Margarita Charykova, a Moscow bartender arrested on a drug offense, gained more than 25 percent of her body weight in March, and not because of the food served at the Pechatniki pre-trial detention facility. Charykova, born without part of her lower intestine, was denied medical equipment needed to maintain her health, and was refused necessary dietary accommodations. As a result, her body began to slowly fill with waste, sending pain shooting through her gut, causing headaches and bloating, and forcing blood and a part of her intestine out of her body. Her jailers allowed her one stay in the prison's hospital and when her health deteriorated further, offered her aspirin and condolences. Charykova quickly became the focus of intense advocacy by Russian and international human rights defenders, and was released on April 5, 2013, after nearly three months of suffering.
Thousands of others held in pre-trial detention -- that is, convicted of no crime -- suffer without medical attention, and so are de facto sentenced to pain, illness or worse. A month ago in Kyiv, Ukraine, a young man was allegedly denied methadone, a medicine taken daily for heroin addiction, after police arrested him and placed him in pre-trial detention. The painful withdrawal symptoms started, and soon he was dead. While the details of his case are still being investigated, others in Ukraine report that police have used the pain of withdrawal from heroin as a tool to coerce confessions. It leaves fewer marks than pulling fingernails.
Drug users are often the largest share of those imprisoned, and suffer particularly in pre-trial detention. But hundreds of thousands of others with acute medical needs are ignored routinely in multiple countries. Prison officials argue that pre-trial detainees are with them for too short a time to warrant that the system ensure they get medical attention. Around the world, detainees languish in desperation for months or years, far longer than the detention periods supposedly allowed on paper. Their stories -- of untreated TB infection, diabetic episodes, hepatitis, AIDS and death -- are rarely heard. Pictures of the overcrowding and deprivation do not make it out of facilities where cameras and cell phones are not permitted.
There are more humane approaches to pre-trial detention, even in countries with harsh penal systems like Russia's. In St. Petersburg, for example, a partnership between a forensic medical examiner and a lawyer committing to visiting pre-trial holding cells has secured the release of patients on medical grounds -- a clause in the law that authorities do not observe unless pushed to do so. Having recognized that pre-trial detention is bad for health and human rights, a Global Campaign for Pretrial Justice is working to decrease the numbers of those held needlessly in detention facilities by piloting release and paralegal programs, and advocating for policy changes to decrease excessive use of pre-trial detention and the time those awaiting trial spend behind bars. In the United States, other programs -- like that called Law Enforcement Assisted Diversion, or LEAD, in Seattle -- route small-time drug offenders to services, rather than to jail. Police engaged in the program report that people who they had previously arrested repeatedly are now doing better, and cost the police and the penitentiary system less of time and money.
Russians suffering as Charykova did have turned to international authorities for justice, with mixed success. The European Court of Human Rights has judged Russia's failure to provide health care in pre-trial detention, and the overuse of pre-trial detention itself, to be cruel, inhumane and degrading. Individual plaintiffs -- too often family members of the deceased -- have received modest settlements, but systemic change has been less visible.
The court of public opinion should also condemn the excessive suffering caused by overuse of detention and the denial of health care. Perpetrated in the name of public protection, pre-trial detention is a broken system that routinely releases the powerful, even when accused of serious crimes, and leaves those charged with minor offenses languishing behind bars.
Whether in the U.S., Latin America, Africa or Eastern Europe, there are too many prisons where detainees outnumber beds and where people are forced to sleep in shifts or stacked like sardines. Too many detention facilities are places where tuberculosis control is absent, and pain relief unavailable. Seeing the evidence summed up in reports by health experts, the verdict is clear: Condemning people to pain and illness while they wait for a trial isn't justice, it is cruelty. And it must stop.