Report on the Results of the Monitoring Visit to Dnipropetrovsk Multidisciplinary Hospital No. 4
On 22 December 2025, in accordance with the Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, taking into account the provisions of the UN Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules) and the decisions of the European Court of Human Rights, and on the basis of Article 24 of the Criminal Executive Code of Ukraine — “Visiting penal institutions”, a group of monitors from the Kharkiv Human Rights Protection Group and the NGO “Protection of Prisoners of Ukraine” carried out a follow-up visit to Dnipropetrovsk Multidisciplinary Hospital No. 4, a branch of the State Institution “Health Care Centre of the State Penitentiary Service of Ukraine” in the Dnipropetrovsk and Donetsk regions (hereinafter — the hospital, the institution, the facility).
A planned, unannounced visit took place. The previous visit occurred on 30 December 2024.
In preparation for the visit, the monitors used materials from appeals submitted by prisoners/convicted persons and their relatives, materials from previous reports, and a report by monitors from the National Preventive Mechanism (NPM) under the Commissioner for Human Rights of the Verkhovna Rada of Ukraine.
The visit was conducted as part of the project “Reducing Prisoners’ Suffering in the Context of the War in Ukraine”, funded by the government of Denmark in partnership with DIGNITY — The Danish Institute Against Torture.
The visit was carried out by the following monitors:
- Andriy Didenko — Assistant to the People's Deputy of Ukraine Yaroslav Yurchyshyn, programme coordinator of the Kharkiv Human Rights Protection Group, experienced in monitoring visits since 2014;
- Serhiy Zuykov — Assistant to the People's Deputy of Ukraine Kostiantyn Kasai, member of the Public Council under the Ministry of Justice of Ukraine, member of the public organisation “Protection of Prisoners of Ukraine”, with many years of experience in monitoring visits;
- Oleh Tsvilyi — member of the Public Council under the Ministry of Justice of Ukraine, head of the public organisation “Protection of Prisoners of Ukraine”, with extensive experience in monitoring visits, specialising in issues of torture and cruel, inhuman treatment.
During the monitoring visit, despite the presence of individual measures taken to improve the material and technical base of the medical unit (renovation of offices, replacement of furniture, equipping of the laboratory and X-ray room), systemic violations were established in the sphere of organisation and provision of medical care. In particular, improper medical record-keeping was recorded, as well as an absence of inpatient medical charts and patients’ informed voluntary consent, formal or incomplete recording and documentation of bodily injuries, and non-compliance with requirements for the organisation of treatment for persons with drug dependency, including the lack of substitution maintenance therapy and psychosocial support.
Furthermore, numerous violations of the conditions of detention and treatment in the hospital were identified, including failure to comply with living space standards, non-compliance of wards and specialised premises with the requirements of the State Building Norms (DBN) and international standards, the absence of proper conditions for persons with disabilities and persons with mental disorders, a shortage of medical personnel in certain specialities, limited access to diagnostic and telemedicine services, inadequate infectious and sanitary-hygienic provision, violations of fire safety requirements, and the hospital’s lack of necessary security and accessibility systems. The totality of the established violations indicates that the medical unit's activities do not meet the requirements of national legislation and international standards for the treatment of persons deprived of their liberty.
General Information
Head of Dnipropetrovsk Multidisciplinary Hospital No. 4, a branch of the State Institution “Health Care Centre of the State Penitentiary Service of Ukraine” in the Dnipropetrovsk and Donetsk regions — Bohdan I.I.
Dnipropetrovsk Multidisciplinary Hospital No. 4, a branch of the State Institution “Health Care Centre of the State Penitentiary Service of Ukraine” in the Dnipropetrovsk and Donetsk regions (hereinafter — DMH No. 4) has a capacity of 130 beds. It includes: a therapeutic department — 60 beds; a neurological department — 30 beds; a surgical department — 40 beds; an outpatient/polyclinic department (hereinafter — OPD) — 40 beds for prisoners, 20 of which are for patients with outpatient-controlled tuberculosis; a clinical diagnostic laboratory and a pharmacy.
The staffing level for doctors is 86.7%; for paramedical staff — 91.5%. The overall staffing level at the hospital is 89.0%.
According to information provided by hospital staff, the following positions are vacant: head of the therapeutic department — 1 staff unit; inpatient nurse / inpatient male nurse — 2 staff units; orthopaedic trauma surgeon — 0.5 staff unit; surgeon — 1.25 staff units; neurologist — 0.25 staff unit; inpatient nurse — 1 staff unit; ultrasound diagnostics physician of the OPD — 0.5 staff unit; feldsher (paramedic) — 1 staff unit; nurse / male nurse — 1 staff unit; infectious disease specialist of the infectious diseases office — 2 staff units; phthisiologist of the phthisiology office — 1 staff unit.
Over 11 months of 2025, in order to clarify diagnoses and determine further treatment tactics for patients (including for consultations with narrow specialists and additional diagnostic methods), 396 patients, including prisoners of war, were referred to the health care facilities of the Ministry of Health of Ukraine.
As part of auxiliary diagnostic methods, 84 X-rays were performed. Computed tomography, including intravenous contrast, was performed in 39 cases. Echocardiography (ECHO-CG) was conducted for 23 patients. Ultrasound examinations (USG) were carried out in 10 cases. Fibrocolonoscopy with biopsy was performed 10 times. Spirography was carried out in 4 cases, 2 of which included a salbutamol test. Electroencephalography (EEG) was performed 4 times. Elastography was performed in 5 cases.
Regarding consultations with narrow specialists, 36 visits were made to an oncologist, including consultations and chemotherapy. A cardiologist provided 18 consultations. Thoracic surgeon consultations were conducted in 15 cases. A urologist consulted 33 patients. Proctologist consultations were conducted in 4 cases. A traumatologist provided 26 consultations. A pulmonologist consulted 4 patients. Additionally, in 2 cases, a pelvic bone metastasis biopsy was performed.
For the provision of emergency medical care, 83 calls were made to emergency medical service teams at DMH No. 4.
The clinical diagnostic laboratory conducted 943 tests using the GeneXpert molecular-genetic diagnostic system. Of these, sputum analysis for TB/Rif was performed in 422 cases, blood analysis for HCV — in 303 cases, and blood analysis for HIV — in 218 cases.
Work of the Medical Advisory Commission over 11 months of 2025: cases considered by the MAC — 13; denied by the MAC — 2; died before referral of materials to court — 1; materials referred to court — 10; died during court consideration — 2; released by court order — 5; of which died within 7 days — 0; release denied by court — 3; of which died — 0; pending in court — 0.
The system is working on assessing the daily functioning of individuals. Over 10 months of 2025, 55 document packages were prepared and submitted for consideration by expert teams.
Positive Aspects
In the first quarter, renovation works were completed in the senior nurses’ office. In the clinical diagnostic laboratory, furniture was replaced in accordance with current standard requirements. The sanitary-hygienic room for medical personnel was renovated, and furniture was replaced in the medical facility’s treatment rooms.
Furniture for the storage of personal belongings and outerwear for personnel has been purchased. Stationery for medical record-keeping has been purchased in accordance with the requirements of current Ukrainian legislation.
Consumables for ensuring infection control are purchased on an ongoing basis. Comprehensive renovation works of the X-ray room in accordance with current DBN were completed with funds from the ICRC, and an X-ray machine was installed with funds from the Global Fund. Renovation works have begun in the phthisiology office of the OPD of DMH No. 4.
Violations of National and International Legislation Identified
During the monitoring visit, violations of national legislation requirements and non-compliance with international recommendations in the sphere of the treatment of prisoners were identified, which lead to the violation of the rights of convicted persons:
1. During the visit, the monitoring group established that for some patients receiving inpatient treatment in the hospital’s outpatient/polyclinic department, primary accounting document form No. 003/o, “Inpatient Medical Chart”, approved by Order of the Ministry of Health of Ukraine No. 110 of 14.02.2012, had not been initiated. All data regarding inpatient treatment and diagnostics, including examination results of the convicted person and the prescription sheet, must be entered into this form.
This is a violation of the requirements of paragraph 5 of Chapter 5 of Section II of the Procedure for the Organisation of Medical Care for Persons Sentenced to Imprisonment, approved by the Joint Order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine No. 1348/5/572 of 15.08.2014 (hereinafter — the Procedure for the Organisation of Medical Care).
2. In violation of the requirements of the Instructions for completing primary accounting document form No. 003-6/o, “Informed Voluntary Consent of the Patient to the Conduct of Diagnostics, Treatment, and the Performance of Surgery and Anaesthesia, and to the Presence or Participation of Participants in the Educational Process”, approved by Order of the Ministry of Health of Ukraine No. 110 of 14.02.2012, it was established that signed informed voluntary consent forms for diagnostics and treatment were absent for patients receiving inpatient treatment in the hospital’s outpatient/polyclinic department.
This may indicate the absence of voluntary consent from patients for the application of diagnostic, preventive, and treatment methods, which constitutes a violation of Article 43 of the Law of Ukraine “Fundamentals of Ukrainian Legislation on Health Care” and paragraph 47 of the recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT/Inf(93) 12-part).
3. During the visit, the monitoring group established that medical personnel do not ensure the proper recording and documentation of bodily injuries sustained by persons deprived of their liberty.
In accordance with paragraph 2.11 of Section II of the Procedure for Interaction between Health Care Facilities of the State Penitentiary Service of Ukraine and Health Care Facilities regarding the Provision of Medical Care to Persons Taken into Custody, approved by the Joint Order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine No. 239/5/104 of 10.02.2012 (hereinafter — the Procedure), in the event of detecting bodily injuries on a person taken into custody, the medical worker who discovers such injuries shall draw up a certificate in three copies, which must specify in detail: information (a written statement, oral or written explanation by the convicted person regarding the circumstances of receiving bodily injuries (date, time, place of occurrence, methods of inflicting injuries, information about the person(s) who, in the opinion of the convicted person, inflicted them), as well as other information regarding the receipt of bodily injuries); a comprehensive description of medical indicators characterising the health status of the convicted person, the nature of the injuries, their size and location; the medical worker's assessment based on the information provided by the convicted person and medical indicators, as well as the justification for their correlation.
The medical worker shall attach to the certificate the primary accounting document form No. 511/o, “Certificate of Recording Bodily Injuries”, approved by Order of the Ministry of Health of Ukraine No. 110 of 14.02.2012, registered with the Ministry of Justice of Ukraine on 28.04.2012 under No. 661/20974, and photographs of the convicted person’s existing bodily injuries. Two copies of the certificate and its attachments are to be included in the materials of the personal file and the outpatient medical card No. 025/o; the third copy is given personally to the convicted person who underwent the examination.
However, as established during the monitoring visit, in cases of discovering bodily injuries, medical personnel effectively only complete form No. 511/o without drawing up the certificate in three copies and without performing the full complex of actions provided for by the Procedure. This indicates a systemic violation of the requirements of paragraph 2.11 of Section II of the Procedure and improper organisation of the medical recording of bodily injuries.
4. In violation of the requirements of paragraph 2.11 of Section II of the Procedure and the Instructions for completing primary accounting document form No. 511/o, “Certificate of Recording Bodily Injuries”, medical workers do not properly complete the certificates.
In particular, in most cases, point 8 of the form, which provides for specifying the circumstances of receiving bodily injuries, is filled out formally, without specification, for example: “through one's own negligence”, which does not allow for identifying the actual circumstances of the event.
The absence of full documentation of the circumstances of injury and improper recording of bodily injuries does not correspond to paragraph 60 of the Committee's recommendations (CPT/Inf(93) 12-part), which states that medical services in places of detention can contribute to the prevention of violence against persons in custody through the systematic registration of bodily injuries, as well as, if necessary, through informing the relevant authorities.
5. The hospital has not organised the provision of substitution maintenance therapy (hereinafter — SMT) for persons with mental and behavioural disorders resulting from opioid use in accordance with the Procedure for Conducting Substitution Maintenance Therapy for Persons with Mental and Behavioural Disorders Resulting from Opioid Use, approved by Order of the Ministry of Health of Ukraine No. 200 of 27.03.2012.
Drug-dependent persons are not provided with social-psychological support, cognitive-behavioural therapy (CBT), relapse prevention, motivational interviewing, mutual aid groups, etc. Thus, these persons are deprived of the opportunity to receive SMT, which violates their right to choose methods of treatment in accordance with Article 38 of the Law of Ukraine “Fundamentals of Ukrainian Legislation on Health Care”.
At the same time, the Committee, in its report following the visit to Ukraine in 2023, notes that entering a penal institution is an opportunity to resolve drug-related problems, and therefore it is important that appropriate assistance is offered to all interested persons. Consequently, appropriate medical care must be available in all institutions. The assistance offered to such persons must be diverse; substitution therapy programmes for persons with drug dependency should be combined with genuine psychosocial and educational programmes for persons with opioid dependency who are unable to cease drug use.
Furthermore, access to SMT programmes in institutions should be easily accessible, and they should also be managed by prison doctors who have undergone special training on issues related to drug use (CPT/Inf(2024) 20, paragraph 86).
6. In violation of Part 1 of Article 115 of the Criminal Executive Code of Ukraine (hereinafter — CEC of Ukraine), as well as rule 13 of the UN Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules), it has been established that the requirements regarding the living space standard per convicted person in inpatient treatment conditions (not less than 5 m²) are violated in the hospital’s outpatient/polyclinic department.
Specifically, in ward No. 817, where 5 patients were housed, the area of the premises according to the living space measurement certificate is 14.0 m². Thus, the actual area per convicted person was 2.8 m². A similar violation was established in wards No. 819, 820, 821, 823, 824, 825.
At the same time, paragraph 13 of the Committee's Seventh General Report states that the problem of overcrowded cell-type premises leads to unhygienic conditions, a constant lack of privacy, overloading of medical services and the institution’s infrastructure, and provides grounds for the conclusion that the negative impact of overcrowding very often results in cruel, inhuman or degrading treatment or punishment (CPT/Inf(97) 10).
7. The hospital wards do not meet the requirements of clauses 8.3.2.4, 8.3.2.7, 8.3.2.11, and 8.3.5.1 of the State Building Norms of Ukraine V.2.2-10:2022 “Health Care Facilities”.
In particular, the insufficient area of the wards and the use of bunk beds do not ensure the placement of beds with the possibility of access from three sides, do not create proper conditions for use, and may pose a danger of falling during sleep or when descending from the upper tier. The wards lack furniture for the storage of patients’ personal belongings, in particular, wardrobes for clothes and bedside tables. Also, the wards are not equipped with shower cabins.
The ward premises are not provided with an adequate level of natural lighting, as the windows are located at a significant height, are of insufficient size, and have excessive grilles, as a result of which natural light practically does not penetrate into the premises. The premises are not provided with tanks for drinking water. The mechanical ventilation system does not function in the premises, and the bathrooms are not equipped with doors or sufficient partitions (from floor to ceiling) that would ensure the possibility of privacy.
Such conditions do not correspond to paragraph 53 of the Committee's recommendations (CPT/Inf(93)12-part) and rules 13, 14, 15, and 22.2 of the UN Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules).
8. In violation of the requirements of paragraph 7 of Chapter 2 of Section III of the Procedure for the Organisation of Medical Care, sick convicted persons are placed in ward-cells not on the basis of a confirmed diagnosis and the medical personnel’s decision on referral to a specialised department of the hospital, but by the decision of the institution’s personnel.
9. The hospital staff lacks a clinical psychologist position, which complicates the timely and effective provision of mental health care to convicted persons.
The Committee, in its report following the visit to Ukraine in 2023, recommends further strengthening the provision of psychological assistance in institutions, as well as developing the training and role of prison psychologists, especially in terms of therapeutic clinical work with convicted persons. In this context, efforts must be made to recruit clinically trained psychologists, who should be part of the medical team and, in their work, should not combine two different roles, i.e., risk assessment and therapeutic clinical work (CPT/Inf(2024) 20, paragraph 85).
10. The layout of the isolation ward for persons with mental disorders does not meet the requirements of paragraph 9 of the Rules for the Application of Physical Restraint and/or Isolation in the Provision of Psychiatric Care to Persons Suffering from Mental Disorders, approved by Order of the Ministry of Health of Ukraine No. 240 of 24.03.2016, registered with the Ministry of Justice of Ukraine on 15.04.2016 under No. 570/28700, as well as clause 8.3.4 of the State Building Norms of Ukraine V.2.2-10:2022 “Health Care Facilities”.
In particular, the premises are designed for the stay of more than one person (two beds), which does not align with the principles of isolation; the equipment elements have sharp corners, which creates a potential danger for patients; there is no supply-and-exhaust ventilation or a tank with boiled drinking water.
11. In violation of the Measures and Means for Preventing Infection During Patient Care, approved by Order of the Ministry of Health of Ukraine No. 1777 of 03.08.2020, the hospital is equipped with only one isolation ward for infectious patients, which makes it impossible to simultaneously place patients with dangerous infectious diseases separately from each other and from other prisoners.
12. In violation of the requirements of the Norms of Provision for Bedding, Special Clothing, and Special Footwear (inventory property) for Convicted Persons undergoing treatment in medical-preventive institutions, institutions with the status of medical ones, and in medical units at penal institutions and remand prisons, approved by Order of the Ministry of Justice of Ukraine No. 280/5 of 20.02.2012, convicted persons do not receive hospital property (hospital suit, bathrobe, and slippers). Convicted persons remain in the inpatient ward in their everyday clothes, sometimes — with their own bedding.
13. In violation of the requirements of the State Building Norms of Ukraine V.2.2-40:2018 “Inclusivity of Buildings and Structures. Basic Provisions”, conditions for accommodating persons with disabilities have not been created in the medical unit.
14. In violation of paragraph 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 of 02.03.2016 “On Approval of Licensing Conditions for Conducting Economic Activity in Medical Practice”, the medical unit lacks a conclusion confirming free access to the buildings and premises of the medical facility for persons with reduced mobility, the obtaining of which is mandatory.
15. In violation of the Procedure for Organising Medical Care at the Primary, Secondary (Specialised), and Tertiary (Highly Specialised) Levels Using Telemedicine, approved by Order of the Ministry of Health of Ukraine No. 681 of 19.10.2015, personnel of the medical unit are deprived of the ability to send requests for telemedicine consultations and receive professional assistance for providing medical services to convicted persons due to technical limitations.
16. In violation of the requirements of the List of Equipment for One Workplace of a Dentist and Dental Technician, approved by Order of the Ministry of Health of Ukraine No. 158 of 11.04.2005, the medical unit lacks a dental X-ray machine, which makes it impossible to conduct in-depth dental examinations of convicted persons and does not ensure the timely provision of proper dental care.
17. In violation of the requirements of the Standards of Medical Care for HCV in Adults, approved by Order of the Ministry of Health of Ukraine No. 1178 of 23.07.2025, not all persons (48 persons as of 19.12.2025) with suspected viral hepatitis C undergo PCR testing, due to which they do not receive the necessary treatment, which may lead to the deterioration of their health status and the spread of the specified infectious disease among convicted persons and those in custody.
18. In accordance with paragraph 3.19.1 of Section III of the Regulation on the Organisation of Bath and Laundry Services for Persons Held in Penal Institutions and Remand Prisons, approved by Order of the Ministry of Justice of Ukraine No. 849/5 of 08.06.2021 (hereinafter — the Regulation), sanitary processing involves washing convicted persons (persons taken into custody) in a bathhouse using soap and a washcloth, mandatory replacement of bedding and underwear, as well as disinfection (destruction of pathogenic microorganisms) and disinsection (destruction of insects and mites that are vectors of infectious diseases) of personal clothing and bedding (pillows, mattresses, blankets) in a disinfection chamber.
However, as established by the monitoring group, the disinfection chamber in the institution is not working, which makes proper sanitary processing of bedding and clothing impossible, increases the risk of the spread of infectious diseases among convicted persons and personnel, and contradicts established sanitary-hygienic norms.
19. In violation of the Fire Safety Rules in Ukraine, approved by Order of the Ministry of Internal Affairs of Ukraine No. 1417 of 30.12.2014 (hereinafter — the Rules), the hospital premises are not equipped with fire extinguishing and fire alarm systems.
20. In violation of Part 5 of Article 110 of the Criminal Executive Code of Ukraine, convicted persons while staying in the hospital ward are not provided with the right to use the global Internet network.
The lack of access to the Internet limits their ability to receive information, exercise the right to education, self-education, and maintain social ties, which contradicts paragraph 63 of the Committee's recommendations (CPT/Inf(93) 12-part).
Recommendations:
1. Take measures aimed at eliminating the identified human rights violations and preventing torture, other cruel, inhuman or degrading treatment or punishment at Dnipropetrovsk Multidisciplinary Hospital No. 4, a branch of the State Institution “Health Care Centre of the State Penitentiary Service of Ukraine” in the Dnipropetrovsk and Donetsk regions.
2. Ensure control over the proper maintenance of medical documentation in accordance with the Procedure for the Organisation of Medical Care for Persons Sentenced to Imprisonment, approved by the Joint Order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine No. 1348/5/572 of 15.08.2014, the Procedure for Interaction between Health Care Facilities of the State Penitentiary Service of Ukraine and Health Care Facilities regarding the Provision of Medical Care to Persons Taken into Custody, approved by the Joint Order of the Ministry of Justice of Ukraine and the Ministry of Health of Ukraine No. 239/5/104 of 10.02.2012, and other regulatory legal acts.
3. Provide the hospital staff with specialist doctors and medical personnel according to needs.
4. Ensure timely and proper recording of bodily injuries in convicted persons and persons in custody.
5. Ensure the maintenance of form No. 003/o, “Inpatient Medical Chart”, for all patients receiving inpatient treatment, in accordance with the requirements of the Procedure.
6. Ensure the obtaining of informed voluntary consent from patients for examinations and treatment in the prescribed form.
7. Ensure the possibility of receiving substitution maintenance therapy on the basis of a diagnosis of mental and behavioural disorders resulting from opioid use.
8. Ensure the placement of sick convicted persons in wards in accordance with the established diagnosis and the decisions of medical personnel, with the prevention of the institution’s personnel from interfering in medical decisions.
9. Ensure that the conditions of patients' stay in the hospital wards are brought into compliance with the requirements of DBN V.2.2-10:2022, CPT standards, and the UN Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules) by eliminating overcrowding, abandoning bunk beds, and ensuring adequate natural lighting, ventilation, sanitary privacy, drinking water supply, and equipping the wards with necessary sanitary-household equipment.
10. Ensure the accessibility of the institution’s buildings in accordance with the State Building Norms of Ukraine V.2.2-40:2018 “Inclusivity of Buildings and Structures. Basic Provisions”.
11. Fulfil the requirements of paragraph 37 of the Resolution of the Cabinet of Ministers of Ukraine No. 285 of 02.03.2016 “On Approval of Licensing Conditions for Conducting Economic Activity in Medical Practice”.
12. Ensure the proper operation of the telemedicine complex for doctors to make requests for telemedicine consultation.
13. Provide the medical unit with a dental X-ray machine and necessary equipment for conducting full-fledged dental examinations and treatment.
14. Ensure the equipment of the necessary number of isolation wards for infectious patients.
15. Ensure the equipment of an isolation ward for persons with mental and behavioural disorders in accordance with established requirements.
16. Provide all persons with suspected HCV with access to PCR testing in the shortest possible time and organise the necessary antiviral treatment for persons with a confirmed diagnosis.
17. Provide the hospital with hospital property (hospital suit, bathrobe, and slippers).
18. Ensure the operation of the disinfection chamber for proper sanitary processing of bedding and clothing of convicted persons.
19. Equip the hospital premises with fire extinguishing and fire alarm systems in accordance with the Fire Safety Rules in Ukraine.
20. Provide convicted persons with access to the global Internet network to exercise the right to information, education, and maintenance of social ties.