By Stephen Kalin
DAMIETTA, Egypt (Reuters) - Muslim Brotherhood lawmaker Mohammad al-Falahgi was arrested on terror charges in 2013 and held in prison, but never convicted. Earlier this year, after pleading for medical help, he died "handcuffed to the hospital bed," according to his son Osama.
Falahgi's family believes his death was deliberate, a way for the Egyptian state to deal with a prisoner it wanted to get rid of. Egyptian and international human rights groups, including Amnesty International and Human Rights Watch, say cases like Falahgi's amount to a little-noticed abuse of human rights under President Abdel Fattah al-Sisi. They have recorded more than 100 cases of what they call death "by neglect" in prisons over the past two years.
Human Rights Watch says Egypt is obliged under international law to give detainees the same health care that is available to ordinary citizens. As well, Egypt's constitution forbids treatment of prisoners that "contradicts human dignity or puts (their) health at risk."
Despite this, the rights group said in emailed comments, "prison authorities routinely refuse life-saving care to detainees and appear to be under little or no pressure or oversight from higher officials in the Interior Ministry or Sisi's administration."
Over the past three months, Reuters has spoken to the families and lawyers of five prisoners who said they saw a pattern of neglect with political detainees. Three of their accounts, supported by documents, are detailed here.
No officials have been prosecuted for the death of Falahgi or any of the other alleged "deaths by neglect." Khalid Naguib, director of Azhar Hospital where Falahgi died, said he had received proper treatment.
Spokesmen for Sisi and Egypt's prime minister declined to comment and referred Reuters to the Interior Ministry, which did not respond to a detailed request.
An Interior Ministry source, who declined to be named, rejected the charges. Egyptian prisons have "very good medical care and hospitals and highly qualified doctors," the person said. "Upon entering prison, prisoners are given medical tests ... If needed, they are sent to the prison hospital."
The ministry source said the public prosecutor decides when to move prisoners. A judicial source in the public prosecutor's office, who also declined to be named, said prisoner requests for treatment at external hospitals are "studied and taken seriously." If medical reports show a patient has recovered, they are moved back to their cell and their condition is tracked.
The claims come as Sisi is struggling to enforce security. The former military man overthrew Egypt's first freely elected president, Mohamed Mursi, in 2013, following massive street protests against Mursi's rule. Sisi declared Mursi's Muslim Brotherhood a terrorist organization, which the Brotherhood denies. Hundreds of Brotherhood supporters have been killed and thousands more arrested. Top leaders, including Mursi, have been sentenced to death.
Sisi has said his security crackdown would be accompanied by a campaign promoting religious tolerance. So far, though, much of the state's energy has been focused on crushing its opponents. Last month, Sisi approved a new anti-terrorism law which sets up special courts and shields security forces from legal ramifications of using force.
Prisoners' families, rights activists and Muslim Brotherhood officials say part of the crackdown is happening in prisons, which by some counts hold up to 40,000 political detainees and are getting more crowded by the day. They allege prison authorities routinely decline to hospitalize sick prisoners, refuse to send physicians to critical cases, and pressure doctors to write medical reports that make prisoners seem healthier than they are.
A Brotherhood spokesman said responsibility for the deaths rests with Sisi, his prime minister and interior minister as well as the prison authorities.
A CASE OF KIDNEY STONES
In a modest home in the Mediterranean port city of Damietta, Falahgi's family sat under a framed verse from the Koran as they recalled how plainclothes security agents grabbed their father from outside his office and took him to a local police station.
Falahgi was taken to a central security camp. It was a few weeks after Mursi's ouster. His wife, Umm Ammar – a pious woman whose clothing revealed only her eyes, hands and feet - said Falahgi was held in solitary confinement on suspicion of forming a terrorist group. Those charges were later dropped but new ones raised, she said. On Jan. 10, 2014, the former Education Ministry employee was moved to Gamasa high-security prison, west of Damietta.
According to Umm Ammar, Falahgi suffered from diabetes and liver cirrhosis before his detention. When she began visiting him, he told her 20 inmates were surviving on food portions fit for only two men. The Interior Ministry did not respond to requests for comment on that claim.
In late 2014, Falahgi started having trouble urinating. Test results on blood and urine samples smuggled out of jail at the time showed high levels of uric acid, which can form kidney stones. In the subsequent months, his health slipped further. His wife says he lost weight, looked jaundiced and complained of severe abdominal pain. She said he was taken to hospital five times between March and May 2015 but never given adequate treatment, despite doctors' advice. Medical reports from that period seen by Reuters show a deterioration of Falahgi's kidney and liver functions.
Doctors detained alongside Falahgi repeatedly pressed prison officials to transfer him to a hospital, said Umm Ammar. On March 9, 2015, officials took him to a specialized hospital in Damietta. Within hours he was moved to a police station, where his wife said she visited him, before being sent back to prison four days later. His health worsened and on April 8 he was moved to the specialized hospital for X-rays. Thirty minutes later – after he was told he had stones in the left kidney and inflammation in the right – he was back in detention, according to Umm Ammar.
She showed a reporter a blood analysis dated May 7 showing levels of enzymes and bilirubin up to eight times the normal range, which two medical professionals, consulted by Reuters, said was abnormal and reflected less than optimal liver function.
But when Falaghi was moved to the hospital five days later, Umm Ammar said doctors wrote a report indicating his condition was stable. During another visit on May 19, doctors recommended he be hospitalized, but security officers returned him to prison, she said. Reuters could not independently verify these claims.
"He told me he couldn't raise his arm or leg," said Umm Ammar.
On May 20, Falahgi called his wife from Azhar Hospital in Damietta, she said; a security officer there had told him the hospital did not want to accept him. Tests showed he had liver and kidney failure, she said. "The doctor demanded he be hospitalized and he finally was for four days. He died on the fifth day." Falahgi would have been 59 in August.
Naguib, director of the hospital where Falahgi died, said the only treatment the hospital could have given Falahgi would have been to perform a kidney transplant, which he said his facility was not equipped for and involves a long waiting list.
"A BUCKET OF BLOOD"
Falahgi is not the only Brotherhood supporter who family and colleagues believe died of neglect.
Tarek Ghandour, a prominent doctor and a Mursi supporter, received a five-year sentence in 2014 for protesting without a permit – a charge he denied. His wife, Iman, a professor of immunology, petitioned for him to be released on medical grounds. She showed Reuters requests that she had written to Sisi, the public prosecutor and other top officials explaining that the 52-year-old required care for several ailments.
In November 2014, Ghandour was transferred to Shebeen al-Kom prison for tests at the nearby National Liver Institute, said Iman, who hoped the results would lead to his medical release.
Doctors there conducted surgery on Ghandour's enlarged oesophagus, according to his wife. But rather than recovering in the hospital, she said, Ghandour was immediately returned to prison. Days later, he began vomiting blood when a stitch opened, but had to wait nearly six hours – first in prison and then at a university hospital – before seeing a doctor, Iman said. "I have bled a bucket of blood," his son Ziad recalled him saying.
Ghandour bled to death following another operation at the Liver Institute the following day, said Iman, adding that the procedure had been conducted hastily. "This sort of case should be sent to the hospital immediately," she said. "When you leave him three hours in prison, three hours at the university hospital ... he had to die. They killed him."
The Interior Ministry did not respond to a request for comment on the case. Ahmed El-Shaarawy, head of the Liver Institute, said Ghandour had received the best possible care and rejected claims that the security apparatus had delayed or restricted treatment.
He confirmed that Ghandour had died there after losing eight bags of blood. But he said doctors at the institute had not performed surgery on Ghandour's oesophagus days before his death. Ghandour's "uncontrollable bleeding" resulted primarily from end-stage liver disease, he said.
Moawad El Khouly, president of Menoufia University where Ghandour was hospitalized, said he had suffered from accumulated health problems and arrived in critical condition but received proper treatment. "The patient's family could have a different opinion," said Khouly. "But the specialized doctor is the technical authority who decides."
Mohamed Elmessiry, Egypt Researcher at Amnesty International, said Amnesty is aware of at least 124 deaths in custody since the beginning of 2014, most of them "because of poor detention conditions" such as overcrowding, people who were not transferred to hospital, or people denied treatment for chronic diseases.
The person at the prosecutor's office said Amnesty's claims were groundless. The prosecutor's office conducts surprise inspections of prisons and police stations to guard against overcrowding and mistreatment, the source said.
SENT BACK TO PRISON
In the Suez Canal city of Ismailia, Mahmoud Abdel Hadi was a senior official in the state electricity company. At around 3 am on Oct. 12, 2013, police raided his home, according to relatives. They accused the 58-year-old of distributing pro-Islamist pamphlets in the wake of Mursi's ouster, which his family denied.
Abdel Hadi was taken to the city's Future Prison with no legal process such as registration at a police station, said his son Amr and daughter Asma. They worried because he had a weak heart and had undergone open-heart surgery twice. Abdel Hadi shared a cell with about 50 people, some of whom smoked. He slept on the ground.
He was examined by a prison doctor a week later. Ten days after that he was sent to the public hospital in Ismailia and seen by a doctor, who sent him to intensive care. "We did not get ... reports," said Asma. "We learned it from the doctors and the hospital. Nobody permitted us to even make a copy of the reports or take pictures with our phones."
A senior official at the Ismailia hospital and a local health ministry official declined to comment.
Asma and Amr showed Reuters medical release requests the family had sent to judicial and security officials, including the interior minister, at least six times between October 2013 and March 2014. They said they received no response.
On Nov. 19, 2013, Abdel Hadi had a heart attack in intensive care, slipped into a coma and then had a second heart attack the same day, according to his children. On Dec. 15, an X-ray showed water in his lungs. He was sent back to prison, his family said.
In February, Abdel Hadi developed a fever. During her last prison visit in March, Asma said, her father told her that fellow detainees had pressured the authorities to bring a doctor to treat him the night before. Instead, she said, prison guards pushed a nurse to issue a report reflecting good health. Reuters was unable to independently verify this version of events.
The Interior Ministry did not respond to a request for comment. The source at the public prosecutor's office did not comment on Abdel Hadi's case but said that when a request for medical treatment is made, the prosecutor orders an examination. "If needed, he is moved to an external hospital in coordination with the prison authorities."
Moments after Asma left her father's cell, Abdel Hadi lost consciousness and was sent to the hospital, other inmates told her later. She learned the next morning that he had died.
"I insisted on seeing my father," she said. "He was already in the fridge."
(Additional reporting by Mostafa Hashem, Ahmed Mohamed Hassan and Haitham Ahmed; Editing by Michael Georgy, Simon Robinson and Sara Ledwith)