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Belgium

Capital city — Brussels

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Panorama

Health

Organisation of health care

Ministry in charge

Federal Public Service of Justice (FPS)

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Loi de principes, Article 98

During its 2021 visit, the European Committee for the Prevention of Torture (CPT) was informed about an action plan being developed to transfer the responsibility of health care from prisons to the Federal Public Service of Health (SPF Santé). The CPT noted that this project was being discussed during its 2017 visit. Health care is still the responsibility of FPS Justice.1

  1. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 24 (in French). ↩

Every prison facility has a health care unit

yes

The condition and equipment of the health care units vary among facilities.1
In 2021, the CPT reported problems with the equipment in the healthcare units of the facilities visited. In Antwerp, the medical unit was cramped and lacked ECG equipment. In Saint-Gilles, the rooms and the equipment were dilapidated; this facility is the only one with a medical-surgical centre. The CPT noted that basic equipment was lacking, some of it is outdated or in short supply.2

  1. Central Prison Monitoring Council, “Rapport annuel 2021”, 2022, p. 30 (in French). ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 14 (in French). ↩

  • Since November 2022, the medical service at Tournai prison has been installed in a new, more appropriate space that is well ventilated, quiet and spacious. However, the CCSP reported that the waiting room is too small and poorly ventilated, and that the location does not allow for quick emergency response. Restrictions on movements within the prison and security conditions also impact how consultations are organised, sometimes leaving doctors without patients.

    i
    15/05/2023
    / Conseil central de surveillance pénitentiaire (CCSP)

Number of medical staff (FTE)

221

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Council of Europe, SPACE I - 2021 Report, 19 april
2022, p. 89, table 19.

The number of health personnel decreased between 2017 and 2021. There were 207 general practice physicians, 40 psychiatrists, and 19 psychologists in 2017.1 The CPT reported a shortage of general practitioners in the prisons visited.2 Most of the doctors work part-time for the administration.

  1. World Health Organization, Health in prisons: Fact sheets for 38 European Countries, 2019, p. 21. ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 27 March to 6 April 2017”, 8 March 2018, p. 37 (in French). ↩

General medical care is usually provided in detention facilities. Medical teams are insufficient in number and skills.

There is an absence of specialists across the board: physiotherapists, dentists, ophthalmologists, dermatologists. The medical team is usually made up of nurses. Medical personnel are usually only on duty during the day.1

Most dentists are part of a mobile team who offer their services for a few days a month in each prison. Many prisoners complain about the quality of dental care (too many extractions, not enough anaesthetic, poorly done fillings). Some of them do not go to dentists because of poor treatments.2 There are no dentists in Tongres, and prisoners must go to another facility, which causes longer wait times.3 In Lantin, the wait times to see a dentist are up to four months.4

The working conditions for healthcare professionals are seen as difficult: insufficient equipment, finances, training, organisation, etc. Treatment rooms do not have all the necessary equipment. This is especially the case for the physiotherapy room in Ittre prison, where prisoners cannot always get the treatments prescribed.5

Prisoners complain that medical appointments are too short and not thorough enough. The shortage of medical personnel is partly to blame. Some appointments last only one minute or take place at the reception desk. The attitude of health personnel is described as “formal” and “distant”.6

  1. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, pp. 45 and 55 (in French). ↩

  2. CCSP, “Rapport annuel 2020”, 2021, pp. 45-46, 57 (in French). ↩

  3. Central Prison Monitoring Council, “Rapport annuel 2021”, 2022, p. 30 (in French). ↩

  4. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 16. (in French) ↩

  5. CCSP, “Rapport annuel 2021”, 2022, p. 30. ↩

  6. CCSP, “Rapport annuel 2020”, 2021, p. 45. ↩

  • A doctor is on site at the Leuven central prison two hours per day, including weekends and bank holidays. He sees up to ten patients per hour. The CSP says consultations in such conditions do not enable doctors to properly inform patients or diagnose them and provide adequate treatment.

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    16/03/2023
    / Conseil central de surveillance pénitentiaire (CCSP), Conseil central de surveillance pénitentiaire (CCSP), "Visite des établissements pénitentiaires de Louvain Central et de Marneffe”, p. 70

Prisons without a medical-surgical centre transfer sick prisoners to public hospitals (Loi de principes, Article 93).
Lantin prison rents four beds in a secure room at the public hospital La Citadelle in Liège.1

  1. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons 2017”, 2017, p.23. ↩

Access to health care

Health care is free

yes

Prisoners are not covered by health insurance while incarcerated. They get free care from FPS Justice.1 Medication is usually free of charge, but prisoners must pay for some procedures, such as dental prostheses. Some over-the-counter medicines are not free (anti-inflammatory creams, nicotine patches) and can be purchased at the canteen. Lack of financial resources limits access to certain treatments.2

  1. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons 2017”, 2017, p.32. ↩

  2. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 46 (in French). ↩

A medical examination is performed upon admission

yes

A medical examination must be carried out within 24 hours after admission to prison.1 Doctors must inform the prison psychiatrist if they suspect the person has psychological or psychiatric problems.
During its 2017 and 2021 visits, the CPT observed that the entry medical exam is usually done by a nurse within 24 hours following admission, followed by a consultation with a general practitioner a few days later. The exams included a quick visual check-up and a few questions. The admission procedure consisted of routine TB testing, but no other infectious diseases.23

  1. ministère de la Justice, Arrêté royal déterminant la date d’entrée en vigueur et d’exécution de diverses dispositions des titres III et V de la loi de principes du 12 janvier 2005 concernant l’administration pénitentiaire ainsi que le statut juridique des détenus, 8 avril 2011 (in French). ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 27 March to 6 April 2017”, 8 March 2018, p. 39 (in French). ↩

  3. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 14 (in French). ↩

A medical file is opened upon admission

yes

The CPT reported that the computer program for maintaining the electronic medical records of prisoners (Épicure) is outdated. One of the main problems is that it is incompatible with the electronic records used by outside health services; this makes sharing information slow and cumbersome between prison health professionals and their health colleagues on the outside.1
Doctors on the prison Monitoring Commissions reported problems accessing records.2
Prisoners who need access to a copy of their medical records must designate a trusted person to make the request and forward the file to them.3

  1. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 19 (in French). ↩

  2. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 48 (in French). ↩

  3. Centre d’action laïque, “Guide de la personne détenue”, November 2019, p. 10 (in French). ↩

  • The computer programme Epicure, made available to medical personnel at the Leuven central prison, no longer allows access to the files and medical histories of prisoners.

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    16/03/2023
    / Conseil central de surveillance pénitentiaire (CCSP), Conseil central de surveillance pénitentiaire (CCSP), "Visite des établissements pénitentiaires de Louvain Central et de Marneffe”, p. 70

Prisoners can access health care units after

  • a written request
  • an oral request

According to the Belgian Health Care Knowledge Centre (KCE), prisoners must complete a form to see a doctor and give it to the guards.1 In some establishments, the request forms are placed in sealed boxes which are then collected by the medical staff. In others, the CPT observed that the requests are made verbally to prison staff, and prisoners generally have to give a reason for their request. According to the CPT, this practice is a breach of patient-doctor confidentiality.2
Prisoners complain of delays in obtaining appointments and, sometimes, the lack of response to their requests.3 Two “health” reports from the KCE and Monitoring Commissions, published in 2017, pointed out that:

  • half of the prison population say they are in poor health: prisoners see a general practitioner an average of 18 times a year and a psychiatrist three times a year;
  • consultations are often very short: sometimes two to four minutes per patient;
  • delays for a specialist appointment are long (two months for the dentist).

  1. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons 2017”, 2017, p.23. ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 27 March to 6 April 2017”, 8 March 2018, p. 39 (in French). ↩

  3. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 45 (in French). ↩

Medical examinations are carried out on a confidential basis

in most cases

Breaches of patient-doctor confidentiality have been reported, especially during outside consultations, as well as in shared patient rooms. In 2017, the CPT reported that the prison staff is always present during the medical exams conducted in solitary confinement cells.1
During a recent visit in 2021, the CPT noted persistent breaches of patient-doctor confidentiality and of medical data. Requests for appointments continue to go through prison guards who are often present during the consultation. Sometimes, doctors examine patients through the barred door of a cell in plain sight of others (non-medical personnel, fellow prisoners). Doctors and nurses must call on fellow prisoners during consultations with patients who do not speak French, Dutch or English (except for Antwerp prison which has signed a contract with a telephone interpretation group).2

  1. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 27 March to 6 April 2017”, 8 March 2018, p. 39 (in French). ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 18-19 (in French). ↩

Prisoners have the right to receive treatment in prison (Loi de principes, Article 89). Continuity of care for prisoners is a major concern: there is no protocol to link medical follow-up before, during, and after incarcerated.

Prisoners’ medical records are stored on a different platform than the one used for people outside prisons. The medical record of someone entering prison is not transferred to the prison medical service.1

  1. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 48 (in French). ↩

  • In its 2022 annual report, the CCSP disclosed that prisoners face extensive delays in accessing primary, specialised, or mental health care, largely due to insufficient staffing for transport to off-site services. Consequently, many prisoners receive minimal medical follow-up as their healthcare requests often go unheeded.

    i
    19/09/2023
    / Conseil central de surveillance pénitentiaire (CCSP)

  • The CCSP noted in 2022 that Mons prison had a problem with access to care: 30% of their actions there were related to care, compared with 18% in 2020 and 28% in 2021. The figures are even higher for female prisoners: 34% of requests.

    i
    15/05/2023
    / Conseil central de surveillance pénitentiaire (CCSP)

The nursing staff is responsible for distributing medication, but sometimes it is done by guards or prisoners. In 48% of prisons visited by the KCE in 2016, this task was entrusted entirely to guards.1 In Antwerp, Bruges, Saint Gilles, and Lantin, prisoners reported to the Monitoring Commissions that they did not always receive their medication on time or did not receive it at all.

The list of available medication is limited. Certain drugs are difficult to obtain (antibiotics, sedatives), and prisoners must sometimes take a different medication than the one they normally take. The labels are sometimes crossed-out and re-used for other patients, which can cause a breach of confidentiality.2

The Belgian section of the International Observatory of Prisons (OIP Belgique) denounced the cases of antipsychotic over-medication.3 Nearly 60% of prisoners found that they were prescribed at least one medication for anxiety in 2016.4.

The CPT reported that during the strikes of 2016, prisoners had more difficulty accessing medication and treatments, which led to more anxiety and stress, especially for people with mental health problems. Some people in the psychiatric annex of Jamioulx prison had their medication increased to deal with this situation.5

  1. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 48 (in French). ↩

  2. CCSP, “Rapport annuel 2020”, 2021, p. 48 (in French). ↩

  3. International Prison Observatory- Belgian section, “Notice 2016 pour le droit à la dignité des personnes détenues”, 2016, p. 184 (in French). ↩

  4. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons. Current Situation and Scenarios for the Future - Short report”, 2017, p. 13. ↩

  5. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 7 to 9 March 2016*, 2016, pp. 4 and 9 (in French). ↩

Medical transfers, which allow hospitalisation or outside consultations, are difficult to organise. Prison staff is not always available to do these transfers. There is a lack of hospital appointments, and the procedures are often cancelled or postponed.1 In 2020, a prisoner in Saint-Gilles prison was not transferred in time and lost vision in one eye.2

Prisoners are always accompanied by prison guards for medical transfers.3 Some are handcuffed during the transfer and consultation. The procedures can be uncomfortable and embarrassing for prisoners, as they sometimes take place in front of guards.4 Some prefer to refuse treatment and wait to see a doctor after release.5

  1. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 27 March to 6 April 2017”, 8 March 2018, p. 37 (in French). ↩

  2. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 49 (in French). ↩

  3. CCSP, “Rapport annuel 2020”, 2021, p. 49 (in French). ↩

  4. I.Care, “Extractions pour raisons médicales”, July 2021, pp. 4-6 (in French). ↩

  5. Concertation des associations actives en prison, Adeppi, Centre d’action laïque, I.Care, Ligue des familles, Sireas, “La loi de principes : quand la théorie juridique rencontre les réalitéscarcérales”, 2022, p. 20 (in French). ↩

Physical health care

There are no studies of prevalent diseases.
Prisoners are seven times more affected by hepatitis C1 and ten times more by tuberculosis 2 than people on the outside.

  1. Coalition belge contre le VHC, “Document de vision : La Belgique sans hépatite à l’horizon 2030”, October 2020, p. 10 (in French). ↩

  2. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons. Current Situation and Scenarios for the Future - Short report”, 2017, p. 47. ↩

  • The most common diagnoses at the Leuven central prison are injuries from work or sports, diabetes, cardiovascular illnesses, chronic obstructive pulmonary disease and health problems related to substance addiction.

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    16/03/2023
    / Conseil central de surveillance pénitentiaire (CCSP), "Visite des établissements pénitentiaires de Louvain Central et de Marneffe”, p. 70

Not all patients receive the appropriate treatment, such as those who are positive for hepatitis C.1

  1. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons. Current Situation and Scenarios for the Future - Short report”, 2017, p. 47. ↩

  • A report from the World Health Organisation indicates that in 2021, all prisoners in Belgium had access to HIV prophylaxis before and after exposure.

    i
    15/02/2023
    / Organisation mondiale de la santé (OMS)

There are some measures in place for the prevention of contagious diseases and epidemics.
Testing for infectious diseases is not always carried out and the methods are not standardised. According to a KCE study, the only routine testing done in 75% of prisons is for tuberculosis. Only six prisons in 2017 offered HIV and hepatitis tests when entering prison. Half of the facilities offer these tests to prisoners during their time in detention.1
Patients with infectious and contagious diseases, such as tuberculosis or scabies, are isolated. Sometimes, officials may place in the same section prisoners with the same condition. They give practical reasons for doing so, such as managing their movements. These people are sometimes denied the right to work. During the COVID-19 pandemic, wearing a mask was mandatory for prisoners and staff. The CCSP reported that this measure was not always followed by staff in Jamioulx, Leuze-en-Hainaut, Marche-en-Famenne, Namur, Saint-Gilles and Saint-Hubert prisons.2

  1. Belgian Health Care Knowledge Centre “Health Care in Belgian Prisons. Current Situation and Scenarios for the Future - Short report”, 2017, p. 47. ↩

  2. Central Prison Monitoring Council, “Rapport annuel 2021”, 2022, pp. 13-17 (in French). ↩

  • A report from the World Health Organisation indicates that in 2021, all prisoners in Belgium had access to various vaccinations including DTP, HPV, Hepatitis A, Hepatitis B, seasonal flu, MMR, meningococcus, pneumococcus and COVID-19.

    i
    15/02/2023
    / Organisation mondiale de la santé (OMS)

Actions regarding risk reduction are limited. There are only a few pilot projects in progress. The administration indicated that prisoners may obtain condoms and lubricant from medical services, as well as information on hepatitis C and the risks of infection (brochures, flyers).

Mental health care

People with mental health issues are over-represented in prison. The CPT reports that there is not enough psychiatric and psychological care, and that there is a marked lack of mental health professionals. In most prisons, a psychiatrist is present for a few days per week. In 2020, there were no psychiatrists present in Andenne, Arlon, and Berkendael (closed since November 2022) prisons.1 Requests for outside support for treating mental disorders may, in some cases, entail a waiting time of up to one or two years.2

There are many cases of mental disorders in Ittre prison: severe depressions, suicidal states, breakdowns, poly-drug use. The administration gives priority to treating the most urgent cases. The others lack treatment and regular follow-ups.
Prisoners suffering from mental health problems can be placed in psychiatric annexes. These annexes are intended for relatively short detention periods, but, in practice, prisoners often stay there for between two and four years, pending a transfer decision to a specific facility. Psychiatric annexes accommodate, on a permanent basis, individuals undergoing mental health treatment when there are no specific facilities available to take them in.
Individuals with mental health problems are sometimes placed in confinement cells while waiting to be transferred, or when a prison does not have a psychiatric annex.3

Antwerp, Brussels, Gand, Haren, Jamioulx, Lantin, Louvain Secondaire, Mons and Namur prisons all have psychiatric annexes.
The broken windows in the psychiatric annex of Saint-Gilles prison have been replaced with plexiglass and plywood panels, which do not meet fire safety standards.4 During its 2021 visit, the CPT delegation met with prisoners who were living in very dirty cells, and who were demonstrably incapable of looking after their own personal hygiene or that of their cell.5

The European Court of Human Rights (ECHR) condemned Belgium several times for the poor management of their psychiatric annexes.[^echr] It found that the overcrowding and the lack of regular treatment constitute inhumane and degrading treatment. In 2016, the Court stated that the management of the psychiatric annexes represented a structural and systemic problem and asked the State to reduce the number of individuals they take in. Five years later, the European Court of Human Rights (ECHR) condemned Belgium following the complaint of five prisoners (Judgment Venken and Others v. Belgium). They claim to have been interned in the psychiatric wings of an ordinary prison. The ECHR recognised that the applicants had not had access to appropriate care and that they had not had any effective means of redress to change their situation.

Offenders deemed to be not responsible for their actions are interned in specific facilities:

  • social defence facilities (établissement de défense sociale, EDS), in Paifve, and social defence sections (sections de défense sociale, SDS), in Antwerp, Bruges, Merksplas and Turnhout
  • forensic psychiatry centres, in Ghent and Antwerp
  • civic hospitals

For more information on specific facilities, consult our thematic paper Belgium: walling up madness.

  1. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, p. 47 (in French). ↩

  2. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 27 March to 6 April 2017”, 8 March 2018 (in French). ↩

  3. CCSP, “Rapport annuel 2020”, 2021, p. 47 (in French). ↩

  4. Central Prison Monitoring Council, “Rapport annuel 2021”, 2022, pp. 30 and 51 (in French). ↩

  5. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), “Report to the Government of Belgium on the visit carried out by the CPT from 2 to 9 November 2021”, 29 November 2022, p. 20 (in French). ↩

  • On 14 December, the Appeals Court of Hainaut passed several judgments ordering the Belgian State to place several people in the Tournai regional psychiatric centre within eight days. After this deadline, the State would be fined €2,000 per day until it complied. These prisoners, currently in the psychiatric wing of Mons Prison, are not receiving appropriate care for their needs.

    i
    15/12/2023
    / RTBF

  • In 2022, the CCSP observed that many prisoners (1 in 3) at Nivelles prison suffered from mental disorders. It noted that many did not belong in prison. Others needed care and refused to go into CMCs, because this transfer would mean losing their job and benefits obtained in their associated prison.

    i
    15/05/2023
    / Conseil central de surveillance pénitentiaire (CCSP)

Each prison must have a psychosocial service consisting of psychiatric and psychology professionals. A team for additional care must be assigned to facilities with a psychiatric annex or a social defence section (SDS).1

Guards take a course in narcotics during their basic training. It deals with the identification of drugs and their effects, as well as how to manage people with drug addictions. They can also register for continuing education on this topic.

In September 2017, the ECHR found a lack of training for guards in the case Tekin v. Belgium. One of the guards concerned had received no training whatsoever on how to deal with people with mental illness.

  1. International Prison Observatory- Belgian section, “Notice 2016 pour le droit à la dignité des personnes détenues”, 2016, p. 58 (in French). ↩

Points of contact for people with substance use disorders are available in the Flemish, Brussel, and Wallonia prisons. Specialised external teams visit the prisoners and work with them to determine the proper treatment and ensure they receive treatment when released.
There are two “drug-free” sections for prisoners who wish to stop using drugs in Hasselt and Bruges prisons. The person is placed in these sections at their request. They receive psychological support while withdrawing and can obtain methadone treatment.1

In Ruiselede prison, the b-leave programme guides people with addictions towards withdrawal through sports and therapy.2 A booklet on the health problems associated with narcotics is available for prisoners.

In Brussels, the Ambulatoire-Forest Association offers specialised psychosocial support for defendants who have problems with alcohol, drug, or medication consumption.

  1. International Prison Observatory- Belgian section, “Notice 2016 pour le droit à la dignité des personnes détenues”, 2016, p. 193 (in French). ↩

  2. Central Prison Monitoring Council, “Rapport annuel 2020”, 2021, pp. 47 and 57 (in French) ↩