Correctional health: Abuse prevention



These guidelines form the ethical framework for the treatment of detainees and inmates

These guidelines provide that doctors will not condone, partake in mental or physical torture of inmates. Doctors may also not supply others with the skills to carry out such actions.

Torture in the prison setting is the offence committed by a public official with the goal of inflicting severe physical or mental suffering. Torture can never be seen as in the public interest

Doctors must

  • maintain confidentiality
  • not use patient records for the means of interrogation
  • respect the wishes of hunger strikers’
  • avoid conflict-of-interest situations which could compromise the doctor-patient situation

Other relevant legislation includes the Constitution 1996, Correctional Act 111 of 1998, common law, ethical rules of the Health Professions Council

In prisons of international standard there should not be any prisoner abuse but the correctional health staff have the duty to be on guard for aberrant practices. Prison authorities would never condone these abuses but due to the size and complexities of prisons, such abuses may take place.


Torture is the deliberate, systematic or wanton infliction of psychical or mental suffering by one or more persons acting alone or on orders of authority to force another person to yield information, make concessions or for any other reason (declaration of Tokyo on Guidelines for physicians concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in relation to Detention and Imprisonment (1975).

The Constitution of the Republic of South Africa 1996 provides that prisoners, detainees and accused persons should be held in conditions of detention that are consistent with human dignity nad provided with medical care at state expense.

There are multiple methods of abuse (inmate-on-inmate or correctional staff-on-inmate) that theoretically can be practiced in prisons if there is not good control

Possible abuses include

  • Beatings; this can lead to bruising, abrasions and lacerations, tram-line bruises due to use of battons, wrist chaffing or ulceration due to chronic handcuff application
  • Telefon: the slapping of both ears simultaneously leading to tympanic eardrum rupture
  • Falanga which is the beating of the soles of feet leading to permanent disability in walking
  • Hanging suspended┬áleading to dislocations and injuries to nerves
  • Submarino asphyxia where the head is submerged in water till unconsciousness sets in
  • Dry submarino is asphyxia with a plastic bag till unconsciousness sets in
  • Electrical torture
  • Sexual humiliation and assault
  • Drug administration
  • Psychological assault such as food deprivation, water deprivation, isolation, continuous hyperstimulation by means of noise or lights, mock executions

Due to the ethical code of wardens and the ethical code of health care workers above abuses may never be condoned in prisons and need to be reported to higher authorities

Restraint techniques include

Arm holds are characterised by fingerprint marks on the medial aspects of arms. Usually caused by bending the arm behind the back  to apply hand cuffs

Chokeholds around the necks can lead to larynx fractures. This is when the arm is flexed around the neck resulting in airway compression.

The carotid sleeper hold can lead to sudden unconsciousness and is at post-mortem diagnosed by petichae of the conjunctiva and face. The one biceps is flexed around the neck and the other elbow is pressed against the carotid artery

Body holds can lead to asphyxia if lying prone and pressure is applied to the back. Simultaneous tying of ankles and wrists called hog-tying while lying prone can also lead to asphyxia and death

Very tight application of straight jackets can lead to asphyxia. Restraint belts or straps are very effective in restraining a person without harm in a chair or bed. Such “use of force” should be documented in a prison

Chemical or medicinal restraints or tranquilisation should be used as a last resort in the prison setting

Rubber bullet mark

Round bruises may indicate being shot by means of rubber bullets. Shots to the head at very short range may be fatal, but fortunately not always.

Non-fatal shot at torso

Tear gas and CN spray leads to blinking, lacrimation, runny nose, burning sensation of respiratory tract

Pepper spray has similar effects than the above but it can cause blistering. It can lead to deaths to persons in custody

Handcuffs can lead to neuropraxia if put on too tightly. The superficial radial nerve, median nerve and ulnar nerve can develop neuropraxia due to handcuffs.

Taser (Thomas A Swift Electrical Rifle) shoots out two dart-like electrodes which shocks the victim for 5 seconds leading them to fall and go into uncontrollable spasms



– Inmates may not be handcuffed to fixed objects such beds or poles

– Inmates may be handcuffed to a custody officer

– Pregnant inmates giving birth may not be handcuffed

– Pregnant inmates may not be handcuffed during antenatal examinations

– If handcuffs cause severe pain or affect health adversely a request by the medical officer can be lodged to have the handcuffs removed