Accessing external medical services in detention: Prevalence and challenges in Geneva

• In Event: Prison Working Group: Education, treatment, and rehabilitation of people in prison

Abstract

According to international recommendations for the health care of detained persons, patients are transported to local hospitals or clinics for specialist consultations, medical investigations, or treatments that are not available in prison. Despite this, there is a notable gap in research concerning external medical services. This study assesses the prevalence, variety of medical services provided, and characteristics associated with external medical visits among persons detained in Geneva, Switzerland, from January to March 2023. In total, 681 external medical visits were planned for 336 patients, averaging 0.3 visits per person monthly, but with significant variation across institutions (0.2-0.5). Medical services covered specialties (41%, dermatology being prominent), diagnostics (23%), surgeries (12%), emergencies (9%), and other treatments (15%, including dental care). Most visits were for somatic conditions (96% vs. 5% psychiatric). However, 36% of these visits did not occur as planned due to rescheduling (38%), cancellations (34%), or patient refusal (28%). Refusal rates significantly differed across institutions, even when adjusting for patient age and gender. Furthermore, an older age was associated with an increased number of external visits. These findings highlight the need for improved management of medical resources within detention settings and underscore the barriers faced by detained persons in accessing health care.

Author

• Leonel da Cunha Gonçalves, Geneva University Hospitals & University of Bern