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Portugal

Capital city — Lisbon

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Panorama

Health

Organisation of health care

Ministry in charge

Ministry of Justice and Ministry of Health

Every prison facility has a health care unit

yes

Number of medical staff (FTE)

249

i
01/01/2021
/ Council of Europe, SPACE I – 2021 Report, p. 90.

  • On 15 February 2023, the World Health Organisation published a report on the healthcare services in European prisons, drawing on data provided by the ministries overseeing prison health. According to the report, as of 2021, Portugal had only 33 doctors for its 49 prisons, a ratio of 2.9 doctors per 1,000 prisoners, which is lower than the 5.3 per 1,000 in the general population. The report also highlights that in 2021, the national prison system employed 318 nurses, amounting to 27.9 nurses per 1,000 prisoners, significantly higher than the 7.1 per 1,000 in the general population. Moreover, in 2019, there were 19 psychiatrists working in the prison system, or 1.7 psychiatrists per 1,000 prisoners, compared to just 0.1 per 1,000 in the general population.

    i
    15/02/2023
    / CNN Portugal

The main care provided in prison is pharmaceutical treatment, general medicine and psychiatric care. Specialized medicine and hospitalization are provided by public hospitals (National Health Service) and the São João de Deus Prison Hospital1. The medical team consists of nurses, general practitioners, psychiatrists, pharmacy technicians and pharmacists.
Prisoners held in Funchal prison can, since December 2021, access remote medical consultations.

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 72. ↩

Hospitals do not have units dedicated to prisoners. The latter are cared for within the services, under the supervision of prison officers.

Access to health care

Health care is free

yes

The prisoner may choose an external doctor. The costs are then at their own expense. This request must be addressed in writing to the warden of the establishment (article 60 of the Regulations).

A medical examination is performed upon admission

yes

A clinical assessment must be made within 24 hours of entering prison. A nurse collects the information necessary to open the medical file. A doctor is required to consult within a maximum of 72 hours (article 53 of the Regulations). This consultation includes screening for contagious and communicable diseases (article 61 of the Regulations).

A medical file is opened upon admission

yes

During the admission consultation, the nurse opens a medical file containing personal information on the state of health of the prisoner. The individual clinical file accompanies the prisoner during their prison journey, even in the event of a transfer. It is accessible in the event of their return to prison. The medical file can be dematerialized.

Prisoners can access health care units after

a written request

Medical examinations are carried out on a confidential basis

yes

Portuguese law ensures the confidentiality of medical interviews (article 32 of the Code for the enforcement of punishment). Persons having access to data relating to the health of the prisoner are bound by professional secrecy, even after the end of their duties (article 57 of the Regulations).
Observers report frequent non-compliance with confidentiality rules. Health workers appear not to be sensitized to this clause.

Access to care must be ensured in continuity and quality. The prisoner’s access to health care must be identical to that of any free citizen (article 32 of the Code for the enforcement of punishment).

  • The Portuguese League Against Cancer (Liga Portuguesa Contra o Cancro, LPCC) has launched an oral cancer screening campaign at the Carregueira prison. On its first day, 150 prisoners were attended to by dentists. The campaign aims to screen around 3,830 prisoners, both men and women, who are 40 years old or older, from 20 facilities nationwide.

    i
    13/02/2023
    / Justiça.gov.pt

Drugs are distributed by the nursing staff. Medication is prepared by pharmacists and/or pharmacy assistants. The prisoner takes their medication under the nurse’s supervision 1.

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 72. ↩

A hospital transfer is decided by the Directorate General of Prison Services (DGRSP). In the event of a medical emergency, the warden of the institution may decide, alone, on this transfer. The DGRSP must be notified as soon as possible (article 34 of the Code for the enforcement of punishment).

Physical health care

Infectious diseases are most prevalent in Portuguese prisons. As of December 2017, 2,017 prisoners were affected by HIV or hepatitis (B and C). Hepatitis C affects 58.3% of this group 1.

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 74. ↩

  • In 2020, the country’s prison population faced significant rates of HIV (3.9%), hepatitis C (8.5%), and hepatitis B (1.6%).

    i
    15/02/2023
    / Organisation mondiale de la santé

Hepatitis and AIDS care is provided by the National Health Service in the hospital units closest to the prison 1.

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 74. ↩

Preventative measures for epidemics and contagious diseases are implemented. The warden may, on the advice of the medical service, remove a contagious person.
Each prison develops and submits a plan for health promotion and disease prevention to the Directorate General. This plan focuses particularly reducing risk behaviour.
A doctor (or other qualified person) carries out regular inspections of prisons. Recommendations are submitted to the warden. These recommendations concern the food that is distributed, hygiene and cleanliness of the facility, sanitation, heating and ventilation. If the warden of the institution ignores the recommendations, the physician may refer the matter to the Directorate General (DGRSP) (article 37 of the Code for the enforcement of punishment).

  • The World Health Organisation’s report details that:

    • 11 prisoners, accounting for 14.5% of those diagnosed with tuberculosis in 2020, completed treatment.
    • 386 prisoners, representing 87.3% of the prison population diagnosed with HIV, are receiving treatment.
    • 81 prisoners, which is 8.5% of those diagnosed with hepatitis C, are being treated.
    i
    15/02/2023
    / Organisation mondiale de la santé

Free screening tests are offered periodically to prisoners (article 61 of the Regulations).

  • The World Health Organisation’s report states that condoms are distributed in all Portuguese prisons, but none of these facilities distribute syringes.

    i
    15/02/2023
    / Organisation mondiale de la santé

Mental health care

Persons suffering from mental disorders are detained in facilities within prisons or in psychiatric hospitals.
Since 1998, the São João de Deus Prison Hospital has had a psychiatry and mental health department. It provides clinical assistance, outpatient care and hospitalization of patients. The service has 18 beds for men and eight for women.
Santa Cruz do Bispo - Men Prison has a psychiatric ward with 73 individual cells, nine dormitories and a double cell for prisoners with mental disorders.

Prison wardens at Caxias Prison Hospital and in the psychiatric wing of the Santa Cruz do Bispo prison are trained to provide care for people with mental disorders.

  • The Portuguese Bar Association’s Human Rights Commission has observed that the Tires correctional facility struggles to meet the needs of prisoners suffering from mental disorders.

    i
    05/01/2023
    / Commission des droits de l’homme du barreau portugais (CDHOA)

Persons who are addicted to drugs can benefit from a substitution program (methadone, subutex, antagonists, suboxone).

  • Following the establishment of a care unit, the Lisbon prison now provides a support programme specifically designed for prisoners with addictions.

    i
    05/01/2023
    / Commission des droits de l’homme du barreau portugais (CDHOA)