On July 25, the family of 69-year-old Abd al-Moniem Abu al-Fotouh, the detained leader of the Strong Egypt Party, said he had suffered symptoms resembling a heart attack the night before while in solitary confinement in Cairo’s notorious Tora Prison. According to the family, Abu al-Fotouh, who is a doctor himself, knocked on his cell door the whole night, asking for help in vain from the prison guards. Abu al-Fotouh, unjustly detained without trial since 2018, is a widely respected political figure who finished fourth in the first round of Egypt’s first (and last) free and fair presidential elections in 2012, with over 4 million votes. Family members told Human Rights Watch that Abu al-Fotouh suffers from several serious and chronic medical pre-detention conditions, including hypertension and diabetes, and that the authorities had denied his request to undergo prostate surgery scheduled shortly before his arrest. He also developed a herniated vertebral disc in prison. Abu al-Fotouh’s case is emblematic of the reprisals meted out to those who dare to speak out against Egypt’s autocratic government, which includes the vindictive and unlawful deprivation of detainees’ rights to adequate medical care. Security forces arrested Abu al-Fotouh in February 2018 after he made comments criticizing President Abdel Fattah al-Sisi and called for a boycott of the 2018 presidential elections due to the “absence of competition.” Since then, the authorities have kept him in detention without trial, even exceeding the two-year limit on pretrial detention under Egyptian law. Since al-Sisi orchestrated a military coup in July 2013, when he was the defense minister, Egypt’s prisons have been filled with political dissidents of all stripes, many of whom have experienced what amounts to a slow death sentence due to deliberately insufficient medical care. In November 2019, following the death of former President Mohamed Morsi in abusive detention, United Nations experts wrote that due to Egypt’s detention conditions, “thousands more detainees across Egypt may be suffering gross violations of their human rights, many of whom may be at high risk of death.” An Amnesty International report released in January titled “‘What do I care if you die?’” and documenting the detention experiences of 67 people in 16 prisons found that “prison officials show utter disregard for the lives and wellbeing of prisoners” and that authorities intentionally deprive political detainees of “health care, adequate food, and family visits.” I have interviewed dozens of detainees and detainees’ families in Egypt, but even so, I was appalled by what Khaled Dawoud, a journalist and the former president of Egypt’s secular Constitution Party (and a longtime correspondent in Washington), recounted in his haunting memoirs of his 19 months in Tora Prison. He wrote that the authorities placed him in a 6-by-9-foot cell with two prominent political science professors, Hassan Nafaa and Hazem Hosni, arrested around the same time. Dawoud wrote that they were each allowed only one “dirty prison suit” that made their skin itch and were made to walk barefoot around the prison and to the prosecution hearing session. Dawoud described how they had to eat from plastic bags, in the absence of spoons or utensils, and improvise knives made from tuna can tops. Soap was scarce and hot water almost nonexistent.
The cell was poorly ventilated and without sunlight.
There was no laundry, and inmates washed their clothes in primitive ways and hung them inside their cells, which contributed to the prison’s sickening dampness. Exercise was mostly limited to walking in the prison yard for 30 minutes a day and could be denied at the whim of the prison guards. His memoirs are a sober reminder: If this is how prison authorities treat well-known, prominent critics in detention, then the conditions for unknown detainees are likely far worse. Last September, 64-year-old Ahmed Abdelnabi Mahmoud died in prison after being detained for two years without trial, despite multiple pleas from his U.S.-based family for the government to release him or improve his prison conditions. He was among four prisoners who died in a 72-hour span in August-September 2020. Shady Habash, a 24 year-old filmmaker, died in prison in May 2020 after he reportedly ingested a toxic form of alcohol. He suffered for a day or two with only halfhearted interventions by a prison doctor, despite the fact that he could have been easily treated in a functioning hospital. International law is clear that prisoners’ health is governments’ responsibility.
The U.N. rules on treatment of prisoners (named after Nelson Mandela, who spent 27 years in a South African prison) require governments to allow prisoners access to the standard attainable health care in the community and ensure treatment continuity for chronic illnesses. In Egypt, even the lowest standards seem a mirage.
There are several reasons why. First, prisons are unhygienic and, combined with inadequate health care, have an environment that undermines anyone’s well-being, as Dawoud described. Second, there appears little to no urgent care system or procedures when a detainee suffers a medical emergency. What prisoners do, as many have explained to me, is that they yell and knock on their cell doors until a guard manages to communicate with an officer who has the keys. Typically, that takes hours, sometimes because the officer who has the keys is not sleeping in the prison or because officers take hours to finally believe that there is a serious issue and it is not just someone pretending to be sick. Third, even though prison officers oversee prisons, they often follow orders from an officer of Egypt’s notoriously abusive National Security Agency (NSA) who is supervising a given prison.
The NSA is the agency that rounds up, disappears, and tortures people—and it is also well documented that NSA officers use the deprivation of medical care as a punishment, even if diabetes or hypertension may kill someone if left untreated. For the lucky inmates who get transferred to an outside clinic, officers tasked with accompanying the prisoner frequently show lack of respect for the timing of their appointments, which leads to the prisoner arriving too late in the afternoon and missing the window to see the specialist. I heard this story numerous times from detainees’ families and experienced it firsthand when I used to work as a doctor in the Cairo University Hospital, where most of the city’s prisoners are taken when they finally get permission for an outside intervention. But first and foremost, the lack of health care in Egypt’s prisons is because authorities treat people in detention as less than human. It is far from being a question of resources or management. It is simply a question of human and political will.
The United States and Egypt’s other international partners know that many Egyptians are still fighting for dignity and democracy and that al-Sisi’s government brutalizes them. Instead of occasionally raising a voice here or there with an eye on maintaining the status quo in their strategic relations with Egypt, they should consistently and forcefully support what they claim are their values: human rights and democracy. Western governments cannot instill democracy in Egypt, but their continued, almost unconditional, security assistance and intelligence-sharing relationships with Egypt’s abusive agencies are an additional impediment to the pro-democracy efforts of brave Egyptians who are paying with their lives.
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