Fieldset
Water, sanitation and rehabilitation

Lebanese logistician Ibrahim returns from Malawi, and a project that's helping to prevent disease amongst an often-neglected group of people: prisoners

Ibrahim Al Laham with MSF colleagues in Malawi

My destination was Malawi, where MSF operates in two of the country's central prisons.

When I got the call from the MSF office I had never heard of the country before, so I started researching.

I read about Malawi's history, climate and population. I also found some beautiful nature photos, and read an article that described the people as "peaceful and polite".

I googled to see what the food would be like. Then I thought to search for the types of diseases that are common in the country.

I found out that the only "scary" disease there was malaria. Malaria wasn't something I was too worried about personally, given that MSF staff take preventive medications on a daily basis when they're working in countries where the disease is present.

The prisoners’ desperation was immediately obvious to me while they were lining up to wait for the only meal they used to be offered a day.

Once I'd been offered the job, I didn't for a moment second-guess my decision to go. My friends and family were the ones who objected to the idea of me travelling abroad, especially given that I had a prestigious job in Lebanon.

However, my answer was that joining MSF was a passion of mine.

Arriving in Malawi

The flight lasted 12 hours – five hours from Beirut to Addis Ababa, followed by four hours of travel to Malawi. After the plane landed at Lilongwe, the capital city, the other passengers got off. Meanwhile we waited on board to be moved to an MSF area - my assignment in Malawi had begun...

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An example of overcrowding in Malawai's prison system, Chichiri Prison was originally build to house 800 prisoners but now holds over 2,000. In these conditions, the spread of disease is common.
An example of overcrowding in Malawai's prison system, Chichiri Prison was originally build to house 800 prisoners but now holds over 2,000. In these conditions, the spread of disease is common.

MSF operates in Maula prison in Lilongwe. The biggest prison in the country, it houses 2,650 prisoners who are serving short sentences.

We also operate in Chichiri prison in the southern city of Blantyre, which holds a further 2,000 prisoners. Commuting between the two prisons required a five-hour drive or a half-hour trip by plane.   

MSF’s medical teams are composed of four employees in each prison. As a neglected group, prisoners have healthcare needs that have not been met, and our objective is to address this.

As I watched them lining up for the only meal they would be offered that a day, the prisoners’ desperation became immediately obvious to me. The food was a plate of maize meal, and sometimes, beans or vegetables. Proteins were almost entirely absent from their diet.

Water, sanitation and rehabilitation

We started working on improving the water and sanitation conditions in prisons, which is, in fact, a serious problem in Malawi.

Water is not available in jail, and sanitary services are cut off. As you can imagine, this has real impacts on hygeine, which in turn impacts people's health. So MSF has agreed with the authorities on working inside the prison, equipping the prison's toilets and extending water pipes so they would reach inside.

This gesture, albeit simple, used to put a smile on their faces and this was what made me friends with them.

The terms of the cooperation were that MSF provided primary materials and necessary training in order for the prison administration to put together a workforce. This was instead of bringing workers in from outside the prison, and despite many prisoners not possessing practical experience in plumbing or sanitation.

My role was to train the prisoners chosen to help MSF with the prison’s refurbishment.

Prisoners of different backgrounds were chosen by the administration, based on their sentences – especially those who would soon be released, those with good conduct and those who were quick learners.

Construction

We planned to build five complete sanitation blocks, including a total of 60 toilets, 60 showers, four laundry sections and 60 cesspools. This meant there would be one toilet to every 50 prisoners, as per the recommendations of the International Committee of the Red Cross (ICRC).

As well as building the sanitation blocks, we also refurbished the sanitary network reserved for the women's toilets, including the extension of over 850 pipes in all the toilets of the detainees’ sections.

The air quality in these areas was also improved to fight the spread of infections, including tuberculosis (TB). This also decreased the temperature and helped to limit bad smells.

A simple gesture

I think it's natural for someone starting work in a prison for the first time to have a few preconceived ideas about it.  But that really changed for me as I got to know the prisoners I was working with.

I used to bring food to the prisoners, as a means of support from MSF. This gesture, albeit simple, used to put a smile on their faces and this was what made us friends.

The prisoners loved MSF immensely.  Both they and the guards said that MSF had helped to change their lives completely.

I have to say that MSF has changed my life too.

Despite all the hard work, my experience in Malawi has not drained all my energies… I would like to go on a new assignment with MSF at the earliest opportunity.