On July 28, the world marked the international day dedicated to the fight against hepatitis C. In recent years, new medications have been developed that have ushered in an unprecedented change in dealing with the virus and prompted the World Health Organization to set its sights on eradicating it by the year 2030.
The State of Israel, on board with the goal, announced the development of a national program for the early detection of carriers and has gradually introduced the expensive medication treatment into the health basket, so that all carriers of the virus are entitled to the treatment as of 2018.
However, according to a position paper recently published by the Israeli NGO Physicians for Human Rights (PHR), so far Israel’s commitment to implement this policy has not been applied consistently and uniformly to inmates incarcerated in state prisons. In fact, whereas the authorities are promoting the fight against the virus and its increased diagnosis and treatment within the civil healthcare system, in most cases these programs have not made it past prison walls. Despite estimates putting the rate of carriers among prisoners between 15-20%, as compared to 2% in the general population, prisoners have hardly been treated against the virus.
The PHR position paper entitled Israel Prison Service (IPS) Failures in Diagnosis and Treatment of Inmates with Hepatitis C, details how, based on testimonies that have been collected by PHR in the past two years and from requests sent to the organization by prisoners diagnosed as carriers, the IPS is trying to withhold treatment from inmates who need it based on various bureaucratic pretexts, and is unreasonably delaying those tests that are vital for starting treatment. According to IPS statements made in 2017, out of around 340 known carriers among the prisoner population, only 10-20 were given the medication as treatment.
Over the last year, PHR has supported a number of prisoners in their struggle to complete their medical diagnosis and receive the medication. After interceding with the IPS, and in some cases after petitioning the court, their treatment moved forward, and some of them have already finished it and have recovered.
It is unreasonable that those prisoners should be forced to appeal to PHR or other associations for help in order to receive medical treatment, which could be life saving. This is why PHR have teamed up with other organizations to write a letter to the Ministry of Health demanding that it act to ensure proper treatment for prisoners with hepatitis C. A passive policy on the part of the Ministry of Health and a shifting of responsibility between the Ministry and the IPS is one of the main causes behind the failure to treat carriers in prison.
For years now, professional bodies have been advocating proactive testing to screen for the virus among high-risk populations, such as individuals with a history of intravenous drug abuse. Despite the fact that many prisoners fall within these higher-risk categories and the Ministry of Health has even adopted these principles, the IPS is not carrying out early-detection tests among prisoners of its own initiative. As the IPS sees it, since the Ministry of Health did not expressly instruct it to run these tests for prisoners, it is not obliged to do so. The Ministry of Health, for its part, declares that it does not have the authority to set prison policy and it does not establish specific policies for specific entities but one policy for the healthcare system in its entirety.
In addition, while the authorities are passing the buck between them, it is estimated that hundreds of prisoners remain undiagnosed and untreated with a cure that can prevent their deterioration into life-threatening situations.
Beside the faulty conduct by the authorities, the work of PHR also yields achievements and successes: As part of a petition we filed on behalf of a prisoner requiring the treatment, the IPS has made it known that it is currently working on an agreement with a medication supplier to buy the medication for all prisoners who need it.
The PHR report summarizes work undertaken by the organization in this area during the past two years. A spokesperson is quoted there as saying that this is “not the end of the line for us. We have only recently addressed a demand to the IPS to start carrying out early-detection tests for the virus as per the guidelines of the health organizations.”
Related: PHR Position Paper (download as PDF)