THE RIGHT TO HEALTH IN PRISON: RESULTS OF A NATIONWIDE SURVEY AND REPORT 3.19 Surprisingly, more than half, 55 per cent (3,014), believe that they are not exposed to infectious diseases, including TB, HIV and skin diseases in prison. For those who felt that they were exposed to scabies, 28 per cent54 (352) cited direct contact with other prisoners as the main reason. 3.20 As indicated through the survey responses, infectious diseases including scabies, tuberculosis and HIV are the most prevalent illness and have major consequences on the health of prisoners. Discussion on the Common Diseases Reported by Prisoners Scabies 3.21 Scabies, a parasitic disease, is a major public health problem in many countries, but remains comparatively neglected.55 Scabies is a communicable disease and human beings are the only reservoir. Transmission occurs via direct body contact – in 95 per cent of cases – or via contaminated clothes, bedding, towels and others.56 Scabies is the most commonly reported health problem in prisons, largely due to poor conditions of confinement, limited access to clean clothing, overcrowding, and improper management of the disease. Scabies can cause significant disturbances to a prisoner’s daily activities, disrupt sleep patterns, and may promote bacterial skin infections. 3.22 With regard to the control of scabies, the Commission observed that there were no formal preventive measures in place, and the management of the disease depends largely on topical treatment; a treatment that might not be applied properly by prisoners and might be ineffective given the high transmission levels in prison. Although the use of the oral medication ivermectin has been shown to be effective and safe in the treatment of scabies, particularly in prisons,57 this medication is not available in Malaysian prisons. 3.23 The Commission recommends that, whenever possible, prisoners clothes, bedding, towels and other linens should be washed at 60°C (at least) or in boiling water, and ironed, or treated with permethrin in advance and kept safe, out of range of re-infection.58 Percentage based on total 1280 prisoners which reported that they had scabies during imprisonment. “Health Care in Detention Managing Scabies Outbreaks in Prison Settings”. Accessed via https://www.icrc.org/eng/assets/ files/publications/icrc-002-4241.pdf on 19/2/2016. 56 Ibid 57 Ibid 58 Ibid 54 55 40