Cambodia: Tackling the root causes of scabies in prisons

Scabies is a major health problem in many parts of the world. Outbreaks occur where people live in confined areas with poor sanitation. Prisons are particularly vulnerable. Overcrowding, limited access to water and health care, misdiagnosis and shortage of drugs are all contributory factors.

One such outbreak was reported in Kampong Cham provincial prison in central Cambodia earlier this year. Out of a population of just over a thousand inmates, 30% were found to be infected. As one sufferer said, "We even scratch in our dreams." The ICRC, in collaboration with the prison authorities, were quick to respond.

Invisible to the naked eye, the mites that cause scabies spread through direct body contact and also via clothes and bedding. Crusted scabies, another clinical form of the disease, is also highly contagious.

Scabies outbreaks in prisons are relatively easily dealt with – it's simply a case of disinfecting clothing and bedding and the environment, as well as the detainees themselves. Once treatment is successfully completed, hygiene standards must be maintained to prevent further outbreaks. Educating both staff and inmates is also part of prevention.

A disinfection campaign

In March 2016, ICRC medical staff, together with prison staff and health workers from the General Department of Prisons, mounted a disinfection campaign in Kampong Cham prison. The ICRC provided steamers, medicines, benzyl benzoate lotion (for scabies treatment), detergent, clothing, soap and scrubbing brushes. Buildings were disinfected, clothing was steamed, cells were cleaned and the inmates treated.

The whole process took four days. Cell by cell, block by block, the detainees put their belongings in bags. They were given one bar of soap and were told to go to the showers wearing their bath towels and to wash thoroughly. After going to the treatment area, and having placed their towels and clothing in drums for steaming, they were given a clean set of clothes.

While the cells were being cleaned, the inmates were instructed on hygiene and prevention. The following day, after showering and receiving a second application of lotion for the scabies, they retrieved their clothes and returned to their cells.

A successful outcome

After the campaign at Kampong Cham prison, Dr Luca Falqui, the ICRC's detention doctor, and two ICRC medical officers met with Yun Pao, director of the prison. Yun Pao reported that the campaign had been a success, covering 95% of the prison population (the remaining 5% were female prisoners, among whom none was found to have scabies).

It was agreed that the local health authorities, together with local non-governmental organizations, would play a more active role in the prevention and control of scabies in the prison. The commitment of prison staff was decisive in achieving a successful outcome. The ICRC's work to improve the water situation in Kampong Cham prison was another contributing factor to the success of the campaign.

The ICRC health team left a stock of medication in the prison in the event of re-infections and for the treatment of newly arriving prisoners, and prison health workers were encouraged to continue screening for scabies.