Sofia, Vienna, Skopje, January 2005. On 29 and 30 June representatives of the International Helsinki Federation for Human Rights (IHF) conducted a mission on monitoring places of detention in the Republic of Macedonia. The mission was the second one under the project "Preventing Torture in the Closed Institutions of Central and Eastern Europe", financed by the European Commission. The IHF delegation included representatives from:

• Bulgarian Helsinki Committee
• Greek Helsinki Monitor
• Helsinki Committee for Human Rights in the Republic of Macedonia
• Helsinki Committee for Human Rights in Serbia
• Helsinki Foundation for Human Rights in Poland
• Hungarian Helsinki Committee
• International Helsinki Federation for Human Rights
• Moscow Helsinki Group

  The mission monitored the respect for the human rights of the persons placed involuntarily in state institutions. These included institutions for confinement of persons sentenced for criminal offences or detained on a suspicion for having committed an offence under the authority of the Ministry of Justice; institutions for involuntary psychiatric hospitalization for the purposes of active treatment of mentally ill under the authority of the Ministry of Health, and institutions for involuntary placement of persons with severe developmental disabilities for the purposes of social care under the authority of the Ministry of Labor and Social Policy.

  With few exceptions the Macedonian authorities were cooperative and allowed the IHF delegation to conduct a thorough monitoring of ten facilities: seven under the authority of the Ministry of Justice, two under the authority of the Ministry of Health and one under the authority of the Ministry of Labor and Social Policy. The delegation spoke with the administration, observed the premises and checked documentation. It was able to conduct private interviews with inmates. At the end, the delegation made a number of recommendations on all types of facilities.

  With regard to the Ministry of Justice facilities the delegation observed that the Macedonian prison system does not allow for diversified forms of custody in all prisons. Some efforts were under way in that regard although in those prisons where individualized placement was made possible, it did not always allow for common activities during the day and resulted to forms of custody akin to solitary confinement. In the system as a whole, the engagement of the remand prisoners in meaningful activities during the day was a serious problem. In some facilities the delegation observed overcrowding. It found that holding prisoners for prolonged periods of time in the pre-trial units of the prisons of Bitola, Tetovo, Stip and Ohrid and in the disciplinary cells in these and in the other prisons amounted to inhuman and degrading treatment contrary to international standards. The cells were unheated, unhygienic and not sufficiently lit for reading. Inmates had no possibilities to communicate with other detainees; outside contacts were very limited and controlled; and correspondence was censored. Detainees were allowed to spend only one hour per day out of cells to walk in an isolated yard. In addition, they were subjected to pressure to confess while in pre-trial detention. A worrying finding was the excessive use of force by the security guards in the Idrizovo prison. It was not for the first time the IHF observed such practices in that prison.

  The use of solitary confinement as a disciplinary punishment of juveniles also ran against international standards.

  Medical services in the institutions of the Ministry of Justice were not integrated with the national health system as required by the international standards. In some prisons the newly admitted prisoners were not examined immediately by a qualified doctor and their complaints were not registered upon admission.

  In several prisons the IHF delegation found problems with the right to privacy. On several occasions it observed arbitrary censorship of correspondence. This breach of confidentiality extended to the correspondence of the prisoners with their lawyers and with the European Court of Human Rights. The delegation expressed concerns about the permanent surveillance with cameras in the cells of the prisoners in the Stip prison.

  The delegation recommended that the prison in Tetovo should stop admitting women, as the present conditions there do not allow for appropriate segregation and protection. It also recommended that the prison system in Macedonia should make a concerted effort to recruiting women in the staff of all prisons.

  With regard to the psychiatric institutions the IHF delegation noted that the procedure for commitment of a person to an institution for active treatment falls short of the due process standards. It does not envisage a specific procedure for appearance in person before a court for determination of the legality of his/her detention shortly after the initial placement. The court hearings for involuntary hospitalization are not conducted according to the due process standards. The civil and the criminal commitment to a psychiatric institution for active treatment are not subject to ex officio judicial review periodically and in short periods of time. The commitment procedure also does not allow for a participation of a lawyer already from the moment of detention and an obligatory representation during the entire proceedings, including the appeals. Placement of persons under guardianship to psychiatric institutions for active treatment or to social care institutions for disabled persons does not take place through a court procedure in accordance with the due process standards.

  The treatment procedure in the institutions for active treatment in Macedonia does not envisage obtaining an informed consent from the involuntary patients, nor a system to evaluate the capacity of the patient to give an informed consent for treatment. The treatment methods in some institutions were nor sufficiently diversified and in some institutions were restricted to pharmacotherapy. In the Neuro-Psychiatric Hospital in Negorci the delegation found application of an unmodified electro-convulsive therapy (ECT), i.e. one without anesthesia and muscle relaxants. The use of means of restraint in the psychiatric institutions of Macedonia is not based on law and is not registered in a special register.

  The delegation was concerned with the living conditions of the patients in some institutions. They were unacceptable in the 5th and the 6th wards in the Demir Hisar Psychiatric Hospital and in the ward for patients with severe developmental disabilities in the Neuro-Psychiatric Hospital in Negorci.

  With regard to the special institution for mentally disabled persons in Demir Kapija, the delegation recommended that all residents in the Demir Kapija social care institution and especially those in the "Health" Ward should be offered meaningful activities and rehabilitation programs. It also urged the Macedonian government to reconsider the capacity and the location of that institution and, if there is a need for such institutions at all, to establish them more evenly on the territory of Macedonia.