SoS-Oct2014

Handbook of WMA Policies
World Medical Association ½ S-2014-03-2014

WMA STATEMENT
ON
SOLITARY CONFINEMENT
Adopted by the 65th
WMA General Assembly, Durban, South Africa, October 2014
PREAMBLE
In many countries substantial numbers of prisoners are held at times in solitary confine-
ment. Prisoners are typically kept in isolation for most of the day, and are allowed out of
their cells only a short period of time of solitary exercise. Meaningful contact with other
people (prisoners, prison staff, outside world) is kept to a minimum. Some countries have
strict provisions on how long and how often prisoners can be kept in solitary confinement,
but many countries lack clear rules on this.
The reasons for the use of solitary confinement vary in different jurisdictions. It may be
used as a disciplinary measure when a prisoner does not respond to other sanctions in-
tended to address his or her behaviour, for example, in response to seriously disruptive
behaviour, threats of violence or suspected acts of violence.
The legal authorities in some nations allow individuals to be held in solitary confinement
during an on-going criminal investigation or to be sentenced to solitary confinement, even
when the individual poses no threat to others. Individuals with mental illness may be
kept in high-security or super-maximum security (supermax) units or prisons. Solitary con-
finement can be imposed for hours to days or even years.
Reliable data on the use of solitary confinement are lacking. Various studies estimate that
tens of thousands or even hundreds of thousands of prisoners are currently held in soli-
tary confinement worldwide.
People react to isolation in different ways. For a significant number of prisoners, solitary
confinement has been documented to cause serious psychological, psychiatric, and some-
times physiological effects, including insomnia, confusion, hallucinations and psycho-
sis. Solitary confinement is also associated with a high rate of suicidal behaviour. Nega-
tive health effects can occur after only a few days, and may in some cases persist when
isolation ends.
Certain populations are particularly vulnerable to the negative health effects of solitary
confinement. For example, persons with psychotic disorders, major depression, or post-
traumatic stress disorder or people with severe personality disorders may find isolation
unbearable and suffer health harms. Solitary confinement may complicate treating such
individuals and their associated health problems successfully later in the prison environ-
ment or when they are released back into the community.
S-2014-03-2014½ Durban
Genetics and Medicine

Human rights conventions prohibit the use of torture, cruel, inhuman or degrading treat-
ment or punishment. The use of pronged solitary confinement against a prisoner´s own will
or the use of solitary confinement during pre-trial detention or against minors can
be regarded as a breach of international human rights law, and must be avoided.
RECOMMENDATIONS
The WMA urges National Medical Associations and governments to promote the follow-
ing principles:
1. Solitary confinement should be imposed only as a last resort whether to protect
others or the individual prisoner, and only for the shortest period of time pos-
sible. The human dignity of prisoners confined in isolation must always be res-
pected.
2. Authorities responsible for overseeing solitary confinement should take account of
the individual’s health and medical condition and regularly re-evaluate and docu-
ment the individual’s status. Adverse health consequences should lead to the im-
mediate cessation of solitary confinement.
3. All decisions on solitary confinement must be transparent and regulated by law.
The use of solitary confinement should be time-limited by law. Prisoners sub-
ject to solitary confinement should have a right of appeal.
4. Prolonged solitary confinement, against the will of the prisoner, must be avoided.
Where prisoners seek prolonged solitary confinement, for whatever reason, they
should be medically and psychologically assessed to ensure it is unlikely to lead to
harm.
5. Solitary confinement should not be imposed when it would adversely affect the
medical condition of prisoners with a mental illness. If it is essential to provide
safety for the prisoner or other prisoners then especially careful and frequent
monitoring must occur, and an alternative found as soon as possible.
6. Prisoners in isolation should be allowed a reasonable amount of regular human
contact. As with all prisoners, they must not be subjected to extreme physical
and mentally taxing conditions.
7. The health of prisoners in solitary confinement must be monitored regularly by a
qualified physician. For this purpose, a physician should be allowed to check both
the documentation of solitary confinement decisions in the institution and the actual
health of the confined prisoners on a regular basis.
8. Prisoners who have been in solitary confinement should have an adjustment period
before they are released from prison. This must never extend their period of in-
carceration.
Handbook of WMA Policies
World Medical Association ½ S-2014-03-2014

9. Physician´s role is to protect, advocate for, and improve prisoners´ physical and
mental health, not to inflict punishment. Therefore, physicians should never parti-
cipate in any part of the decision-making process resulting in solitary confine-
ment.
10. Doctors have a duty to consider the conditions in solitary confinement and to pro-
test to the authorities if they believe that they are unacceptable or might amount to
inhumane or degrading treatment.