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Rapport des soins de santé dans les prisons belges : Un drame chronique aux symptômes familiers

jeudi 19 octobre 2017 à 14:05
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Grand absent du dernier rapport annuel de la direction générale des établissements pénitentiaires1, le droit des détenus aux soins revient à nouveaux sur le devant de la scène suite au rapport du Centre fédéral d’Expertise de Soins de santé (KCE), rendu ce 18 octobre 2017 et tirant un bilan alarmant de l’état des soins de santé dans les prisons belges.

 

Cet état des lieux ne surprendra personne, certainement pas les professionnels du terrain, ni l’association I Care ni les Commissions de surveillance des prisons.

 

Cette actualité est l’occasion de revenir sur un rapport rédigé par celles-ci sur la question de la santé en prison, sur la base de 26 rapports récoltés entre 2015 et 2016 auprès des membres médecins des différentes commissions.

 

Les constats de ce rapport décrivent une situation catastrophique particulièrement interpellante du fait de sa persistance.

 

Dès 20082 et encore dans sa dernière notice 20163, l’OIP dénonçait l'organisation et la pratique des soins de santé en milieu pénitentiaire qui constituaient déjà autant de violations du droit à la santé des détenus.

 

Du manque de personnel qualifié et disponible à l’absence de véritable permanence médicale la nuit ou le week-end en passant par la qualité de soins insuffisante; force est de constater qu’aucune amélioration globale des soins médicaux en prison n’a pu être observée en dix ans.

 

La situation régulièrement dénoncée au cours des dernières années par divers associations semble encore ignorée par les acteurs institutionnels du monde carcéral.

 

Ainsi, l’analyse des rapports d’activité de la Direction Générale des Etablissement pénitentiaires des cinq dernières années montre que les questions de l’accès et de la qualité générale des soins de santé en prison ne sont pas une préoccupation du gouvernement et encore moins une priorité.

 

A l’heure où la Belgique possède l’un des taux de mortalité carcérale les plus élevés d’Europe avec une personne détenue qui décède toute les semaines en moyenne4, l’OIP appelle le gouvernement prendre des mesures concrètes et durables afin d’améliorer substantiellement l’accès et la qualité des soins de santé en prison notamment par la finalisation du transfert de la compétence des soins médicaux des détenus au SPF Santé.

 

Sources :

 

Rapport du Centre fédéral d’Expertise de Soins de santé (KCE), 18 octobre 2017  

 

La Libre Belgique, « Les détenus belges sont en mauvaise santé »

 

Le rapport santé des Commissions de Surveillance

 

 

 

1

 http://oipbelgique.be/fr/?p=549

2

 Voy. la Notice de l’OIP 2008, page 101 à 112.

3

 Voy. la Notice de l’OIP 2016, page 177 et s.

4

 Voy. le rapport annuel de la DGEPI 2016, p. 51 : 259 décès ont été enregistrés depuis 2012. Près d’un tiers d’entre eux sont des suicides. 

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(publié le 19 octobre 2017)

Rapport santé des Commissions de surveillance des prisons

jeudi 19 octobre 2017 à 14:04
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L’OIP a obtenu une copie du rapport « Santé » des Commissions de surveillance des prisons.

 

Rédigé sur la base de 26 rapports récoltés entre 2015 et 2016 auprès des membres médecins des différentes commissions, ce document aborde neuf thématiques1 synthétisant les difficultés rencontrées dans la grande majorité des établissements pénitentiaires du Royaume.

 

Pour chacune d’entre elles, le rapport identifie les lacunes les plus fréquemment rencontrées.

 

Morceaux choisis 2 :

 

« L’accès aux soins de première ligne est un soucis majeur »

 

Après avoir constaté que le travail des professionnels de la santé en prison est l’œuvre de personnes compétentes et dévouées, les Commissions de surveillance dénoncent les conditions dans lesquelles ces professionnels doivent exercer comme particulièrement difficiles.

 

Ainsi, le rapport constate que le délai d’attente entre le moment où un détenu demande à voir un médecin et la consultation est à l’origine de plaintes courantes, et ce, qu’il s’agisse d’une consultation de psychiatrie, de kinésithérapie ou même de médecine générale.

 

Les commissions notent par ailleurs que s’il existe en général une présence quotidienne de médecins en prison, le temps alloué aux consultations est bien souvent trop faible. Certains rapports font état de consultations d’une durée de deux à quatre minutes ce qui est largement insuffisant pour effectuer une anamnèse ou un examen physique digne de ce nom.

 

Le rapport épingle l’absence d’accès continu aux soins de santé en prison. Ceci se traduit par exemple par une insuffisance du nombre de médecins généralistes ou par l’absence de garde médicale non seulement le soir et les week-ends mais également la nuit et les jours fériés. 

 

Dans ces deux dernières situations, si une urgence médicale se présente, la prison fait en général appeler le médecin de garde local (qui peut refuser de se déplacer) ou même parfois le 112…

 

« Au-delà de l’insuffisance temps-médecin, la pratique médicale survit entre manque de moyens et décisions arbitraires de l’administration »

 

Les Commissions de surveillance rapportent que les équipes soignantes sont incomplètes tant en diversité qu’en nombre.

 

Ainsi, les rapports font état d’une absence criante de spécialistes (kinésithérapeutes, dermatologues, ophtalmologues…) face aux besoins de la médecine carcérale. Plus particulièrement, le manque de professionnels de santé mentale est cruellement ressenti face à la haute fréquence de ce type de pathologies.

 

Les décisions de l’administration en matière de rationalisation et de budget sont également critiquées et notamment les retards excessifs voire les suspensions dans le paiement des honoraires des médecins.

 

« Il y a parmi les détenus, hors internés, énormément de problèmes psychiatriques ou psychologiques. Au moins la moitié des consultations concernent des problèmes d’ordre psychologique (…) »

 

Selon le rapport, les problèmes psychiques constituent la charge la plus lourde du fardeau du personnel soignant qui demeure en nombre totalement insuffisant pour y apporter une réponse adéquate. Les capacités de prise en charge interne des détenus souffrant de pathologies psychiatriques sont trop faibles et les demandes de soutien externe à la prison peuvent dans certains cas exiger un délai d’attente d’un à deux ans.

 

Le rapport suggère à cet effet de faire intégrer obligatoirement les psychiatres aux équipes de médecine générale de base tant les demandes à ce niveau sont importantes.

 

Le rapport regrette également l’absence totale d’outils d’évaluation du risque suicidaire3 et les réponses inadaptées aux tentatives. Ainsi, les Commissions ont constaté que le détenu qui a tenté de mettre fin à ses jours est en général mis en cellule d’isolement voire au cachot.

 

« Les détenus semblent recevoir beaucoup trop souvent de produits tranquillisants, hypnotiques et autres psychotropes »

 

Les commissions interrogent également la difficulté qu’il existe d’avoir une vue globale sur l’activité des services médicaux en prison.

 

La différence entre les normes des prestations de santé du SPF Justice et du SPF Santé est, pour les commissions, incompréhensible et contraire aux règles de l’éthique4.

 

Ainsi, le rapport épingle notamment la non-observance par le personnel de surveillance des prescrits médicaux (ex : adapter le régime de douches ou le régime alimentaire d’un détenu pour raison médicale) et son absence de connaissance des besoins liés à certaines pathologies (diabète, maladies infectieuses,) ou encore l’absence d’infirmières sur certaines sections de prisons accueillant pourtant des bébés en postnatal.

 

« Les conditions d’internement sont alarmantes »

 

Sur le plan du traitement des internés en prison, le rapport constate l’insuffisance totale du dispositif actuel : Trop peu de psychiatres, manque de formation des agents pénitentiaires dans les annexes psychiatriques, cellules d’isolement inadaptées, quasi absence de thérapeutique éducative…

 

Le rapport s’émeut également de la situation des femmes internées qui sont mélangées à la population générale sans encadrement ni structure d’accueil spécifiques.

 

L’état général des annexes psychiatriques est aussi dénoncé car peu favorable au rétablissement des internés. 

 

Le rapport constate une prédominance de l’aspect sécuritaire de la détention sur les soins.

 

« La réalisation d’un IRM ou de n’importe quel examen ou traitement spécialisé en externe tient de l’exploit »

 

Le rapport met également en lumière les difficultés qui rongent les rendez-vous externes. Outre une proportion d’annulation et de reports particulièrement élevées, les Commissions de surveillance ont également noté que le temps d’attente, le type de soins et d’examens de la population carcérale sont largement inférieurs à ceux reçu par la population carcérale.

 

Plus spécifiquement, les problèmes fréquents d’extraction pour raisons médicales sont également épinglés. Les difficultés à l’origine de ces difficultés sont, toujours selon le rapport, à trouver non seulement dans le manque d’effectifs (réduits pour cause de restrictions budgétaires) mais aussi dans un manque de collaboration entre la prison et la prison et les services privés chargés d’assurer le transport des détenus hors de la prison.

 

Les Commissions de surveillance proposent également une série de mesures concrètes qui permettraient de faciliter les soins en prison et notamment :

 

  • Améliorer les conditions générales d’hygiène, de salubrité et de régime alimentaire pour non seulement améliorer l’état des malades (en particulier les diabétiques, les infectieux, les malades chroniques et les grabataires) mais aussi prévenir de nombreux problèmes affectant l’ensemble de la prison, y compris le personnel de surveillance ;

  • Organiser la distribution des médicaments par le personnel de santé plutôt que par les agents qui aurait le triple avantage de multiplier les contacts entre soignants et patients, d’améliorer les suivis et diminuer probablement les demandes de consultation pour de simples questions d’information ;

  • Prendre en considération de manière plus substantielle la situation médicale des détenus dans le cadre de sanctions disciplinaires ;

  • Compte-tenu de l’importante proportion de détenus étrangers, introduire la possibilité pour le personnel soignant d’avoir accès à des services d’interprétariat professionnel afin de mener plus efficacement les consultations ;

  •  Améliorer le contrôle des soins en facilitant l’accès aux dossier médicaux des détenus, et ce sur une période de temps plus étendue5.

 

Les conclusions du rapport sont sans appel : outre les carences importantes qu’elles ont relevé, les Commission de surveillance constatent que le budget accordé aux soins de santé a été raboté de quelques 14 millions d’euros entre 2014 et 2016.

 

Aux yeux des Commissions de surveillance, la qualité des soins de santé en prison, déjà insatisfaisante par manque de moyens, de cohérence et de leadership a fortement été détériorée par les mesures de rationalisation et de réduction du personnel tant infirmier que pénitentiaire.

 

Les Commission de surveillance appellent donc de manière urgente au transfert des soins des détenus au Ministère de la Santé conformément aux recommandations du Conseil de l’Europe en la matière6.


Le rapport est disponible dans son intégralité 
ici.

1

 Les thématiques sont les suivantes : Infrastructure, accès aux soins de première ligne, composition des équipes soignantes, traitements, problèmes psychiques, problèmes dentaires, conditions d’internement, rendez-vous externes/spécialisés, disparité des soins à l’entrée/sortie de la prison.

2

 Toutes les citations en gras sont extraites du rapport.

3

 Le taux de suicide est sept à onze fois plus élevé au sein de la population carcérale. Voy. la Notice de l’OIP 2016, page 156.

4

 Actuellement, les soins de santé aux détenus en Belgique relèvent de la compétence du SPF Justice et non du SPF Santé.

5

 Actuellement l’Ordre des médecins autorise la consultation du dossier médical d’un détenu par le médecin de la commission de surveillance pour une durée d’un mois, selon le rapport, ce délai devrait être porté à trois mois afin d’optimiser les suivis.

6

 Voy. à cet égard la Recommandation n° R (98) 7 du Comité des Ministres aux Etats Membres du Conseil de l’Europe relative aux aspects éthiques et organisationnels des soins de santé en milieu pénitentiaire (B.12) et la Recommandation Rec (2006) 2 du Comité des Ministres aux Etats membres sur les Règles pénitentiaires européennes (40.1 à 40.5).

 

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La prison s’étend

lundi 16 octobre 2017 à 16:10
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L’une des premières fermes bio de Belgique apparait aujourd’hui menacée par un projet d’extension de l’établissement pénitentiaire de Lantin. 

 

En effet, il est prévu de construire sur le même site un nouvel établissement pénitentiaire avec une section de haute sécurité. Ce sont 15 à 20% des 44 hectares de terres qui pourraient être amenés à disparaitre1. 

 

Les gestionnaires de la ferme de l’Arbre sont conscients des problèmes que rencontre la prison de Lantin. 

 

D’un côté, la question de la surpopulation. 

 

En Belgique, le taux moyen de surpopulation à la fin 2015 était de 10,10% et la prison de Lantin fait partie des prisons les plus surpeuplées de Belgique avec un taux supérieur à 30%. La surpopulation s’explique en partie par le fait que si la séparation prévenus/condamnés est prévue légalement elle ne reste que « souvent théorique puisque les ailes réservées aux condamnés accueillent des prévenus en raison de la surpopulation des maisons d’arrêt et vice versa »2, à tel point que certains détenus nouvellement incarcérés se sont parfois retrouvés au cachot (parfois même en duo) par manque de place. 

 

Les bébés eux-mêmes sont parfois victimes de la surpopulation car si théoriquement, « trois enfants peuvent être accueillis simultanément à Lantin en pratique, ce nombre est largement dépassé. Lorsque les cellules adaptées sont occupées, l’enfant et la mère en « surnombre » se retrouvent dans une cellule normale, qui peut être occupée par une autre détenue »3. 

 

De l’autre côté, la question de la vétusté. 

 

A à peine 40 ans, l’établissement pénitentiaire de Lantin vieillit mal. 

 

En effet, la prison rencontre notamment d’importants problèmes d’humidité, de moisissure dans les cellules, de pannes ou encore de mauvaise aération. Concernant les douches, « les détenus se plaignent fréquemment de leur difficulté d’accès. Même en période de canicule, ils ne peuvent prendre une douche qu’une fois tous les trois jours, alors qu’il règne dans les cellules une température moyenne de 35° »4. Lors d’une de ses visites, le CPT, Comité européen pour la prévention de la torture et des peines ou traitements inhumains ou dégradants a encore rappelé que « le niveau de prise en charge des patients placés à l’annexe psychiatrique était en dessous du minimum acceptable du point de vue éthique et humain »5. 

 

Toutefois, les travailleurs de l’Arbre ne comprennent pas que l’Etat fédéral n’ait pas envisagé d’alternatives. Selon eux, il s’agirait d’accroitre la capacité de l’établissement de défense sociale de Paifve et de la prison de Verviers pour délocaliser les détenus vers ces deux prisons afin de reconstruire ce qui est obsolète à Lantin et ainsi pouvoir ensuite y rapatrier les détenus. 

 

Cela permettrait d’éviter les conséquences négatives sur l’environnement de Lantin. 

 

Plus encore, l’existence de la ferme de l’Arbre pourrait apparaître comme l’opportunité d’aller plus loin et de développer, avec l’administration pénitentiaire, un projet de réinsertion par le travail dans la ferme pour certains détenus en fin de peine. 

 

 

 

 

 

 

 

 

 

 

 

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(publié le 16 octobre 2017)

Les J.O. des prisons

lundi 9 octobre 2017 à 08:20
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L’administration pénitentiaire française organise depuis 2012 les jeux pénitentiaires. Cette manifestation permet aux personnes détenues de se mesurer en participant à différentes compétitions sportives.

Pendant deux semaines, une cinquantaine de prisons de France accueillent les jeux pénitentiaires auxquels participent quelque 20.000 détenus.

Ce jeudi matin, à la maison d'arrêt de Grasse, les détenus ont piqué un 10.000m. Course de fond, sprint, basket, vélo, rameur et pétanque... Autant d'épreuves qui se poursuivent pendant deux jours et auxquels une cinquantaine de détenus se sont inscrits.

"Les jeux pénitentiaires existent depuis 2012. Avant les attentats, ils se déroulaient en extérieur. Depuis, nous les organisons au sein des prisons de France. Cette année, 20.000 détenus d'une cinquantaine d'établissements s'y sont inscrits", précise le directeur des Jeux pénitentiaires, Sabry Beldjiilali1.

Une initiative de nos voisins français pouvant être soulignée par l’OIP, qui rappelle dans sa dernière notice qu’il est désormais prévu, en théorie, que le détenu ait la possibilité d’exercer une activité sportive durant au moins deux heures par semaine. Néanmoins, de nombreuses barrières se dressent vis-à-vis des différentes activités pouvant être proposées au sein de la prison (manque de moyens, prisons surpeuplées…). La notice rappelle par exemple que depuis mai 2015, les services sociaux externes ne peuvent plus organiser d’activités avec comme motif invoqué, la surpopulation2.

« La pauvreté au sein du monde carcéral se marque également par la dimension temporelle : la grande majorité des détenus sont inactifs. Le travail est un bien rare en prison et les activités manquent, malgré les besoins en formation de base, en alphabétisation et en sport3. »

 

 

 

 

1

 https://actupenit.com/2017/10/05/%F0%9F%87%AB%F0%9F%87%B7-grasse-les-detenus-participent-aux-jeux-penitentiaires/

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(publié le 9 octobre 2017)

La Belgique condamnée en raison du décès en prison d’une personne souffrant d’un trouble mental

samedi 30 septembre 2017 à 18:37
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Dans un arrêt du 5 septembre 20171, la Cour européenne des droits de l’Homme a dû traiter d’une affaire concernant le décès de Michael Tekin, une personne internée soit une personne ayant commis un fait qualifié infraction mais déclarée irresponsable de ses actes, en date du 8 août 2009 à la prison de Jamioulx.

 

Michael Tekin avait déjà été interné à l’annexe psychiatrique de la prison de Jamioulx en 2007, 2008 et 2009, et avait à chaque fois bénéficié d’une libération à l’essai. En raison du non-respect des conditions de sa libération, le procureur du Roi a ordonné sa réintégration à l’aile psychiatrique de la prison de Jamioulx, où il est arrivé le 7 août 2009 au soir. Le lendemain matin, la directrice adjointe de la prison a décidé de prendre à son égard des mesures de sécurité particulières. Les agents R., L. et D., chargés d’informer Michael Tekin de cette décision, expliquèrent qu’après lui avoir communiqué la décision de la directrice, furent provoqués par celui-ci au point de se sentir menacés. Les agents décidèrent alors de placer Michael Tekin au cachot. Vu qu’il refusait de s’y rendre, pour l’y emmener, l’un des agents fit une clé de bras en lui saisissant le cou en vue de l’amener au sol. D’autres agents arrivèrent en renfort et placèrent des menottes aux poignets et des entraves aux chevilles de Michael Tekin. Ce dernier fut ensuite transporté vers le cachot, maintenu par les épaules, son corps traînant sur le sol et sa tête pendant, le visage vers le bas. Une fois au cachot, les agents s’aperçurent que le visage de Michael Tekin était cyanosé. Dès son arrivée sur place, l’équipe médicale constata le décès de Michael Tekin. Le tribunal correctionnel de Charleroi acquitta les trois gardiens, qui étaient poursuivis du chef de coups et blessures volontaires ayant entraîné la mort sans intention de la donner. Les parents de Michael Tekin ont porté cette affaire devant la Cour européenne des droits de l’Homme.

 

Dans son arrêt, la Cour européenne relève l’insuffisance et l’imprécision du cadre juridique et administratif qui prévoient le recours aux mesures de coercition. Elle relaye les préoccupations des observateurs internationaux dénonçant les lacunes des formations des agents pénitentiaires et pointe le fait que l’un des agents concerné n’avait aucune formation relative aux personnes souffrant d’un trouble psychiatrique. Elle ajoute que la place de Michael Tekin, au vu de son état de santé mentale, connu des autorités, et ayant conduit à son internement, n’était pas dans une cellule d’une aile ordinaire de la prison. 

 

La Cour européenne souligne que Michael Tekin était particulièrement vulnérable en raison de ses troubles mentaux et de sa privation de liberté et que le tribunal correctionnel ayant acquitté les agents pénitentiaires n’a aucunement pris en considération cet aspect primordial de l’affaire dans l’analyse de la nécessité et de la proportionnalité de la force utilisée par ceux-ci. La Cour constate que Michael Tekin semble avoir été traité tant par les agents pénitentiaires que par la directrice adjointe de la prison et par le tribunal correctionnel comme un détenu ordinaire disposant de toutes ses facultés mentales ». Enfin, la Cour fait le constat de l’absence de réflexion sur la manière dont les mesures de sécurité allaient être communiquées à Michael Tekin au vu de sa problématique psychiatrique, et du fait qu’aucune autre mesure que l’immobilisation et le placement au cachot ne semble avoir été envisagée par les agents, qui n’ont pas privilégié le dialogue.  La Cour ne comprend pas non plus pourquoi les agents ne sont pas simplement sortis de la cellule afin de ne pas être menacés d’une quelconque agression. La Cour s’interroge sur le choix de la manœuvre utilisée, dès lors que le risque létal d’une clé d’étranglement a été enseigné dans la formation suivie par l’agent ayant réalisé cette clé. La Cour note aussi que lorsque Michael Tekin était immobilisé au sol, entravé aux mains et aux pieds et donc ne présentant aucun danger pour autrui, aucun des agents, pourtant nombreux, n’a cherché à s’assurer de son état de santé. La Cour conclut qu’elle n’est pas convaincue que le recours à la force était  absolument nécessaire en l’espèce, en soulignant que l’absence de règles claires et de formation adéquate peut expliquer les actes de l’agent. 

 

Par conséquent, elle déclare qu’il y a eu violation de l’article 2 de la Convention et condamne l’Etat belge à verser un montant de 20.000 euro aux parents de Michael Tekin à titre de dommage moral.

 

Ce nouvel arrêt est l’occasion de rappeler que le fait que des personnes souffrant de troubles psychiatriques soient placées dans les annexes psychiatriques des prisons – voire, comme ce fût le cas de Michael Tekin – dans les ailes ordinaires de la prison, a été maintes fois condamné par la Cour européenne des droits de l’Homme, et par d’autres acteurs nationaux (dont l’OIP2), européens et internationaux, au point que la Cour européenne a rendu un « arrêt pilote »3 en date du 6 septembre 20164. Cet arrêt pilote identifie cette problématique comme un « problème structurel » au sein de l’ordre juridique belge, et oblige l’Etat belge à prendre des mesures pour y mettre fin endéans un délai de deux ans, soit avant le 6 décembre 2018. 

 

1

 Cour eur. dr. h., Tekin et Arslan c. Belgique, 5 septembre 2017, req. n°37795/13.

2

 Observatoire International des Prisons, Notice 2016 – Pour le droit à la dignité des personnes détenues, pp. 195 – 213.

3

 Cour européenne des droits de l’homme, Unité de la Presse, « Fiche thématique – Les arrêts pilotes », juin 2017, http://www.echr.coe.int/Documents/FS_Pilot_judgments_FRA.pdf.

4

 Cour eur. dr. h., W.D. c. Belgique, 6 septembre 2016, req. n°73548/13, J.L.M.B., 2016, p. 1703 ; F. Vansiliette, « Les internés : la fin d’une politique des oubliettes ? », Justice en ligne, 25 octobre 2016, http://www.justice-en-ligne.be/article923.html. 

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