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Germany

Capital city — Berlin

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Panorama

Health

Organisation of health care

Ministry in charge

Ministry of Justice

Every prison facility has a health care unit

yes

The types of care provided vary according to the prison size. At least one health unit is present in each of them. It allows for the provision of routine care.

Most of the time, specialists (dentists, dermatologists, etc.) are consulted outside of the prison. Visits must be authorised by a general practitioner.

The number of health care staff varies from one state to another.

The ratio is one doctor per 127 prisoners at Heidering prison. The authorities in several states use telemedicine to cope with the shortage of staff.

Prisoners requiring hospitalisation are usually transferred to a prison hospital, such as Hohenasperg (Stuttgart), Lingen (Bremen and Lower Saxony), Willich (Düsseldorf) and Plötzensee (Berlin). They are transferred to a public hospital when the administration considers that they do not present any risk.

Access to health care

Health care is free

yes

The prison administration does not usually pay for expensive treatments (electric wheelchairs, dentures) for prisoners serving short sentences.

A medical examination is performed upon admission

yes

The timing of the examination and procedures vary according to the prison or state. Chest X-rays (diagnosis of tuberculosis) and blood tests are usually done to detect transmittable diseases (hepatitis A, B and C and HIV).

A medical file is opened upon admission

yes

Sometimes the medical file opened upon prison admission consists of two parts. One is accessible to the prisoner, the other is reserved for medical staff.

Prisoners can access health care units after

  • a written request
  • an oral request

The process depends on the prison or the state.

Medical examinations are carried out on a confidential basis

in most cases

This confidentiality is not always guaranteed in case of signs of addictions or possible self-mutilation.

Continuity of care is ensured throughout imprisonment. It is not provided after release.

There is no coordination between prisons and public health services.

Prisoners do not choose their doctor. Care is provided by the prison doctors. The quality of care highly depends on the prisons’ investments.

Physical health care

The most common diseases are of infectious origin (hepatitis A, B or C). Addictive disorders are usually associated with them.

All people with an infectious disease (HIV/AIDS, tuberculosis, hepatitis) receive treatment. Late treatment is common.

The authorities have reduced their efforts to implement risk reduction programmes, particularly in Bavaria. No needle exchange programmes are offered. In Fühlsbüttel prison (Hamburg), the automated machine which allowed to exchange needles has been removed.

Condom distribution is very rare.

Mental health care

The law states that prisoners suffering from addictions may be placed in detoxification centres.

Six states provide comprehensive treatments for addictions in some prisons1. All prisons are obliged to offer methadone substitution treatment. It is administered by prison staff under the supervision of medical staff and social workers.

Most patients receive a single detoxification course with substitution treatment. Only a minority of prisoners with addictions access treatment for more than six months.

  1. Lana Osment, “The Complexity of Rehabilitation in Open and Closed Prison Setting”, Lund University, 2018, p. 14. ↩

  • Marlene Mortler, Federal Commissioner for Drug Control, laments the fact that prisoners do not always have access to methadone, an opiate substitution treatment. Half of the Bavarian prisons do not provide treatment for heroin addiction. The difficulty in accessing substitution treatment promotes the black market for drugs in prison and increases the risk of infections from used syringes.

    In 2016, the European Court of Human Rights described the refusal to provide substitution treatment to a dependent prisoner, as “inhuman treatment”.

    i
    05/2019
    / Süddeutsche Zeitung

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  • The Sicherungsverwahrte from Rosdorf prison (Göttingen) struggle to access therapy centres for their reintegration. According to the Federal Constitutional Court, the aim of the special detention scheme for the Sicherungsverwahrte must be the reintegration of prisoners. A prisoner condemns the lack of coherence on the part of the prison administration in this regard.

    See the column, “Persons sentenced to long-term imprisonment” for more info on Sicherungsverwahrte.

    i
    26/06/2019
    / TAZ