches

Women have to undergo searches in rooms intended for this purpose, when they are admitted or transferred to a correctional institution. The same obligation applies upon release. These examinations are body searches which entail the removal of clothes, and they are mandatory for all inmates, men and women. Body searches with removal of clothes are also carried out when an inmate is transferred to a specially secured cell in case they pose a danger to others or themselves. 

Law requires that body searches with removal of clothes can only be carried out in the presence of two prison guards of the same gender as the searched person, and when persons of the other gender are absent. 

However, findings from the NPM revealed that in some cases these requirements are not met.25  Women deprived of liberty reported instances when they were not allowed to put on their underpants before uncovering their upper bodies. They also reported that they had to squat, cough and spread their legs without any specific reason. The prison guards inspected all body orifices. Women detainees found these proceedings very humiliating and unpleasant. Some women also reported that the door to the room in which they had to undress was open or not completely closed so that third parties (male staff) could see inside the room. In one correctional institution, a camera monitors the body searches of persons deprived of liberty, which can then be seen on a monitor at the prison guard’s base.26

Women in special situations of vulnerability

Pregnant and nursing women

Another major issue in relation to women in detention are always pregnant women and mothers of small children. Sensitive areas are the care of pregnant inmates, the procedure of giving birth and whether the baby or toddler should stay with the mother in the detention facility and for how long. In Austria, there are currently32 five children who are in prison with their mothers. These inmates and their children are housed in a specific ward for women with children. Four children were born in detention in 2018. On average, children stay with their mothers in prison for 144 days.33

In relation to pregnant women in prison, the most important recommendation from the NPM is that these women must get the same medical exams which pregnant women in the “outside world” have access to, i.e. regular preventive health check-ups offered to them within the so-called “mother-child-booklet”. The NPM further recommends that pregnant inmates should give birth outside the correctional institution, i.e. in a regular hospital, and that they should have access to a midwife or a female prison staff with experience in childbirth while in prison, prior and after the birth of their child.

Older women

As of 1 February 2024, 632 women were in prison: 600 of them are under the age of 60; 14 of them are between the age of 60 and 65; and 18 of them are older than 65. At the moment, the oldest female inmate in Austria is 92 years old. She was sentenced to 12 years in prison at this advanced age, which means that she will most likely remain in prison until her death. 

The demographic development is also reflected in the prison population, i.e. inmates are getting older and are reaching an age at which they will inevitably need more care. The Austrian NPM draws attention to this and to the fact that solutions need to be found to guarantee that these inmates can age and die with dignity. Older inmates have other needs and requirements. They want quiet living and a place of retreat. Prisons must provide settings, which take this into account as well. It must be ensured that the detention rooms are equipped for older women with disabilities, that medical and nursing care is provided and that the staff is adequately trained.

Since the number of women in prison is significantly lower than the number of male inmates, the number of elderly women in prison is even lower. This inevitably means that the specific needs of elderly women in prison are addressed even less.

Other Relevant NPM Information on Women in Prison