According to Georges Canguilhem, French philosopher and physician, « health is the prolonged capacity of an individual to face his environment».

Therefore, the role of AJEM is to help the prisoner to face the multiple dimensions of the hostile environment of the Lebanese prisons.

In fact, the conditions of hygiene and healthiness in the majority of Lebanese prisons do not meet international requirements: overpopulation and lack of hygiene, ventilation, natural light, beds, access to care and lack of budget and human resources allocated to prisons can have detrimental consequences on the physical and psychological health of the detainees, promote the appearance and spread of diseases and constitute many obstacles to the abilities of prisoners to face this environment.

Nevertheless, access to healthcare is a fundamental right recognized by international law, for every prisoner during his detention period.

In order to address the multiple health concerns in prisons, AJEM has a multidisciplinary team that allows physicians and nurses to work in collaboration with social workers and specialized educators and psychologists.

In order to improve the access to healthcare, AJEM nurses and physicians work hand in hand so that every prisoner could voluntarily have access to appropriate care. AJEM has therefore established a multi-faceted strategy:

1) Arranging of the prisons to support the development and preservation of the hygiene of the places: development of systems for waste disposal, the distribution of hygiene items etc.

2) Individual advice to prisoners in order to discuss their personal hygiene and the prevention of risky behaviors;

3) Holding « Information Education Communication » (IEC) sessions for prisoners concerning the prevention of transmitted diseases. The topics discussed could be:

– seasonal (scabies, dermatological infections, breathing…),

– punctual (conjunctivitis in 2010)

– regular, with the availability of 3 free tests (HIV, Hepatitis B and C)

4) Development of sports activities;

5) Individual management of chronic illnesses;

6) Availability of a medical and paramedical team to address the needs of prisoners;

7) Work with the parents to ensure the continuity of healthcare (purchase of medications, medical consultation of experts etc.);

8) Purchase of medications as needed.

The medical and social team of AJEM conducts therefore consultations and monitoring of patients throughout their detention period.

Nurses play a major role in the coordination of the personnel concerned by the health of prisoners and raise the awareness of the patients concerning health during consultations and visits, while taking the time to explain the diseases diagnosed and how to fight them or live with them. They work as well with victims of torture to report the cases of physical abuse, in addition to working with refugees and asylum seekers.

When it comes to physicians of different specializations working with AJEM, they allow through their presence and competencies to prescribe adequate treatments and provide advice on the measures to be taken. Therefore, they provide specialized medical consultations, participate in the organization of care procedures in prison and ensure the quality and monitoring of the treatments carried out, thus complementing prison physicians whose budget is non-sufficient.

All these actions are completed while taking into consideration the specific context of incarceration: constant anxiety (awaiting trial, overpopulation), self-harming, addiction to drugs, torture and other mistreatments, limited access to medications, incorrect intake of medications, active monitoring of patients (chronic, mental and physical diseases).

The medical and nursing services have therefore gained in legitimacy thanks to their constant presence, their attentive listening and conversations, the ties developed with the families… Their work has caused a substantial overall improvement in health conditions at the Roumieh prison for several years. On one hand, prisoners became more aware of health problems and on the other hand, requests of information have significantly increased.

Nevertheless, despite this positive awareness, an important lack of financial, material and human resources persists.

The work left to be done is therefore considerable and the hopes of prisoners are very high. Consequently, it is essential to work on the society as a whole. For this reason, AJEM:

– collaborates with national and international official authorities to shed the light on collective health problems at prison;

– suggests procedures to reduce public health problems at prison;

– develops researches to study the prevalence of diseases etc.;

– trains police officials (fight against torture, prevention of transmitted diseases, reduction in the use of psychoactive drugs, etc.).