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Covert castigation: violations of the right to health in Cuban prisons

While ordinary prisoners' health is compromised by 'indifference and indolence, political prisoners are victims' of 'systematic attacks' on their health through conditions of isolation, and illnesses, explains Juan Carlos González Leyva.

The bed of a prisoner in Caimito Prison, Artemisa, in 2022.
The bed of a prisoner in Caimito Prison, Artemisa, in 2022. Martí Noticias

Magalis González turns on the camera on her cell phone to post her umpteenth complaint on social media about the health of her son, Ismael Rodríguez González. The young man, sentenced to seven years in prison in Cuba for the massive protests in July 2021 (11-J) lies near her, dazed and with swollen feet, after arriving from the Guanajay Penitentiary, west of Havana, where he is serving his sentence.

According to the legal consultancy firm Cubalex Ismael Rodriguez has been diagnosed with an intellectual disability, is a suicide risk, and has a personality disorder. "In prison, Ismael is not given his medication, which is why he is ailing and suffering a full-blown crisis," activist Marcel Valdés stated on social media, posting the video that Magalis sent him.

Ismael's case is not exceptional within the Cuban prison system, characterized by widespread medical neglect. Between March 1, 2023 and May 31, 2024, the Cuban Prison Documentation Center (CDPC) recorded 2,093 incidents of violated rights at detention and imprisonment centers, of which 739 were related to health problems and a lack of medical care ( 35.31%).

Among the most frequent violations documented over the last year related to health issues have been non-compliance with medical prescriptions, and failure by authorities to provide medicines, as is the case with Ismael.

Sometimes this is due to the general shortage of medicines affecting the country. However, several prisoners, mainly political ones, have reported that when their relatives bring them medicines, the authorities do not accept them, or do not get them to the prisoners. They have also reported sometimes being denied medical care as a form of torture. This includes everything from indolent guards in sensitive health situations to delays in taking inmates to medical appointments.

Because of this, some inmates' health has been permanently damaged. Other times, these situations have had deadly results. Between March 1, 2023 and May 31, 2024, the CDPC registered 44 deaths in prison. Of these, 32 (72.73%) died as a result of the authorities' torpor in providing them with medication or medical care.

In addition, the prisons' deplorable sanitary conditions, overcrowding, and the food served lead to frequent outbreaks of tuberculosis, dengue, scabies, diarrhea, respiratory and skin diseases, as well as the existence of rodents, bed bugs and other insects, none of which are, generally, properly addressed by the prison authorities.

Another common complaint is failure to meet the requirements of inmates with special medical conditions, such as people living with HIV, chronic illnesses, or psychiatric disorders; and those who require special diets.

Attorney Juan Carlos González Leyva, who chairs the Council of Human Rights Rapporteurs of Cuba, describes the scenario as "a total is very difficult for a prisoner to obtain assistance from General Medicine. There is no dental care, and when inmates have a fever, cold, or are affected by an outbreak of diarrhea, they must recover on their own. In the prisons they don't give them any kind of medicine, even if they have dengue."

A Right Denied

Dariel Ruiz Garcia wears a prosthesis on his left foot, and is nearsighted. He was locked up for almost two and a half years for participating in a peaceful protest in Aguacate, a town in the municipality of Madruga (Mayabeque) in August 2021. At none of the facilities where he has been held - Melena del Sur Prison, and the El Paraíso labor camp - was his physical condition addressed.

"It's not just people like me, with disabilities. Cuba's prisons are not fit for any human being. The conditions are terrible, there are no medicines," Ruiz García said in an interview with the CDPC.

The Office of the United Nations High Commissioner for Human Rights (OHCHR) states that the right to health is "inclusive" for all people, without distinction, and that one's financial situation does not exempt the State from guaranteeing "minimum essential levels of the right to health," even under adverse circumstances.

The United Nations Standard Minimum Rules for the Treatment of Prisoners also state that medical care for prisoners is a responsibility of the State. According to this regulation, known as the Nelson Mandela Rules, each prison must have "a health care service in charge of evaluating, promoting, protecting and improving the physical and mental health of prisoners, in particular those with special health needs or problems."

Article 70 of the Cuban Penitentiary System's regulations state that at incarceration centers compliance with health programs, under the responsibility of Interior Ministry's Medical Services body, is guaranteed, in coordination with the corresponding Health Directorate. In practice, however, the right to health of those imprisoned in Cuba is not guaranteed.

"There was a nursing station and a full-time doctor at the prison, but it was more for emergencies," Dariel Ruiz recalls. "In fact, I was treated for my foot problem thanks to my family's insistence. (…) but a lot of people don't have that opportunity."

According to the former political prisoner, whistleblowing on failures to provide medical assistance is punished. "The prisoners raised some issues, and then the authorities retaliated against them. They wanted people to bite their tongues," Ruiz Garcia said.

According to Juan Carlos González Leyva, "the health care situation at prisons has deteriorated to the point that at some there's no medical personnel at all, or medications, except for some specific ones that relatives manage to get to certain prisoners, or thanks to a donation."

Mistreatment by prison staff aggravates the prisoners' suffering. Dariel Ruiz remembers a fellow prisoner "with psychological problems, and some rods in his knees, that the guards pushed, handcuffed, from a second floor (...) and they put him in a cell, where he spent a month without any treatment."

Another case he witnessed was that of Kevin, an inmate from Güines who was beaten by several guards and died shortly afterwards, allegedly due to the effects of the abuse: "He began to have problems, he didn't want to eat. It seems that he had a damaged organ or something. But they ignored his requests, and he died."

According to Dariel, the authorities "stated that it was due to a digestive problem, because there the doctors, the court, and those at the prison are all part of the same regime, of the same dictatorship. The doctors have to say whatever they're told to."

Activist Carlos Ernesto Díaz González, known as "Ktivo Disidente" agrees that the doctors at Cuban prisons are not to be trusted. He told the CDPC that, after a beating by prison personnel, they took him for what was supposed to be a checkup, but the doctor ignored most of his injuries. "Many of the doctors who practice at these prisons should lose their licenses, because they sign a Hippocratic Oath that they do not honor," he said.

Attorney González Leyva, who is in contact with dozens of inmates, and hears their complaints by phone, states that at prisons "there is no first aid, which is key in medical care; prisoners have heart attacks and spend hours lying on the floor, or in the infirmary. Many times inmates have to bang on the bars for a long time before the guards respond, while the victim suffers severe chest pains."

Sometimes, González Leyva explains, those who survive these incidents are not taken to a hospital equipped with the resources for intensive treatments. "Prisoners are not heard when they have a crisis or face a life-threatening situation. The officials say they are pretending, and most of the time these situations result in the inmate's death. Other times they are taken to the hospital, dying, after complaining for several days."

Dariel Ruiz recalls that at the El Paraíso camp "they did not administer treatment" to inmate Jorge Luis Moreira Roja, from Madruga, who had cancer. "They gave him a furlough at the last minute. Shortly after leaving he was already dead."

These precedents are alarming for human rights organizations because of the risk they pose to very sick people, many of them political prisoners, whose requests for release have been rejected by the authorities.

Amnesty International (AI) is carrying out a social media campaign calling on the Cuban government to stop "denying access to medical care" by prisoners, among other violations. At the end of May it joined the CDPC to express in a statement "deep concern" about prisoner of conscience Loreto Hernández, arrested with his wife, Donaida Pérez for demonstrating on 11-J.

Hernández, sentenced to seven years, was hospitalized for several weeks in 2023. His family requested leave for health reasons. Despite the fact that a doctor provided by the State recommended his release, "a court denied it, such that Loreto Hernández's health has remained at risk," AI reported.

Hernández's brother Jorge Luis García Pérez, known among opposition activists as "Antúnez," states that the leader of the Yorubas Libres de Cuba organization "is the victim of a clinically induced assassination attempt by top political police officials."

According to Antúnez, his brother's health has greatly declined, leading to a "change in his skin color, traces of blood in his urine and stool, [and] frequent losses of consciousness (temporary fainting)."

The demands for Hernández's release are bolstered by the outcomes of other cases, such as that of Fernando García Consuegra (66), who died on October 9, 2023 in Valle Grande prison (Havana) after a heart attack.

According to Cubalex, the inmate did not receive his required medication for two days, despite having been diagnosed by the prison's own doctors. He was also not taken to an external hospital due to alleged transportation difficulties.

Cubalex concluded that it was "a flagrant violation of the inmate’s right to care, highlighting the Cuban State’s breach of its obligations."

Insufficient Conditions to Live or Heal

In addition to worsening pre-existing health conditions, confinement in the Cuban prison system can cause new ailments. According to Juan Carlos González Leyva, "the prison system in Cuba, far from healing, makes people sick, destroys them, due to its lack of food and because of the conditions where prisoners live, which are utterly unhygienic, without drinking water, and surrounded by flies. It's totally unhealthy."

According to the Office of the High Commissioner, factors such as "access to adequate water and sanitation facilities, (...) and adequate food and nutrition," among others, must be taken into account to guarantee one's right to health. These conditions are not guaranteed at Cuban prisons. This year, as of May 31, the CDPC has recorded 158 complaints related to poor diets, precarious living conditions, and water supply problems.

Biologist and academic Ariel Ruiz Urquiola, arbitrarily tried for "contempt" in 2018 and sentenced to one year in prison, states that "the most shocking thing was the conditions in the cells." 

"You share a room with several inmates. The bathroom is shared; that is, you see everyone else defecating, urinating and washing. I didn't have flip-flops, so to bathe I had to put my feet in the same 'Turkish toilet' where we defecated," he stated.

In addition, "you had to store the drinking and bathing water, which came from reservoirs, untreated." According to the scientist, the water was "muddy, red and full of sediment" and they only supplied the inmates two hours a day. Diarrhea-related diseases are very common.

From January 1 to May 31, 2024 alone the CDPC  registered 35 complaints related to plagues and epidemiological outbreaks in prisons, which affect their general populations.

As for the food, Ruiz Urquiola said it was "spoiled,  to a large extent" and the rice "was full of worms. In the beans and peas there were flies, but you had to wave them aside and eat it. You had no choice."

According to  lawyer and human rights defender Juan Carlos González Leyva, the underlying problem of poor food is "most serious that the prison population has in terms of health." For those who are already sick, "there are no medical diets, which also aggravates the prisoners' health conditions," something that (former) prisoners and family members have confirmed for the CDPC.

Yanay Solaya, a former 11-J political prisoner, told the CDPC that the pregnant inmates she met at the Western Women's Prison, in El Guatao, "did not have [special] diets, it was the same food for everyone." For a friend of hers who was pregnant, "when her blood pressure rose, there were no medicines, there were no cars to get her to appointments, there was no gasoline, there was nothing (...) and they had to give her a furlough."

Others don't receive that benefit in time. Political prisoner Luis Barrios Díaz (age 37) died on November 19, 2023, after respiratory complications aggravated by the authorities' decision not to keep him at a hospital in Havana, according to information from the Cuban Human Rights Observatory. He was granted a leave, apparently when the State considered his death imminent. The Inter-American Commission on Human Rights demanded a "prompt" investigation into his death.

A Practice of Torture

Camila Rodríguez, Director of the CDPC, believes that the denial of medical assistance and medicines is consistent with a desire to cause harm to prisoners, especially those convicted for political reasons. "It is critical for us to talk about denial of medical care as a form of torture," Rodriguez said at a recent event organized by the AC Research and Advocacy Initiative and Amnesty International.

"We are not only talking about a crisis in Cuban prisons due to a lack of medicines and supplies. This is deliberate torture to punish, above all, political prisoners," she added.

According to González Leyva, with the Council of Human Rights Rapporteurs, while the health problems of ordinary prisoners are aggravated by the authorities' "indifference and indolence ... political prisoners are victims of systematic attacks on their health by limiting their diets, subjecting them to inhumane conditions, and inducing diseases."

The Cuban Prisons Documentation Center publishes monthly reports on prison conditions, as well as lists of prisoners with delicate health situations. The data and testimony collected by this program of the AC Research and Advocacy Initiative represent an underreporting of what really happens inside the prisons, since the Cuban State does not publish information about them, or allow independent organizations to access them.

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