Physicians for Human Rights Israel, Tel Aviv, Israel.
School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel.
Harm Reduct J. 2020 Oct 19;17(1):79. doi: 10.1186/s12954-020-00430-y.
The article discusses and analyzes the changes that have taken place since 2016 in Israeli policy with regard to the treatment, diagnosis and detection of hepatitis C (HCV) in prison settings. The article finds indications of promising changes to official procedure, such as the statement by authorities that they plan to begin screening new inmates for HCV, and the increase in the number of inmates provided antiviral drugs. These measures, however, only came about after a prolonged campaign and legal battle by human rights organizations, patient advocacy groups and the medical community. Despite these encouraging changes, it appears that a significant portion of inmates in need of treatment are still not getting it due both to bureaucratic delays and to inmates' reluctance. In addition, in the absence of a suitable screening program, the extant figures of morbidity-high in themselves-may reflect underdiagnosis. The flaws in the policymaking process and in its implementation may be attributed, at least in part, to the fact that the prison healthcare system is under the aegis of the Israel Prison Service and not that of a medical body. This reality places the medical staff in prisons in a state of dual loyalty, and also means the prison healthcare system is excluded from national health plans and major sources of budgeting, leaving it without sufficient means to provide the necessary level of care. These problems plague the prison healthcare system in general and are not limited to its handling of HCV. These challenges are not unique to Israel, and many other Western countries must also face the obstacles that are the result of prison healthcare services being subject to the authority of the correctional establishment. As this test case demonstrates, extended active involvement by civil organizations and the medical community are essential to promoting and ensuring inmates' right to health.
本文讨论和分析了自 2016 年以来，以色列在监狱环境中对丙型肝炎（HCV）的治疗、诊断和检测政策所发生的变化。文章发现，官方程序有一些令人鼓舞的变化迹象，例如当局表示计划开始对新囚犯进行 HCV 筛查，以及为更多囚犯提供抗病毒药物。然而，这些措施只是在人权组织、患者权益团体和医学界经过长期的运动和法律斗争之后才出现的。尽管这些变化令人鼓舞，但由于官僚主义的拖延和囚犯的不情愿，似乎仍有相当一部分需要治疗的囚犯无法得到治疗。此外，由于缺乏适当的筛查计划，现有的发病率数据——本身就很高——可能反映了漏诊的情况。决策过程及其执行中的缺陷至少部分归因于这样一个事实，即监狱医疗保健系统由以色列监狱管理局而不是医疗机构管理。这种现实使监狱中的医务人员处于双重忠诚的状态，也意味着监狱医疗保健系统被排除在国家卫生计划和主要预算来源之外，使其缺乏提供必要护理水平的足够手段。这些问题普遍存在于监狱医疗保健系统中，不仅限于其对 HCV 的处理。这些挑战并非以色列所独有，许多其他西方国家也必须面对由于监狱医疗服务受制于惩教机构而产生的障碍。正如这个案例所表明的，民间组织和医学界的广泛积极参与，对于促进和确保囚犯的健康权利至关重要。
