Introduction

When we speak about the right to health care and medical treatment in places of detention, we are not referring to a privilege or a form of luxury, but to a right guaranteed under international conventions ratified by Egypt, as well as the Egyptian Constitution and domestic legislation.

The right to health care is a fundamental human right that ensures the enjoyment of the highest attainable standard of physical and mental health. It does not stop at providing medical treatment, but also encompasses essential determinants such as clean water, safe food, adequate housing, and healthy environmental conditions. This right constitutes a legal obligation upon states to ensure its provision to all individuals without discrimination.

Objective of the Paper

This paper aims to examine the Egyptian legal and human rights framework governing the right of detainees to health and medical care, and to cite cases documented and monitored by the Egyptian Commission for Rights and Freedoms (ECRF). These cases shed light on whether current conditions in Egyptian detention facilities ensure the level of care necessary to safeguard the safety and lives of detainees. Specifically, the paper seeks to:

• Review legal provisions regulating medical treatment for prisoners.
  • Examine statutory provisions on medical release (“الإفراج الصحي”) and its implementation within rehabilitation and correctional centers.
  • Present documented cases of medical neglect in detention facilities monitored by ECRF during the period from September 2024 to September 2025.
  • Offer recommendations to relevant authorities to ensure that detention and its administration do not become, in themselves, a source of risk to the health and lives of detainees.

The Right of Detainees to Health Care Under International Law

The right to health care is a fundamental human right and does not lapse due to deprivation of liberty. International human rights law and international humanitarian law obligate states to provide an adequate standard of health care to all individuals under their jurisdiction, including detainees, prisoners, and prisoners of war.

Universal Declaration of Human Rights (1948)

Article (25/1) affirms that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including… medical care and necessary social services.” This establishes the universality of the right to health for all individuals without discrimination.

Although Egypt has not formally “acceded” to the UDHR—as it is a non-binding declaratory instrument—it participated in its drafting and considers its principles an integral part of its current constitutional framework. Egypt has been a founding member of the United Nations since 1945 and has signed and ratified many international human rights conventions issued after the UDHR, such as the International Covenant on Civil and Political Rights.

International Covenant on Economic, Social and Cultural Rights (1966)

Article (12) recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” obligating states to take measures to ensure health care for detainees as persons under their direct responsibility.

Egypt acceded to the ICESCR through Presidential Decree No. 537 of 1981. Egypt signed the Covenant on 4 August 1967 and ratified it on 1 October 1981. The Covenant was published in the Official Gazette on 8 April 1982. A declaration attached to the ratification stated a single reservation that Egypt’s obligations shall be implemented insofar as they do not conflict with Islamic Sharia.

International Covenant on Civil and Political Rights (1966)

Article (10/1) requires that “All persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person,” which necessarily includes access to medical care. Egypt ratified the ICCPR in 1982.

Convention Against Torture (1984)

Article 1 defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted…” The Convention prohibits torture and any cruel, inhuman, or degrading treatment. Under Article (16), denial of necessary medical care or medical neglect may constitute such prohibited ill-treatment. Egypt ratified the Convention in 1986.

Legal Obligations of States

States bear full responsibility for the health and safety of persons deprived of their liberty. Medical negligence or denial of treatment constitutes a grave violation of international law and may amount to cruel, inhuman, or degrading treatment under international human rights standards.

Supplementary Rules and Standards

United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules – 2015)

The Nelson Mandela Rules are the UN’s revised Standard Minimum Rules for the Treatment of Prisoners, adopted in honor of Nelson Mandela, to safeguard the rights of persons deprived of liberty. They aim to improve prison conditions through respect for prisoners’ dignity and the prevention of torture and ill-treatment.

Rules (24–35) stipulate that prisoners must enjoy the same standard of health care available in the community and that prison health services must be administered by qualified, independent medical professionals. For example:

Rule 22

Every prison shall have at least one qualified medical officer with some knowledge of psychiatry. Medical services should be closely integrated with local or national health authorities. They must include mental-health services for diagnosing and treating psychological conditions when necessary.

Rule 22(2)

Prisoners requiring specialized treatment shall be transferred to specialized institutions or civilian hospitals. Where hospital-level treatment is available within the prison, equipment, pharmaceutical supplies, and staff qualifications must meet professional standards.

Rule 24

A medical officer shall examine every prisoner as soon as possible after admission, and thereafter whenever necessary—particularly to detect physical or mental illness, take necessary measures for treatment, isolate prisoners suspected of infectious diseases, identify disabilities that may impede rehabilitation, and determine fitness for work.

Egyptian Constitutional and Legal Obligations

Constitution of 2019

Article 18 of the Egyptian Constitution (2019) provides that:
“Every citizen has the right to health and to comprehensive health care in accordance with quality standards. The State shall preserve public health-care facilities that provide services to the people, support them, and work to raise their efficiency and ensure their equitable geographic distribution.”

These constitutional provisions constitute a general guarantee of the right to health and health care for all citizens, including detainees—especially in situations where the denial of medical care poses a threat to life.

Article 55:
“Anyone who is arrested, detained, or whose liberty is restricted must be treated in a manner that preserves their dignity. They may not be tortured, intimidated, coerced, or physically or mentally harmed. They may only be held or imprisoned in locations designated for that purpose, which must be humanely and medically appropriate. The State shall ensure accessibility for persons with disabilities.”

Article 56:
“Prisons are institutions for reform and rehabilitation. Prisons and places of detention shall be subject to judicial oversight. All practices that violate human dignity or endanger the health of inmates are prohibited.”

Prisons Regulation Law

The principal legislation governing prisons in Egypt is Law No. 14 of 2022, amending the earlier Prisons Regulation Law No. 396 of 1956. Its most significant amendment is the replacement of the term “prison” with “rehabilitation and correction center”, emphasizing the role of such institutions in providing social and cultural rehabilitation to convicted persons. It also replaces terminology such as “prisoner” with “inmate.”

Despite these amendments, Law No. 396 of 1956 remains the primary legal framework. Chapter VII of the law regulates health care for detainees as follows:

Article 33

Each penitentiary or non-central prison shall have one or more physicians, at least one of whom must be resident and responsible for medical work in accordance with the internal regulations. A central prison shall have a physician; and if none is appointed, a government physician shall be assigned to perform the duties of the prison doctor.

Article 33 (bis)

Governmental and university medical institutions are obligated to treat inmates referred to them from prisons, in accordance with rules and conditions issued jointly by the Ministers of Health and Higher Education, in coordination with the Minister of Interior.

Article 35

Any prisoner serving a final sentence who is found by the prison doctor to suffer from a mental disorder shall have their case referred to the Director of the Medical Services Department for Prisons for further examination. If deemed necessary, the prisoner shall be transferred immediately to a psychiatric hospital for diagnostic evaluation. If the prisoner is found to be mentally ill, they shall remain in the hospital and the Public Prosecutor shall be notified to issue an order for their continued placement until recovery. Once recovered, the hospital administration shall notify the Public Prosecutor, who shall order the prisoner’s return to prison, and the period of hospitalization shall be deducted from their sentence.

Article 36

Any convicted person who is found by the prison doctor to suffer from a life-threatening illness or a condition causing total incapacity shall have their case referred to the Director of the Medical Services Department for Prisons for examination jointly with the forensic doctor to consider recommending medical release.

Article 37

If an inmate’s medical condition becomes critical, the prison administration must immediately notify the administrative authority in the district where the inmate’s family resides to inform them promptly. Family members shall be granted permission to visit.

Other Relevant Legislation

Article (486) of the Code of Criminal Procedure stipulates that:
“If the convicted person sentenced to a deprivation-of-liberty penalty suffers from an illness which in itself threatens, or whose execution threatens, their life, the execution of the sentence may be postponed.”

In accordance with Article (662) of the General Instructions for Public Prosecutions (Written, Financial and Administrative):
If the convicted person suffers from an illness that by itself threatens, or whose execution threatens, their life, and they have not yet been committed to prison to serve their sentence, the Public Prosecution must appoint a forensic physician to examine their condition. If the illness is confirmed, the execution of the sentence may be postponed.

Prison Regulations

Health care for inmates within prison regulations includes the provision of basic medical care in prison clinics and affiliated hospitals; conducting necessary medical examinations upon admission; isolating and treating inmates with infectious diseases; transferring critical cases to external hospitals; providing free medical treatment; and organizing periodic health examinations. Regulations also include special procedures concerning temporary medical release for inmates suffering from life-threatening conditions.

Main Procedures for Health Care

Initial Medical Screening upon Entry:

A newly admitted inmate is placed under medical observation for 10 days, during which examinations and tests are conducted to assess their health condition.

Medical Care inside Prison:

Cases are presented to doctors in prison clinics or prison-affiliated hospitals, and necessary medication is dispensed from the prison pharmacy.

Infectious Diseases:

Inmates with infectious diseases are isolated in designated areas and provided with special care. Rooms where infections occurred must be disinfected.

Transfer of Critical Cases:

Where necessary, inmates are referred to external hospitals for tests, imaging, or surgical procedures.

 

 

Medical Release:

In exceptional cases, inmates suffering from serious illnesses that endanger their lives or the lives of others may be released based on the recommendation of a specialized medical committee.

The Gap Between Law and Reality

As institutions of deprivation of liberty, prisons impose upon the State a full responsibility for the lives and safety of detainees, including the effective guarantee of appropriate health care. Despite replacing several old prisons with so-called “Rehabilitation and Correction Centers” and promising more humane detention environments with better-equipped infrastructure, reality reveals the persistence of suffering, violations, and medical neglect in detention facilities. Medical neglect remains one of the gravest forms of human-rights violations, as it can exacerbate disease and, in many cases, lead to death.

In Egypt, continuous reports issued by national and international human-rights organizations document deaths and severe medical tragedies, indicating that health care in prisons is not merely a matter of insufficient resources. In many instances, it reflects a quasi-systematic pattern of neglect, delay, or refusal by prison administrations or the security agencies controlling them—far beyond what the law and regulations permit.

Recent years have witnessed a significant increase in cases of medical negligence and a rise in related deaths. Although new prisons are theoretically characterized by stronger medical infrastructure—clinics, hospitals, laboratories, etc.—in comparison with older prisons, the actual provision of health care to inmates remains limited, if not entirely absent. This situation results from several factors, foremost among them:

• Failure to implement preventive measures necessary to prevent the spread of diseases in an inherently closed and overcrowded environment, as seen during the COVID-19 outbreak and in the spread of dermatological conditions linked to overcrowding and denial of personal hygiene materials.
  • Systematic shortcomings in therapeutic care due to the failure to implement provisions of the Prisons Regulation Law and its executive regulations concerning medical care.

Additionally, prison doctors are, in essence, police officers who graduate from medical school and subsequently join the Police Academy. They are appointed by the Ministry of Interior. Placing prison health care under the Ministry of Interior creates a form of “dual loyalty” for medical staff: on the one hand, they are responsible for diagnosing and treating patients—yet are not subjected to the oversight of the Medical Syndicate; on the other, they operate within the structure of the Prisons Authority, which may compromise their professional independence and impairs the effectiveness of their role.

In the absence of an independent oversight system for rehabilitation and correction centers, and with the continued opacity surrounding conditions inside them, medical neglect becomes a “hidden punishment” inflicted on inmates.

The risk to life and safety becomes even more severe where entire prison wings are denied basic rights such as family visits or access to legal counsel, thereby isolating detainees completely from the outside world—as has occurred, and continues to occur, in Badr 3 Prison, where an entire sector is deprived of basic necessities for life and safety.

Documentation and Monitoring by the Egyptian Commission for Rights and Freedoms (ECRF)

September 2024 – September 2025

Documentation Overview

ECRF documented 12 cases of medical neglect in which the detainees remain alive, in addition to 20 deaths resulting from medical negligence during the reporting period.

1. Medical Negligence

Between September 2024 and September 2025, the Egyptian Commission for Rights and Freedoms documented 12 deliberate medical-neglect cases inside places of detention, as follows:

Gender

• 10 males
• 2 females

Age Range

The ages of the detainees ranged between 26 and 68 years.

Place of Detention

Ten detainees — including the two women — were held in prisons; the remaining two were held in police stations. The locations are as follows:

Table: Distribution by Place of Detention

Location	Al-Ashr min Ramadan Prison	Al-Mostaqbal Prison	Badr 1 Prison	Borg Al-Arab Prison	Zagazig First Police Station	Al-Ashr min Ramadan Second Police Station
Governorate	Sharqia	Ismailia	Cairo	Alexandria	Sharqia	Sharqia
Number of detainees	4	1	3	1	1	2

Cases by Health Condition

Badr 1 Prison

• Male, 68 years old– suffering from multiple health conditions including osteochondral inflammation, a dermatological disorder, prostate inflammation and enlargement; he had been receiving medical follow-up before his arrest. His diabetes requires consistent medical care. According to his family, he lost 20 kg in detention, and the prison administration often prevents the entry of medications and essential supplies such as the medical soap he requires, forcing him to rely largely on advice from detained physicians.
• Male, 55 years old– suffers from hypertension, a torn cruciate ligament, and severe depression requiring the antidepressant MartyMash prescribed by the prison doctor, yet the medication is not dispensed regularly and is sometimes deliberately withheld as a form of punishment.
• Male– had leukemia and severe immune deficiency prior to arrest. His condition has deteriorated and he requires release for treatment, yet the prison administration refuses and provides no medical treatment inside prison.
• Male– suffers from chronic mastoid bone decay in the ear since childhood and requires continuous medical follow-up to avoid paralysis. He previously underwent three ear surgeries, including mastoidectomy and eardrum grafting. He also had effusion in his left ear that required a ventilation tube, which the prison doctor confirmed had shifted, causing a rupture in the left eardrum. The prison administration refuses necessary medical intervention.

Al-Ashr min Ramadan Prison

• Male, 37 years old– detained since 2022; denied proper medical care despite severe deterioration, including peripheral neuropathy, knee joint inflammation, and chest pain that remains undiagnosed due to deprivation of specialist access. He is also denied adequate food, further harming his health.
• Male, 27 years old– lost a leg in childhood and requires a prosthetic limb. After repeated requests from his lawyer, the prison approved the entry of a prosthetic, but it was unsuitable in size. The lawyer continues to submit requests for proper measurement and replacement.
• Female, 67 years old– “recycled” into three new cases despite completing a five-year sentence. She is transported to court by ambulance. She suffered a heart attack while detained in Qanater Prison and was transferred to Qasr Al-Ainy Hospital. During one hearing, she requested cardiac catheterization and stents due to her deteriorating condition, yet did not receive the required intervention. She previously experienced failure of one kidney and reflux in the other. After her transfer to the new Al-Asher min Ramadan Prison, her family confirmed continued denial of medication and treatment, placing her life at severe risk.
• Female, 56 years old– detained after publishing a video alleging that her son had been subjected to sexual torture while imprisoned. She suffers from chronic illnesses including diabetes and hypertension, along with conditions requiring regular monitoring. Her health deteriorated significantly in detention due to medical neglect and the lack of necessary treatment, resulting in serious complications.

Borg Al-Arab Prison

• Male, 31 years old– suffered hematemesis (vomiting blood) following a failed suicide attempt amid severe psychological deterioration after being transferred from Gamasa Maximum-Security Prison and placed in solitary confinement. He was not examined by a specialist physician. His case has been “recycled” onto new charges for nine consecutive years.

Al-Mostaqbal Prison – Ismailia

• Male, 26 years old– developed severe chest allergies unusual for his age; detention conditions exacerbated his health problems. Despite the family’s attempts to supply medication, inhalers, and respiratory treatment, the prison administration refused to allow them in. He remains subject to case “recycling” and enforced disappearance upon direct orders from the National Security officer.

Al-Ashr min Ramadan Second Police Station

• Male– “recycled” six times. Suffers from disability in the right foot, along with chronic foot disease severely affecting mobility. He requires urgent surgery to prevent further deterioration. He also suffers from avascular necrosis (“bone death”), a condition in which bone tissue dies due to loss of blood supply, in addition to diabetes, hypertension, and hyperthyroidism.

Zagazig First Police Station

• Male, 42 years old– suffers from severe pain in the third and fourth vertebrae and requires physiotherapy sessions.

2. Deaths Resulting from Deliberate Medical Negligence

Between September 2024 and September 2025, ECRF documented 48 deaths inside places of detention:

• 11 deaths in 2024
• 37 deaths in 2025

These deaths are categorized by cause as follows:

Table: Causes of Death

Year	Medical Negligence	Torture	Unknown
2024	5	4	2
2025	15	7	12

Medical Conditions Leading to Death Due to Lack of Treatment

The cases deprived of treatment and resulting in death included:

• Chronic diseases such as diabetes and hypertension –no medical treatment provided
  • Blood clot in the leg followed by a stroke –delay in hospital transfer
  • Heart attack – delay in hospital transfer
  • HIV/AIDS – denial of treatment
  • Liver diseases – denial of treatment
  • Tumors – obstruction of surgical intervention and therapy
  • Fever – absence of medical intervention
  • Pulmonary fibrosis – denial of medication and surgical care
  • Intestinal obstruction – denial of surgery
  • Cancer – denial of treatment
  • Post-surgical care – detainee returned to prison prematurely, before completing recovery

Many of these illnesses—and perhaps all of them—were preventable deaths

Many of the documented illnesses, if not all, could have been prevented had there been adequate concern for preserving the lives of detainees. It is unacceptable in the twenty-first century for a person to die due to denial of treatment for diabetes or hypertension. Even general practitioners know that a blood clot in the leg is a warning sign indicating the possibility of migration to the lungs, leading to death, and that the patient must be transferred immediately to a hospital—facilities which, according to state propaganda, are supposedly available. The same applies to intestinal obstructions, which can often be addressed through a simple initial intervention before determining whether surgical treatment is required.

It must also be noted that deliberate medical neglect is not the result of a lack of resources. The State has publicly and repeatedly boasted that its new prisons are equipped with the latest diagnostic and treatment technologies. It remains inexplicable why prison authorities fail to use these resources when detainees’ conditions require them, ignoring their pain and suffering. Several of these detainees could have been saved had there been political will to provide appropriate medical care and timely intervention. However, those responsible for places of detention appear to view deprivation of liberty as insufficient punishment, thus compounding it with deprivation of health and life.

Here, it is important to recall what Dr. Mahmoud Naguib Hosny wrote in his commentary on the General Part of the Penal Code, regarding such disregard—especially when it ends in the detainee’s death—classifying it as homicide by omission. He wrote:

**“The crime of homicide by omission occurs in two cases:

• The first case: If the person who abstained from acting was legally or contractually obligated to preserve the life of the victim, and their omission was the direct cause of death.
• The second case: If the omission is preceded by a positive act, legal doctrine unanimously considers the person criminally responsible for intentional homicide when the criminal intent is present. In this situation, the earlier positive act bears the full causal burden for the resulting death, and the omission merely enables the positive act to produce its intended effects. Doctrine has long held:

‘Homicide by omission is realized when the person who abstains is legally obligated—by law or contract—to preserve the victim’s life and fails to intervene with the intent to cause death.’

Homicide by omission is defined as:

‘The perpetrator’s abstention from performing a positive act required by law under particular circumstances, provided that the duty to act exists and that the omission is voluntary and within the perpetrator’s capacity.’ ”**

Conclusion and Recommendations

Medical neglect in Egyptian prisons is not an isolated breach of duty; it is a structural problem that strikes at the core of fundamental human rights, including the rights to life, health, and dignity. The disregard or delay in providing health care affects not only the individual but also families, communities, and the very foundations of justice and the rule of law. Meaningful change requires rigorous documentation accompanied by societal and judicial pressure, as well as genuine political will for substantive reform rather than cosmetic changes. The right to life and to medical care in detention is not a privilege—it is a legal and moral obligation that must not be compromised.

Root Causes of Medical Neglect in Egyptian Prisons

• Lack of transparency and independent monitoring, enabling abuses without accountability.
  •Security and political considerations: political detainees are often deprioritized, and medical care is sometimes used as a coercive or punitive tool.
  • Weak enforcement of laws and regulations, with requests for medical release and similar measures often denied or delayed without justification.

Forms of Medical Neglect

• Delayed or denied transfer to specialized hospitals despite awareness of the critical nature of the condition.
  • Failure to provide essential medications or basic treatment for chronic illnesses.
  • Neglect in conducting examinations and diagnostic procedures, leading to deterioration before detection or treatment.
  • Reliance on painkillers alone in cases requiring actual medical intervention such as surgery or dialysis.
  • Denial of medical release for seriously ill detainees, despite legal provisions allowing it.
  • Detention conditions that exacerbate illness: overcrowded cells, poor ventilation, inadequate hygiene, insufficient nutrition, and disease transmission.

Recommendations of the Egyptian Commission for Rights and Freedoms

In light of the above, ECRF submits the following recommendations to the relevant authorities:

1. Establish an independent monitoring mechanism inside prisons, including representatives from human-rights institutions, international organizations, and civil society, to carry out unannounced visits and document health conditions.
2. Strengthen prison health-care infrastructure by providing specialized physicians subject to oversight by the Medical Syndicate, ensuring adequate medical equipment, pharmaceutical stock, and isolation units for infectious diseases.
3. Introduce legal safeguards to ensure medical release for detainees with chronic or urgent illnesses, without waiting for deterioration or life-threatening complications.
4. Train prison medical personnel in human rights, health care, first aid, and early diagnosis of illnesses.
5. Improve coordination between the Ministry of Interior and the Ministry of Health to facilitate transfers to external hospitals when necessary and ensure adequate security and transportation during such transfers.
6. Review relevant legislation and regulations to ensure they stipulate clear penalties for those responsible for medical neglect, and enforce them with fairness and transparency.
7. Enable detainees and their families to file medical complaints without fear of retaliation and ensure timely responses from the Public Prosecution and oversight bodies.