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Behind the Bars of MACA Prison

May 25, 2004

With a 1,500-person capacity, MACA prison in Abidjan, Ivory Coast, is perpetually overcrowded, averaging 5,400 detainees. The horrendous conditions give rise to cholera epidemics and tuberculosis. In fact a cholera outbreak in 1997 first brought Médecins Sans Frontières to provide care in the prison. Currently MSF's medical team treats tuberculosis, the main cause of death during non-epidemic periods.

In the courtyard at the MACA, one might almost forget the muffled sounds of banging doors, the darkness, the men crammed in the cells. Every day the detainees in buildings A and B can spend the day outdoors-except for those being punished, who are confined to the "blindé" ("armored division"), the solitary confinement cells in building C, where the long-termers live. Under the trees, in the corners of the buildings, men talk endlessly, wait around, and get bored.



MACA prison, Ivory Coast - "An extremely fragile environment where a few days without water or health care can lead to a worst-case scenario." Photo © MSF

MSF has worked here since 1997, first in order to curb a cholera epidemic. In 2003 MSF had performed 19,000 consultations in the prison's infirmary, which includes six hospitalization rooms and an isolation area in case of disease outbreaks.

CHOLERA:
STILL A SERIOUS RISK


In the unhealthy and overcrowded prison environment, the cholera bacterium can spread with frightening speed. A large logistics project launched in 1997 upgraded the prison's drainage network to improve general hygiene in the cells and buildings. Despite this effort, cholera broke out again on September 19, 2002, with more than 600 cases registered. This most recent epidemic to date underscores the extreme weakness of this environment, where a couple days without water and access to health care can lead to a worst-case scenario.

MALNUTRITION AND FOOD INSUFFICIENCY


For the most vulnerable, the most destitute, those who do not have relatives in Abidjan or whose families have disowned them, the conditions for survival can diminish quickly, and malnutrition can also spread rapidly. Today, nearly 220 detainees benefit from a supplemental nutrition program established by MSF.

In the winter of 2002, an outbreak of beriberi (a condition caused by a lack of vitamin B1), affected more than 700 detainees. Since then, MSF has provided adjuvants - high vitamin and micro-nutrient mixture - to the prisoners' diets twice a week to fill in for the severe nutritional gaps.



MACA prison, Ivory Coast - "Malaria and infectious respiratory diseases require rapid treatment." Photo © MSF

DAILY VIOLENCE


Acts of violence are part of the daily routine in the prison. MSF teams, though, are able to work without major security concerns in this environment. Like anywhere else, malaria and infectious respiratory diseases require rapid treatment, and AIDS and tuberculosis - the main cause of death during non-epidemic periods - are spreading as well. MSF will become more involved in these activities, in collaboration with the government program.

 

Tags: Ivory Coast, Prison Conditions

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MSF midwife, Rebecca Ullman, talks about the difficult decisions she had to make in Ivory Coast.

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