Version 2000
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Adopted: October 2000
THE WORLD MEDICAL ASSOCIATION, INC.
WORLD MEDICAL ASSOCIATION
DECLARATION OF EDINBURGH
00
10.300
Original: English
PRISON CONDmONS AND THE SPREAD OF TUBERCULOSIS
AND OTHER COMMUNICABLE DISEASES
A. Preamble
1. Prisoners have the right to humane treatment and appropriate medical care. Standardsfor
the treatment ofprisoners have been set down in a number ofDeclarations and Guidelines
adopted by various bodies ofthe United Nations (See annex).
adopted by various bodies ofthe United Nations (See annex).
2. The relationship between physician and prisoner is governed by the same ethical principles
as that between the physician and any other patient.
3. There are strong public health reasons for reinforcing the importance ofthese rules. The
recently reported increase in incidence oftuberculosis amongst prisoners in a number of
countries reinforces the need for considering public health issues when designing new
prison regimens, and for pressing for reforms ofexisting penal and prison systems.
4. Prisons can be breeding grounds for infection. Overcrowding, lengthy confinement within
closed, poorly lit, badly heated and consequently poorly ventilated and often humid spaces
are all conditions frequently associated with imprisonment and which contribute to the
spread of disease and ill-health. Where these factors are combined with poor hygiene,
inadequate nutrition and limited access to adequate health care, prisons can represent a
major public health challenge. Keeping prisoners in conditions which expose them to
substantial medical risk constitutes a humanitarian challenge. An infectious prisoner poses
a risk not only to other prisoners but also to prison personnel, the prisoner’s relatives,
other prison visitors and the wider community when the prisoner is released. The most
effective and efficient way of reducing disease transmission is to improve the prison
environment, targeting overcrowding for the most urgent action.
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5. The increase in active Tuberculosis (TB) in prison populations and the developmentwithin
some of these populations of resistant and especially “multi-drug” resistant forms of
tuberculosis, as recognised by the World Medical Association in its Statement on Drug
Treatment ofTuberculosis, is reaching very high prevalence and incidence ratesinprisons
in some parts ofthe world.
6. Other conditions, such as Hepatitis C and mv Disease, do not have as high a risk of
person-to- person communicability as tuberculosis but pose transmission risksfrom blood
to blood spread, or sharing and exchange ofbody fluids. Overcrowded prison conditions
also promote the spread ofsexually transmitted diseases. Intravenous drug use will also
contribute to the spread of mv as well as Hepatitis B and C. These need specific
solutions that are not dealt with in this statement. However the principles set out below
will also be helpful in reducing the risk from such infective agents.
B. Actions Required
7. The World Medical Association considers it crucial both for public health and
humanitarian reasons that careful attention is paid to:
7.1 protecting the rights ofprisoners, regardless oftheir infected status, and according
to the various UN instruments relating to conditions ofimprisonrnent. Prisoners
should enjoy the same rights as other patients, as outlined inthe WMA Declaration
ofLisbon;
7.2 ensuring that the conditions in which detainees and prisoners are kept, whether
they are held during the investigation of a crime, whilst waiting for trial, or for
punishment once sentenced, do not contribute to the development, worsening or
transmission ofdisease. This also refers to the conditions in which persons are held
while going through immigration procedures, although prisons shouldnot normally
be used to house such persons;
7.3 ensuring that prisoners are not isolated, or placed in solitary confinement, without
adequate access to health care and all appropriate responses to their infected
status;
7.4 upon transfer to a different prison, inmates’ health status should be reviewed
within 12 hours ofarrival to ensure continuity ofcare;
The Declaration ofEdinburgh (Document 10.300) is an official policydocument ofthe World Medical Association,
the global representative body for physicians. It was adopted in October 2000 in Edinburgh. Scotland.
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7.5 ensuring the provision offollow-up treatment for prisoners who, on their release,
are still ill, particularly with an infectious disease. Because intenuptions of
treatment may be particularly hazardous both epidemiologically and to the
individual, planning for and providing continuing care are essential elements of
prison health care provision;
7.6 the efficacy, necessity andjustification for public health mechanisms, which mayin
the rarest and most exceptional cases involve the compulsory detention of
individuals who pose a serious risk of infection to the wider community. Such
steps should be exceptional and must follow careful and critical questioning ofthe
need for such constraints and the absence of any effective alternative. In such
circumstances detention should be for as short a time as possible and be as limited
in restrictions as feasible. There must also be a system ofindependent appraisal
and periodic review ofany such measures, including a mechanismfor appeal by the
patients themselves. Wherever possible alternatives to such detention should be
used;
7.7 This model should be used in considering all steps to prevent cross infection and
to treat existing infected persons within the prison environment.
8. Physicians working in prisons have the duty to report to the health authorities and
professional organisations of their country any deficiency in health care provided to the
inmates and any situation involving high epidemiological risk for them. NMAs are obliged
tQ..P..r9j~Jhose physicians against any possible reprisals.
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to protect those physicians against any possible reprisals.
9. The WMA calls upon member associations to persuade national and local governments
and prison authorities to address urgently these aspects of health promotion and health
care in their institutions, and to adopt programmes that ensure a safe and healthy prison
environment.
••••
The Declaration ofEdinburgh (Document 10.300) is an official policy document ofthe World Medical Association,
the global representative body for physicians. It was adopted in October 2000 in Edinburgh, Scotland.
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10.300 Annex
International texts relating to medical care in prisons
(Bibliographical information indicated with an asterisk * to be found at the end of this
document)
Universal Declaration of Human Rights (Articles 4, 9, 10 and 11). Adopted by the United
Nations GeneralAssembly on 16 December 1948. •Sources A,B,D,E.
Standard Minimum Rules for the Treatment of Prisoners (Rules 22-26). Approved by the
United Nations Economic andSocial Council on 31 July 1957.*Sources B,C,D,E.
International Covenant on Economic, Social and Cultural Rights (Article 12). Adoptedby e
the UnitedNations General Assembly on 16December 1966. Entry intoforce: 3 January 1976.
“Sources A,·B,D,E.
International Covenant on Civil and Political Rights (Articles 6, 7 and 10). Adopted by the
United Nations General Assembly on 16 December 1966. Entry into force: 23 March 1976.
“Sources A,B,D,£.
Principles of Medical Ethics Relevant to the Protection of Prisonen Against Torture
(principle 1). Adoptedby the UnitedNations GeneralAssembly on 18 Decembec1982. •Sources
(principle 1). Adoptedby the UnitedNations GeneralAssemblyon 18 December 1982. *Sources
B,C,E.
Body of Principles for the Protection of AD Penons Under Any Forms of Detention or
Imprisonment (principle 24). Adoptedby the UnitedNations GeneralAssembly on 9December
1988. •Sources B,C,E.
Basic Principles for the Treatment of Prisoners (Article 9). Adopted by the United Nations e
General Assembly on 14 December 1990. “Sources B,D,E.
United Nations Rules for the Protection ofJuveniles Deprived ofTheir Liberty (principles
50-54). Adopted by the United Nations General Assembly on 14 December 1990. “Sources
B,D,E.
WHO Guidelines on HIV Infection and AIDS in Prison. Issued in March 1993, Geneva
(Document WHO/GPAlDIR/93.3). *Source E.
The Declaration ofEdinburgh (Docwnent 10.300) is an official policy document ofthe World Medical Association,
the global representative body for physicians. It was adopted in October 2000 in Edinburgh, Scotland.
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Bibliographical details ofsources
(Indicated with an asterisk *in preceding section)
A. Brownlie, 1., Ed. Basic Documents on Human Rights. 3
rd
edition. Oxford University Press,
Oxford, 1992.
B. Human Rights: A Compilation ofIntemational Instruments. UnitedNations, New York and
Geneva, 1994 (Vol. I: Universal Instruments). It is understood that this compilation is
available in the five official languages ofthe United Nations.
C. Ethical Codes and Declarations Relevant to the Health Professions: An Amnesty
International ·Compilation of Selected Ethical Texts. 3rd
edition. International Secretariat,
Amnesty International, London, 1994.
D. .Melander, G. & Alfredsson, G., Eds. The Raoul Wallenberg Compilation ofHuman Rights
Instruments. Martinus Nijhoff’Publishers, The Hague, London and Boston, 1997.
E. Alfredsson, G. & Tomasevski, K., Eds. A Thematic Guide to Documents on Health and
Human Rights. Martinus NijhoffPublishers, The Hague, London and Boston, 1998.
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1.2.2001
The Declaration ofEdinburgh (Document 10.300) is an official policy document ofthe World Medical Association,
the global representative body for physicians. It was adopted in October 2000 in Edinburgh, Scotland.
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