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AMNESTY IN ACTION
A Human Rights Journal Documented Through the Voices of Southern Methodist University

Barring the Lesser Sex: A Light on the Experience of Pakistani Women in Jails By: Yusra Jabeen

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The 2006 report of the Joint United Nations Programme on AIDS (UNAIDS) states that prisoners are among the four most at risk and neglected populations in the HIV/AIDS pandemic. The report [calls] prisons [the] sites for illicit drug use, unsafe injecting practices, tattooing with contaminated equipment, violence, rape, and unprotected sex. Prisons are often overcrowded, have limited access to health care, often poor nutrition and have high rates of airborne and blood borne diseases. What makes the situation in prisons more repugnant is that there is little attention paid to the conditions the female inmates live under as they are fewer in number compared with the number of male prisoners. Nonetheless, it is a prison within a prison for women in Pakistan. The United Nations Office on Drugs and Crime (UNODC) Pakistan 2011 Report, Female Behind Bars Situation and Needs Assessment in Female Prisons and Barracks, claims that women make up a very small proportion of the prison population in Pakistan [but] they are faced with much greater challenges than men in accessing healthcare. At another occasion, it states, Of the 359 women prisoners who were interviewed, an astounding 59 percent of the women were reported to be under trial. Their ordeal of the cycle of incarceration is the direct effect of the flawed social justice system and poverty these women live in. It is also a cause for them to end up in jail. They neither have access to healthcare from inside the jail nor do they have a family support system from the outside to get better. They are stigmatized, disempowered and considered guilty until proven innocent in their local community. They suffer from drug addiction, sexual abuse, mental health problems such as depression, and physical health problems. The UNODC, taking

Jabeen 2 notice of that, also said, these most-at-risk marginalized populations are often subject to discrimination and violations of their human rights. Only few have access to treatment and care services. As the cycle of incarceration with its inhumane conditions continues, the struggle for rehabilitation and amnesty for women in Pakistani prison thrives. Pakistan is a country located in South Asia with a population of about 180 million, and of those 180 million, the estimated incidence of mental disorders is about 34 percent (Mirza and R ). In Pakistan, it has been observed that depression is generally more common in women than it is in men (Khan et. al.). Therefore, finding the condition of depression among female prisoners should not be surprising, as one in seven prisoners have been found to be suffering from some type of mental or psychiatric disorder (Danish and Fazel 545). A study conducted on the Incidence of Depression by Khan et. al, among prisoners in the city of Peshawar Pakistan says, out of the 64 prisoners [that were interviewed using the Hamilton Depression Rating Scale (HAMD)], 59.4 percent were found to be suffering from depression. Since the UNODC reported that 68 percent of the 359 prisoners who were interviewed were married with children and the median age reported for female prisoners was 32 years across all prisons, it is safe to say that middle-aged (31-40 years), married women with a low socio-economic status were found to be at a higher risk of depression(Khan et al.). Some of these women are also traumatized because they have been separated from their children and do not want to keep their children of up to the age of 6 years with them in the jail as allowed by the law. Furthermore, more than half of these women interviewed by UNODC were found to be illiterate, which is also a contributing factor to their condition, as these women are not aware that they are suffering from mental health problems such as depression, stress, mental illness, attention-seeking behavior, sleep disorder and generalized anxiety to be able to ask for treatment in the first place. It is also true that these conditions are considered normal phenomenon in many Pakistani families,

Jabeen 3 which causes depression [to be a] common [mental health condition] among urban-dwelling (60.5 percent) and low-income (64.4 percent) prisoners(Khan et. al). Other than the demographic factor causing depression, researchers claim that there is a possibility [for] a [hostile] prison environment andsupply of [poor] heath care services to the prisoners [can serve as] one of the essential factors[contributing to] the incidence of depression among women prisoners in Pakistan. An article published in the British Medical Journal by a professor of forensic psychiatry at University of Birmingham, R Bluglass reported about depression among prisoners and criticized the ineffective management of mental disorders among them. As mental health goes hand in hand with physical health, researchers claim that prison environments are one of the most crucial challenges to the overall health of the prisoners (Khan et. al). UNODC Pakistan reports that A large proportion of female prisoners come from disadvantages economic backgrounds, and most of them, suffer from a variety of health conditions. Therefore, female prisoners often have greater primary health care needs in comparison to men. Female prisoners in nearly all prisons reported that the medical facilities were inadequate. Government doctors are available in most prisons, [but] diagnostic and treatment facilities were found far from satisfactory. As their cultural norms suggest, it is worth noting that Pakistani women from underprivileged backgrounds do not feel comfortable with a male doctor. This adds another hurdle for them to seek medical attention as female doctors [are only] available in only 3 prisons i.e. Karachi, Larkana and Hyderabad, while all other prisons have male doctors(UNODC). Researchers also stress the fact that women do have reproductive health needs to be managed by trained female paramedical staff, [and] this area was found to be extremely deficient in all prisons (UNODC). Some patients with serious medical conditions were referred to the local government-run hospitals but all patients complained of the lack of attention by the hospital

Jabeen 4 staff and the absenteeism of doctors there. Other than the deprecating health care provisional system in the prisons, the living conditions for the inmates are not any better either. The UNODC reports that in most of the jails, there were no beds or floor mattresses reported to be available and the prisoners were either supposed to arrange for their own bedding or [were forced to] sleep on the floor. This adds to the poor quality of life the women inmates are forced to live under. While sleeping on the floor may contribute more pain to the already anxious prisoners, it must be noted that maintenance of health and sanitary conditions in prisons is [crucial] in preventing illness and disease access to sanitary and washing facilities, safe disposal arrangements for bloodstained articles, as well as provision of hygiene items are of particular importance-all of which lack in Pakistani prisons (UNODC). The UNODC states, The number of wash rooms ranged from 3 to 4 prisoners per wash room to 60 prisoners per washroom in one of the larger prisons [where the interviews were conducted]. Three of the prisons where data was collected [had] no separate washroom, which enhanced the concern for privacy among prisoners, especially the ones who are suffering from mental health problems such as anxiety and trauma. Maintaining personal hygiene was also difficult because washing and sanitation facilities were [located] within the barracks. Systemic failure continued as in one of the prisons, four washrooms [existed] but were reported to be non functional. To add to that, many times the cleaning staff neglected to perform their duties. While maintaining cleanliness is an issue, provision of food and water is just as neglected. The report by UNODC says that only one out of the 9 prisons had safe drinking water available for the prisoners. It continues, saying that 7 out of the 9 prisons had tap water available for 24 hours but the water was not purified, thereby causing water borne diseases to spread. Adding insult to injury, most of the prisons have poor quality of food especially the bread which is not well cooked. In Karachi, females cook their food by

Jabeen 5 themselves. Writer Virginia Woolf once wrote in her book, A Room of Ones Own, One cannot think well, love well, sleep well, if one has not dined well. Certainly, it is difficult for the women in Pakistani jails to prepare for a better future and develop healthier habits in prison when they experience such harsh conditions over there. These harsh realities of life continue for the women prisoners. The UNODC emphasizes the importance to have various activities designed for prisoners which should keep them busy, while at the same time enable them to live normal lives after release, by increasing their job skills and improving their education. However, according to the UNODC, they do not have any recreational facilities except television, which was available in only 2 prisons out of the 9 prisons and barracks across the country. There were no efforts undertaken by the prison authorities to provide basic education or any vocational training to the prisoners, notes the UNODC. The inmates do not have any indoor games or activities to help them cope with the stress they go through in prison. It is thus important to ask: how can an inmate be expected to function after release, as an emotionally and physically healthy, contributing member of the society if she is forced to fend with a mental condition as serious as depression and harsh living conditions for an elongated time by herself inside and outside of prison? In such circumstances, these inmates tend to develop a coping mechanism by using drugs and smoking cigarettes to deal with their stress. The UNODC Pakistan reported that 28 percent of the 359 women interviewed said they had used drugs before they were imprisoned. Of those 6.1 percent reported that they ever had injected any form of drug. [It is important to note that] further inquiry into drug injecting practices revealed that all these injections took place among the women who were imprisoned. Other than drugs, a fairly large population of 41.2 percent women said they had smoked tobacco before they were admitted to prison and about half of them continued smoking even within prisons. According to UNODC, a substantial amount of women was

Jabeen 6 using psychotic drugs before being imprisoned, but not enough data is available to claim whether the drugs that they used in jail were accessed legally, and prescribed by a medical personnel or not. UNODC notes that a large number of female prisoners worldwide are imprisoned for drug offenses and are themselves in need of treatment for substance abuse. However, there are no detoxification programs available in any of the jails and no measures to deal with the mental health issues were reported to be provided by the prison authorities. The UNODC says that substandard and unhealthy living conditions [coupled with a gender-insensitive approach] have a negative impact on the physical health of prisoners, while substandard prison conditions and the consequent stressors can negatively affect the mental health of prisoners, or exacerbate pre-existing mental health problems. It also points out that stigma and discrimination is a unanimous issue reported from all prisons across the country. The females are stigmatized on the basis of their crimes [and] prisoners who are not being visited by any family members and the ones who dont have any money also face harassment from other prisoners as well as jail staff. According to another report, more than 70% women in police custody experience physical abuse by their police officials(Ali and Shah 59). Hence, it worsens their chances to reach self-actualization and live a healthier life, physically and mentally. Recovering from life after prison becomes especially difficult, if no proper gender-sensitive healing facilities are provided. Stephanie Covington in her book Women and Addiction: A Gender-Responsive Approach, says: Women and men differ in terms of their risk for physical and sexual abuse. As children, both females and males are at risk from family members and people known to them. However, there are significant gender differences over a life span. In adolescence, boys are at risk if they are gay, young men of color, or gang members. Their risk is from people who dislike or hate them. For a young woman, the risk is in her relationships, from the persons to whom she says I love you. For an adult male,

Jabeen 7 the risk of abuse comes from being in combat or being a victim of crime. For an adult woman, the risk is again in her relationship with the person to whom she says I love you. Clinically, we think that this may account for the increase in mental health problems for women. In short, it is more confusing and distressing to have the person who is supposed to love and care for you do harm to you than it is to be harmed by someone who dislikes you or is a stranger. (25) Women heal relationally. They need special attention in the prisons, thereby helping them get better. A UNODC suggestion covers many the idea behind many reforms that can be established to improve the condition of the incarcerated Pakistani women. The suggestion states that: Due to a high prevalence of various mental issues among female prisoners, the provision of a adequate gender-sensitive and interdisciplinary mental healthcare should comprise an essential component of the services provided to female prisoners. A comprehensive assessment of the womens mental healthcare and psychological support needs should be conducted by the project staff especially psychologists this mental healthcare should be individualized and should aim to improve the self esteem and confidence level of each individual. Reason that provoke distress or depression should be identifies, and all psychiatric problems should be dealt by adopting an integrated approach o counseling, psychological support and medication, if necessary. A comprehensive programme aiming to promote mental health in prisons, should include help within the prison in terms of education, vocational training and building self-esteem, a better understanding of human relationships, family contact, physical exercise and treatment of mental illnesses. A program similar to what the UNODC suggested exists in the city of Dallas, Texas in the United States called Resolana. As mentioned in its pamphlet, Resolana is a community

Jabeen 8 based non-profit organization[offering] holistic and gender-sensitive programming to women at Dallas County Jail. The program aims to educate and empower incarcerated women and stop the cycle of incarceration. The staff visits the different pods in which the inmates are locked up in the jail, and recruits women who willingly sign up for this rehabilitation program. Resolana offers classes in five main areas such as: mental health, where problems like addiction and trauma are addressed and healthy coping skills are taught, life skills, where prisoners are prepared for parenting, anger management and job readiness wellness, to promote physical and mental well being through exercise, creativity workshops, which give an opportunity to the prisoners to express themselves through music, art, dance, writing, interplay and Playback drama, and, 12-Step meetings. According to Society for Advancement of Community Health Education and Training (SACHET), there are were about 7000 women in jails across the country as of 2008, and the numbers of the incarcerated women have been growing ever since. It is an alarming situation for these human beings languishing in prisons and living a degraded life. They need amnesty and an attention to recoup urgently. A program like Resolana if instated in one of the larger prisons would help tremendously. A former inmate from Resolana said that in jail, one learns to be a better criminal. In Resolana, she was learning to be a better person. And that is what needs to be heard from the incarcerated women trapped behind the bars in the flawed criminal justice system of Pakistan.

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Work Cited Ali, Aliyan and Nasreen Aslam Shah. Women Prisoners in Pakistan: Changing practices to Enforce Laws and Rights Kuwait Chapter of Arabian Journal of Business and Management Review. 1.4. (2011): 57-63. Web. 9 December 2012. Bluglass, R. Mentally Disordered Prisoners: Reports but no Improvements Bristish Medical Journal. 296. (1988):1757-8. Web. 1 December 2012. Covington, Stephanie S. Women and Addiction: A Gender-Responsive Approach. Clinicians Manual. The Clinical Innovators Series. Center City, MN: Hazelden, 2007. Print. Danesh, J. and S. Fazel. Serious Mental Disorder in 23000 Prisoners: A Systematic Review of 62 Surveys Lancet. 359. (2002): 545-50 Khan, Tahir M, et al. Incidence of Depression among Incarcerated Woman in Central Prison, Peshawar, Pakistan. European Journal of General Medicine. 1. September. 2012:33-38. Web. 20 November 2012. Mirza, I. and R. Jenkins. Risk Factors, prevalence, and Treatment of Anxiety and Depressive Disorders in Pakistan: Systematic Review. Bristish Medical Journal. 328.3 (2004):393-7. Web. 21 November 2012. Resolana. Dallas: Texas. n.d. Print. Society for Advancement of Community Health Education and Training. AGEHI Resource Centre, SACHET Pakistan, 2008. Web. 17 November. 2012. Woolf, Virginia. A Room of Ones Own. United States of America: Harvest/HBJ: 1929.

Jabeen 10 Print. United Nations Office on Drug and Crime. Couuntry Office Pakistan. Female Behind Bars Situation and Needs Assessment in Female Prisons and Barracks. New York: New York, 2011. Web. 15 November 2012.