Equal on Paper, Unequal in Practice: Health Inequities Behind Bars in Lebanon
Yasmine Fakhry, Faculty Member and Senior Fellow, Institute for Migration Studies, School of Arts and Sciences
When a woman enters a Lebanese prison, she is registered, screened, and assigned a medical file. On paper, the system works. There are procedures. There are protocols. There is, at least formally, access to care. Yet a few weeks into detention, that promise often begins to fade—not through a single dramatic failure, but through a series of smaller gaps: a delayed consultation, an unavailable specialist, or a health need that falls outside what the system is designed to provide. If she needs a gynecologist, she may have to wait or rely on an NGO to arrange one. If she is pregnant, her nutritional needs may not be systematically addressed. If she is a migrant or refugee who does not speak Arabic fluently, navigating services can become an additional challenge. If she lives with a disability, her daily needs may depend less on institutional support than on the assistance of fellow detainees.
These experiences reveal a deeper problem within prison health systems in Lebanon. The issue is not simply whether health services exist, but whether they are designed to recognize and respond to the different needs of the populations they serve. The gap between formal access and lived experience highlights a tension at the heart of prison healthcare: a system built around equal treatment may still produce unequal outcomes.
Health care in Lebanese prisons is largely organized around standardized procedures. Upon entry, detainees undergo health screenings and are integrated into a medical system intended to apply uniformly to everyone. This approach reflects international principles such as the World Health Organization’s concept of equivalence of care, which holds that people in detention should receive healthcare comparable to that available in the broader community. Yet equality in design does not necessarily translate into equality in practice when it comes to fulfillment of the right to health.
As one official explained, screening protocols apply to all detainees without specific adaptations for women or other groups with distinct needs. While this may appear fair, it overlooks a fundamental reality: prisoners do not enter detention with equal health profiles, vulnerabilities, or healthcare requirements. International human rights standards emphasize that healthcare must not only be available, but also accessible, acceptable, and appropriate. A system that treats everyone identically can therefore generate what might be called procedural equality but lived inequality.
For women in prison, the consequences are particularly visible. Interviews with service providers indicate that access to a female gynecologist—an essential service for many detainees—is often facilitated through NGO intervention rather than systematically guaranteed within the prison health system itself. Similarly, nutritional support for pregnant women and new mothers is frequently provided through external organizations when resources allow. These arrangements are not isolated exceptions. Rather, they reflect a broader pattern in which gender-specific healthcare needs, despite being recognized in international frameworks such as the Bangkok Rules, remain insufficiently embedded within routine prison healthcare provision. Instead, they are addressed on a case-by-case basis, often depending on the presence and capacity of external actors.
Persons with disabilities face similar challenges. While immediate needs may sometimes be addressed through the provision of wheelchairs, crutches, or other assistive devices, there is little evidence of systematic accommodation or long-term planning. Navigating crowded detention facilities with limited mobility can become a daily struggle when infrastructure is not adapted and support remains inconsistent. Under the Convention on the Rights of Persons with Disabilities, states are required to ensure accessibility and equal access to healthcare, including within detention settings. Yet disability often remains largely invisible within institutional planning, addressed only when specific problems arise rather than incorporated into system design from the outset.
For migrants and refugees, detention can compound vulnerabilities that already existed prior to incarceration. Although their experiences are less explicitly documented in current interviews, the structure of the system itself suggests potential barriers. Accessing healthcare often requires navigating procedures, communicating effectively with staff, and understanding available services. Language barriers, legal precarity, and limited social support can make these processes more difficult. International human rights law is clear that healthcare must be provided without discrimination based on nationality or legal status. Nevertheless, standardized systems frequently fail to account for the distinct challenges faced by displaced populations. Their relative absence from institutional responses is itself telling.
Across all of these experiences, a common pattern emerges: prison healthcare in Lebanon relies heavily on external intervention. NGOs play a central role in filling gaps, whether by arranging specialist consultations, providing medications, supporting mental health needs, or supplying nutritional assistance. Their contributions are often indispensable. Yet their prominence also reveals a structural weakness within the system itself.
When access to care depends on the presence of external organizations, healthcare shifts from being a guaranteed right to something that must be secured through intervention. Care becomes contingent on funding cycles, project priorities, and organizational capacity. Without these actors, many detainees would simply go without services that are essential to their health and well-being. The result is not the absence of care, but rather a fragmented landscape in which support is negotiated, supplemented, and unevenly distributed.
The challenge, therefore, is not only to expand services but also to rethink how prison healthcare is conceptualized and delivered. A system that treats everyone the same may appear neutral, but neutrality can mask inequality when it fails to recognize difference. Women, persons with disabilities, migrants, and refugees do not require identical forms of care; they require care that responds to their specific circumstances and needs. International standards, from WHO guidelines to the Bangkok Rules and the Convention on the Rights of Persons with Disabilities, increasingly recognize that equitable healthcare requires more than formal equality. It requires responsiveness, inclusion, and recognition.
In Lebanese prisons, the promise of equal access to healthcare exists. Yet equality on paper is not enough. Without a shift toward more inclusive, needs-based, and rights-driven approaches, prison health systems risk leaving the most vulnerable behind. The central question is no longer whether care exists, but who receives it consistently, who receives it conditionally, and whose needs remain unseen within the structures designed to protect them.
This blog is part of the dissemination plan of the postdoctoral early career fellowship of Dr. Yasmine Fakhry with the Arab Council for the Social Sciences. The research is implemented in partnership with the Institute for Migration Studies at the Lebanese American University.