TB Scourge in Uzbek Prisons

Tashkent resident Mavluda spent six months trying to get permission to visit her 25-year-old son Bahrom in prison, where he was in the fourth year of a five-year sentence for theft. But when she finally got to see him in a prison close to the capital, she was shocked.

“He was constantly coughing up blood into his hand,” she told IWPR.

At first she thought he had caught a bad cold due to a particularly severe winter. But the prison doctor told her that he had contracted tuberculosis, most probably from another inmate.

“[The doctor] told me that his condition would get worse with every day that passed,” Mavluda said. “Sometimes he is given aspirin to keep his temperature down, but it does not do much. When he was sentenced, he was healthy.”

Prisoners’ relatives and human rights activists in Uzbekistan warn that the lack of an effective prevention control strategy has turned the country’s prison into a breeding ground for TB. Lack of treatment leaves many convicts facing a slow and painful death.

Mavlon’s brother is serving a five-year term for robbery at a prison in Karshi in southern Uzbekistan.

“We are afraid that our brother, who has an advanced form of TB, won’t survive until his release date,” Mavlon told IWPR.

Describing the conditions in the Karshi jail, he said, “Hygiene is poor; they all sleep on worn-out mattresses on a cement floor. Even relatives have to sleep on the floor when they visit. It gets very hot in summer, with temperatures reaching 40 degrees Celsius.”

Mavlon said there was no provision for halting the spread of TB. Prison cells holding up to ten inmates are never ventilated, and they have to share meals using the same utensils.

“TB sufferers face a slow and painful death – no one can help them now,” he said.

Sayfitdin Qurbanov, 27, who has served four years in prison of a 15-year sentence for rape, is in a similar predicament, his mother Sayora Hokimova told IWPR.

“My son is gravely ill. He has an aggressive form of tuberculosis that affected both his lungs. He suffers terrible pain in his arms and legs and a high temperature, and he coughs up blood,” Hokimova said.

Her request to visit her son’s prison in the western city of Navoi was initially turned down, and was only granted after she called the interior ministry’s hotline to complain.

“The [prison] doctors aren’t doing anything and they say there’s nothing to worry about,” she said following her visit in mid-February. “Maybe they really can’t do much. One prison doctor admitted that they didn’t have the necessary drugs there.”

Hokimova took her son’s X-rays to doctors in Tashkent who informed her that one of his lungs was no longer functioning. They told her that TB sufferers in prison were usually released into their relatives’ care when they were about to die.

“I was surprised to see so many TB sufferers among inmates,” she said of her recent visit. “They don’t get good food and often go hungry. The food they get are low in calories and fats, and there are no vegetables, fruit, salt or sugar. Sometimes relatives don’t recognise them as they have aged so much.”

Hokimova said that in addition to being underfed, cold and lacking proper medical care, TB sufferers were forced to work, which made their lives almost unbearable. Her son told her that even when inmates were running a fever, they were forced to clean toilets and floors with cold water.

She said her son told her he had seen many TB sufferers die in prison.

“I am worried for my son and for all the inmates who are suffering from the disease and have to endure harsh conditions that make it impossible for them to recover,” Hokimova said, adding that she was planning to stage a protest in front of the interior ministry and the prison service authority in Tashkent.

A healthcare professional who spent 15 years working in a prison hospital and asked to remain anonymous confirmed the accounts given by relatives.

He said that the spread of tuberculosis was the biggest problem facing Uzbekistan’s penal system due to overcrowding and lack of ventilation, which resulted in rapid transmission of the disease.

In addition, there was no adequate TB treatment strategy, leaving sufferers with little chance of recovery.

“There aren’t enough medical staff to treat them… the only medicines available at the [main Tashkent] prison hospital are drugs to treat diarrhoea and headaches and to reduce fever,” the he said.

The spread of multidrug-resistant tuberculosis (MDR-TB) was particularly worrying, he added.

“Inadequate treatment when there are no proper drugs leads to the emergence of new types of TB that are even more difficult to treat,” he said.

According to WHO, the proportion of MDR-TB among TB patients in Uzbekistan is among the highest reported by former Soviet Union countries in recent years. In 2012, there were 14,132 TB case notifications, as given in the latest available WHO statistics.

The Initiative Group of Independent Human Rights Activists in Uzbekistan, led by Surat Ikramov, has been monitoring problems in the prison system for more than ten years. He told IWPR that since October 2013, he had been approached by the relatives of ten prisoners suffering from TB who were desperate for help.

Ikramov said that what tuberculosis patients had to endure in Uzbek prisons was similar to the distress experienced by victims of torture and ill-treatment.

One example he gave was the notorious Jaslyk prison in the Karakalpakstan region of northwestern Uzbekistan, known for its high TB infection rate. According to Ikramov, it is those suffering from the disease were unlikely to make it to the end of their sentences.

Citing numerous cases where relatives of Jaslyk inmates had sought help from his organisation, Ikramov said that those with advanced TB were forced to work at a cement factory, which was akin to a death sentence.

“There is dust from the cement which they inhale and they almost suffocate from coughing fits and spitting blood,” he said.

There are no statistics on TB mortality in Uzbekistan’s prisons as it is impossible to get this kind of information from the authorities, Ikramov said, but the total number of deaths in incarceration from disease and ill-treatment is estimated at 225-250 a year.

The prison population in Uzbekistan was about 42,000 in 2012, according to the London-based International Centre for Prison Studies, which used national statistics as its source.

Attempts by international organisations to inspect Uzbek jails have been hindered by lack of cooperation from the authorities. Last April, the International Committee of the Red Cross announced that it had stopped all prison visits in Uzbekistan due “to the conditions imposed by the local authorities and their unconstructive attitude”. The organisation said it was unable to meet detainees in private to assess the conditions in which they were being held and their treatment.

The former prison hospital worker said that the only TB hospital in the penal system was located in the city of Chirchik, not far from Tashkent, but it was unable to accommodate all sufferers.

He warned that without isolating TB sufferers from the general prison population, it was difficult to halt the spread of infection.

“If the authorities continue to lock up thousands of people in prisons, they will need to set up several specialised TB colonies to curb the spread of the disease within the penitentiary system,” he said.