Egyptian authorities should immediately provide appropriate health care to the imprisoned journalist Hisham Gaafar, whose health, including his eyesight, is deteriorating in detention, Human Rights Watch said today. If prison authorities are unable to provide him necessary health care, they should allow him to seek care in private health facilities.

The Interior Ministry’s National Security Agency arrested Gaafar, director of the Mada Foundation for Media Development, a private media company, at his office in October 2015. Prosecutors have ordered Gaafar detained pending investigation on charges that include membership in the Muslim Brotherhood and illegally receiving foreign funds for his foundation, his lawyers told Human Rights Watch.

“Egypt’s Interior Ministry has shown contempt for Hisham Gaafar’s health and well-being,” said Sarah Leah Whitson, Middle East director at Human Rights Watch. “The fact that the Interior Ministry refuses to provide him his rightful care is a sad testament to Egyptian authorities’ disregard for detainees’ most basic rights.”

Gaafar, 53, has an eye condition – optic nerve atrophy – that requires ongoing specialist care or he may risk losing his sight altogether. He also suffers from a years-long prostate enlargement condition and risks complications if he does not receive the proper treatment. His eyesight is deteriorating and his health has worsened during his time in detention, in poor conditions, his family said.

Immediately following his arrest, police took Gaafar to his home, where officers seized his personal publications, work papers, computers, and phones, including those belonging to his wife and children. They detained his family inside the home for 17 hours. Security officers confiscated all his medical documents and reports and have not returned them to his family, despite their requests.

National Security officers then took Gaafar to an undisclosed location and held him for two days without access to his family or lawyers. His family heard of his whereabouts when a lawyer saw him by coincidence in the Supreme State Security Prosecution office in Cairo. Prosecutors have kept him in pretrial detention since then.

Under Egyptian law, prosecutors have broad power to hold those suspected of committing major offenses, including political and national security crimes, in pretrial detention for up to five months without regular judicial review, and judges can extend the detention for up to two years without requiring any substantive justification from prosecutors.

A judge should immediately review the necessity and legality of Gaafar’s detention and either send him to trial without further delays or release him, Human Rights Watch said.

During Gaafar’s time in detention, most of it spent in the maximum security Scorpion Prison in Cairo, the Interior Ministry’s Prisons Authority has not provided needed medicine but has intermittently allowed Gaafar to receive the eye vitamins and prostate medicine he required, after completely banning such supplies for the first two months of his detention. During those two months, his wife, Manar, told Human Right Watch, prison authorities kept Gaafar alone in a cell that, in his words, resembled a “tomb” without sunlight.

Later, they allowed his family very short and irregular visits, with no chance to verify whether he had received the medicine they had given to prison guards for him. Since March 2017, prison authorities have again denied him visits from relatives and his lawyer.

Before he was detained, Gaafar used special optic tools to read and glasses for everyday life. He also needed some assistance in his daily routine, his wife said. Prison authorities allowed his wife to deliver the glasses several months after his detention, but when they reached him, they were broken. The way the glasses were broken suggested it had been deliberate, his wife said. She delivered new ones, but he has not had a new eye examination. His wife said that he recently told her he was not seeing as well as before, even with the glasses, suggesting his eyesight may have deteriorated.

Gaafar has had optic nerve atrophy in both eyes since he was a teenager, according to his wife. Medical documents and reports from 2012, which she provided to Human Rights Watch after she retrieved them from a hospital, stated that at the time he had only 10 percent of his vision remaining in his left eye. Optic nerve atrophy has no cure, but it can be slowed by exposure to sunlight, medicine, and a healthy diet, his wife said doctors had told them. These are not available in adequate amounts to inmates at Scorpion Prison and many other Egyptian detention facilities.

A Human Rights Watch report on Scorpion Prison, published in 2016, documented cruel and inhuman treatment by officers of the Interior Ministry’s Prisons Authority that probably amounted to torture, including preventing food and medicine deliveries and other interference in medical care that may have contributed to prisoners’ deaths.

Gaafar’s wife said he appeared weak and to have lost significant weight during her March 2017 visit. She said she saw bite marks all over his body, which he said were from insects that had infested his cell due to a sewage leak. He told her he had suffered pain for weeks because he was sleeping on the concrete floor without a mattress. Human Rights Watch previously documented that Scorpion Prison authorities deny inmates a wide variety of basic necessities for hygiene and comfort, including beds, pillows, and mattresses.

In late February 2016, after a public outcry and growing criticism from the Journalists’ Syndicate, human rights organizations, and public figures, the authorities transferred Gaafar to the Tora Prison Hospital after he began suffering from urinary retention – the inability to fully empty his bladder. Prison authorities then transferred him to al-Manial University Hospital, which is affiliated with Cairo University. Doctors who examined him there on March 4, and again on March 10, 2016, asked prison officials to allow him to be kept at Cairo University hospitals to prepare for more tests, including diagnostic surgery on his enlarged prostate, the apparent cause of the urinary retention.

Gaafar spent five months at the prisoners’ ward at Qasr al-Aini Hospital, where ill inmates who are hospitalized are usually held, but the authorities repeatedly failed to give Gaafar timely permission to go for needed tests. Human Rights Watch has previously documentedthat prison authorities pressure hospitals not to admit inmates or to return them without necessary treatment.

Gaafar told his wife that he received very little medical care there. In August 2016, the authorities sent Gaafar back to Scorpion Prison before he had undergone the examinations that he was told he needed. Prison authorities and Cairo University hospitals have not allowed Gaafar’s family to read or obtain a copy of the medical reports issued during his detention, his wife said.

The family managed to obtain the hospital discharge report through unofficial means, however, and provided a copy to Human Rights Watch. The report contained no detailed information on any tests Gaafar may have undergone or treatment received but stated that he suffers from “mild prostate enlargement that needed no surgery.” The report did not state what caused the enlargement or whether it was benign or cancerous – a primary concern for the family.

A couple of days after returning to prison, Gaafar found blood in his urine, and officers transferred him again to Tora Prison Hospital. But the facilities there lack a urology specialist, his wife said, and the prison authorities have refused to arrange for Gaafar to be seen by one. He appeared before a court in August 2016 carrying a urinary catheter, his lawyers said.

His wife said that after filing several complaints, a National Security officer visited Gaafar in detention in November 2016, and told him, “don’t worry, we will treat you.” But Gaafar’s request to seek treatment in a private health facility was ignored.

One of his lawyers and his wife both told Human Rights Watch that prosecutors never allowed them to obtain a copy of the official charges against him or the rest of his case file. However, Hossam al-Sayed, another Mada Foundation journalist who was arrested with Gaafar on the same day, was released without bail in March 2016, said the lawyer Karim Abd al-Rady.

Under an amendment to the penal code decreed by President Abdel Fattah al-Sisi in September 2014, Gaafar could face a 25-year sentence if convicted of receiving foreign funds illegally.

Prisoners have the right to the highest attainable standard of physical and mental health guaranteed in the International Covenant on Economic, Social and Cultural Rights, which Egypt ratified in 1982.

The Committee Against Torture, the monitoring body of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment – ratified by Egypt in 1986 – has found that failure to provide adequate medical care can violate the treaty’s prohibition of cruel, inhuman, or degrading treatment.

“It is deeply concerning that Egypt’s judiciary has become complicit in human rights violations by cruelly detaining people like Gaafar for years without justification, exposing them to serious abuse and harm,” Whitson said.