Author: Dr. Elena van der Meer (PhD)

Subject of investigation: Odessa Medical Unit No. 21 and accomplices in “white coats”

When medicine ceases to heal and begins to torture, it becomes the most dangerous instrument of repression. In the case of Oleg Maltsev, we see how officials who took the Hippocratic oath became technical executors of an order to eliminate a scientist.

A hasty forgery: How the lawlessness began

The foundation for this tragedy was laid on September 12, 2024, when the academician, who was in a wheelchair after resuscitation, was detained by SBU officers. In order to legalize his detention in inhumane conditions, falsification was required.

• Exceeding authority: Emergency doctor Yelizaveta Churilova issued a “consultative opinion” stating that a person who uses a wheelchair could be held in a temporary detention center and a pre-trial detention center. This is a direct violation: her competence is limited to stabilizing the patient, not making long-term predictions for imprisonment.
• Bureaucratic forgery: Form No. 028/o was used illegally. Maltsev was not officially referred for consultation, and the “Helsi” electronic system, which contained all his diagnoses, was deliberately ignored.

Note: This is a classic case of “administrative resource.” SBU employees “urgently requested” the doctor, and she committed a crime in her official capacity. This is how medicine becomes an accomplice to the convoy.

Medical Department No. 21: Sterile Indifference

When Maltsev was finally placed in pretrial detention, Medical Department No. 21, headed by Tatyana Vasilyevna Kubali, became responsible for his “health.”

• Circular responsibility for vacations: When Maltsov was illegally thrown into solitary confinement for 10 days on September 26, 2024—without a shower, medicine, or proper food—the head of the medical unit, T. V. Kubaly, “suddenly” went on vacation for exactly those 10 days. This is not a coincidence; it is a tactic to avoid responsibility.
• Imitation of medicine: The entire “examination” in the medical unit consisted of a blood test. There is not a single specialist (cardiologist, pulmonologist, endocrinologist) on staff who is necessary for a person in such a condition. The necessary medications were provided by relatives, not the state.

Chronicle of deliberate destruction

The academician’s opponents ignored direct threats to his life through the medical department:

• Progressive apnea: Since the summer of 2025, the defense had been shouting about suffocation attacks, but the medical unit did not respond. Even when Judge Y. A. Krivokhizha personally observed an apnea attack via video link, the system remained blind.
• Physical trauma: Due to lack of care and frailty, Maltsev fell in his cell, lacerating the skin on his head.

Sabotage of examinations: Only in November 2025 — after more than a year of suffering — did they deign to send him to specialists.

Why is the medical unit management breaking the law while hiding behind it?

The management of medical unit No. 21 uses the “letter of the law” as a shield for lawlessness. They create the appearance of procedures (examination by a certain “specialist” Masaleva before solitary confinement) so that everything looks legal in the reports.

Their logic is simple:

• If the patient dies, “we acted in accordance with Churilova’s certificate.”
• If questions arise, “the boss was on vacation.”
• If there is no treatment, “we don’t have any specialists on staff.”

This is the use of formal rules to achieve an informal goal—to break or destroy the academic.

However, they forgot one thing: on December 15, 2025, the Odessa District Administrative Court recognized Maltsev’s placement in solitary confinement as unlawful. This is the first crack in their “legal” armor.

CASE FILE: Kubalya T. V. and institutional violence in Medical Unit No. 21. Author of the analysis: Dr. Elena van der Meer (PhD)

Subject: Violation of European prison rules and CPT (Committee for the Prevention of Torture) standards.

As a criminologist, I view this case not simply as medical negligence, but as a systemic violation of human rights, where an official deliberately shirks their responsibilities at critical moments.

Profile of the official: Kubalya T. V.

Head of Odessa Medical Unit No. 21. Her role in the case of Academician Maltsev is characterized by the creation of conditions that are classified in international law as “inhuman or degrading treatment.”

Tatyana Vasilyevna Kubalya—head of Odessa Medical Unit No. 21. Her role in the case of Academician Maltsev is characterized by the creation of conditions that are classified in international law as “inhuman or degrading treatment.”

• Tactical self-removal: When the disabled person in the first group was placed in solitary confinement for 10 days, Kubalya T.V. “went on vacation” for the same period.
• Refusal of specialized care: Under her leadership, the medical unit did not provide access to specialized specialists (pulmonologist, cardiologist, etc.) for more than a year, limiting itself to general blood tests.

Ignoring critical conditions: The medical unit under her leadership did not respond in any way to the patient’s progressive apnea since the summer of 2025.

AnaAnalysis of violations of European prison rules

The actions (and inaction) of Kubalya T. V. directly violate fundamental norms of international law:

• Violation of the principle of equivalence of medical care

According to Rule 40.1 of the European Prison Rules, medical care in prison must be equivalent to that provided in the community.

1. Medical Center No. 21 did not have the necessary specialists to treat Maltsev’s systemic diseases.
2. All medications were provided by relatives, not by the state institution.

• Illegal application of disciplinary measures to a sick person

Rule 43.2 (Nelson Mandela Rules) prohibits the imposition of disciplinary sanctions that may worsen the health of a prisoner.

1. The examination by “specialist” Masaleva before solitary confinement was a formality designed to legalize torture.
2. Placing a person in solitary confinement without the possibility of maintaining hygiene and taking medication was found by the court to be unlawful.

Medical destruction: Chronology of inaction

Key points where Kubalya T. V.’s inaction could have led to a fatal outcome:

• September 2024: Maltsev is placed in a detention center in a wheelchair, unable to care for himself. The medical unit does not create conditions for his detention.
• Summer 2025: Symptoms of progressive apnea appear. Complete lack of medical response from Emergency Medical Service No. 21.
• Incident in the cell: Maltsev falls and suffers a head injury due to lack of proper care and supervision.
• Delayed diagnosis: Only in November 2025, under enormous pressure, was Maltsev referred for consultation with specialists at the clinic.

Legal conclusion

The actions of the management of MCh No. 21, headed by Kubalya T. V., fall under the definition of torture by failure to provide assistance. Taking leave during the period of repression (placement in solitary confinement) is evidence of a conscious intention to avoid responsibility for knowingly illegal actions.

Summary for the international tribunal: “We are dealing with a doctor who uses his status not to save lives, but to cover up the crimes of the investigative authorities. This is a direct discrediting of the medical profession on a global level.”

The punishment cell as an instrument of inquisition: Anatomy of unlawful punishment in medical unit No. 21

This is Dr. Elena van der Meer’s eighth investigation. Today, we reveal the darkest chapter of this case: the transformation of a medical facility into a torture chamber. Based on the facts and documents provided, I reconstruct a system where the law is used merely as a backdrop for the physical destruction of human beings.

Solitary confinement as an instrument of inquisition: Anatomy of unlawful punishment in MCh No. 21

Author: Dr. Elena van der Meer (PhD)

Location: The Hague — Odessa (SIZO)

“As a criminologist with 20 years of experience, I have seen a lot, but the Dr. Maltsev case is striking in its cynicism. This is not just a legal error; it is a carefully planned operation to destroy an academic, in which Medical Unit No. 21 acted as a silent executioner.”

Falsification “from the outset”: Biological violence under the cover of the SBU

It all began on September 12, 2024, when academician O.V. Maltsev, who was undergoing rehabilitation in a wheelchair, was detained by SBU officers.

• Manipulation of the law: The temporary detention facility initially refused to accept Maltsev due to his serious condition. However, under pressure from the SBU, ambulance doctor Elizaveta Churilova signed a consultation report authorizing his detention in the temporary detention facility.
• Exceeding authority: Doctor Yelizaveta Churilova grossly exceeded her authority, as she only had the right to stabilize the patient, not to issue expert opinions on the possibility of imprisonment. She used form No. 028/o illegally, ignoring the data from the “Helsi” electronic system.

Punishment cell : 10 days in the “death zone”

On September 26, 2024, O.V. Maltsev, who was unable to care for himself, was placed in solitary confinement for 10 days.

• Conditions of torture: He was denied a shower, a change of clothes, adequate food, and vital medication. They even took away his books.
• Alibi technique: The head of medical unit No. 21, Tatyana Vasilyevna Kubaly, “accidentally” went on vacation for exactly those 10 days while the academician was in solitary confinement. This is a classic scheme for evading responsibility for torture. Before he was placed in solitary confinement, he was examined by a certain Masaleva, whose actions became a formal justification for the torture.
• Verdict: On December 15, 2025, the Odessa District Administrative Court ruled that this decision was unlawful and overturned it, ordering the defendant to pay court costs.

Medical Unit No. 21: Complicity in the liquidation

Medical Unit No. 21 effectively sabotaged Maltsev’s treatment by imitating medical activity.

• Lack of assistance: The entire examination consisted of a blood test; there are no specialists (pulmonologist, cardiologist, endocrinologist) on staff, and medication was provided only by relatives.
• Ignoring fatal risks: Maltsev has been suffering from progressive apnea since the summer of 2025, to which the medical unit did not respond in any way. Even when he fell in his cell and hit his head, the system remained indifferent.
• Conscious inaction of judges: Judges Osik, Ivanov, and Krivokhizha regularly extended his arrest, despite personally witnessing his apnea attacks and injuries.

Why is the medical unit’s management breaking the law while hiding behind it?

The management of medical unit No. 21 and the judges involved are using “procedural fetishism.” They are creating a paper trail of formal certificates (from Churilova, Masaleva) to cover up real human rights violations.

They are deliberately breaking the law for the following reasons:

Psychological breakdown: Prison and solitary confinement for a person after resuscitation is a way to extract a confession.

Biological elimination: The inaction of the medical unit is a silent execution without a shot.

Circular responsibility: When all branches of power (the Security Service of Ukraine, doctors, judges) are involved in lawlessness, everyone protects everyone else.

Dr. van der Meer’s summary: “What is happening in medical unit No. 21 is a disgrace to European medicine. Doctors have become instruments of repression. The court ruling of December 15, 1925, is our trump card. We will prove that behind the ‘white coats’ lie accomplices to the crime.”

Analysis of violations and signs of criminal activity in medical unit No. 21 of the Odessa Pre-Trial Detention Center

Introduction

On October 20, 2025, an official report was published on the results of a visit to Medical Unit No. 21, which serves the Odessa Pre-Trial Detention Center (SIZO). The report identified a number of systemic violations in the provision of medical care to prisoners. These facts raise serious concerns in terms of compliance with Ukrainian national legislation and international human rights standards. The main violations identified are listed below:

• Chronic shortage of medical staff. Medical Unit No. 21 does not have the necessary number of doctors and nursing staff, which leads to overwork for existing employees and a decline in the quality of medical care.
• Lack of rapid tests for hepatitis B and C. On the day of the visit to the medical unit, there were no rapid tests available to detect viral hepatitis B and C. This contradicts the standards of the Ministry of Health of Ukraine (Orders No. 49 and No. 51 of January 15, 2021) and the procedure for providing primary care (Order of the Ministry of Health No. 504 of March 19, 2018).
• Inability to diagnose and prevent liver cancer. The lack of hepatitis testing means that infected prisoners remain undetected and untreated. Chronic viral hepatitis B and C are among the leading causes of cirrhosis and liver cancerncbi.nlm.nih.gov. Thus, ignoring screening deprives patients of the chance for early diagnosis and prevention of liver cancer.
• Lack of access to the electronic health care system (ESOZ). Doctors at Medical Unit No. 21 do not have access to the national electronic health care system (ESOZ), which makes it impossible to properly maintain electronic medical records, prescriptions, referrals, and exchange medical data. This hinders continuity of care and violates requirements for the recording and storage of medical information.
• Lack of X-ray diagnostics in dentistry. The only dental X-ray machine in the medical unit is not working, which prevents dentists from conducting a full examination and treatment of dental diseases. The standards for equipping a dentist's office (Ministry of Health Order No. 158 of April 11, 2005) are not met, and timely and quality dental care is not provided to prisoners.
• Inaccessibility for people with limited mobility. The facility is not equipped with ramps, there is no contrasting marking on the steps, and thresholds in the rooms make it difficult for patients with limited mobility to move around.
• This is a violation of state building standards (DBN V.2.2-40:2018 “Inclusiveness of buildings and structures”) and effectively excludes persons with disabilities from receiving adequate medical care.

Each of the points listed above in itself testifies to the inadequate level of medical care in the SIZO. Taken together, these shortcomings form a systemic problem that affects the fundamental rights of prisoners to health and human dignity. Below, we will conduct a detailed analysis of these violations, assess their legal consequences and compliance with European standards, in particular the requirements of Article 3 of the European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR). The analysis was prepared by Dr. Elena van der Meer and is aimed at the expert and human rights community in Europe, presenting a rigorous legal view of the situation.

Chronic shortage of medical personnel

The first problem noted in the report is the understaffing of medical unit No. 21. In other words, the medical unit has a chronic shortage of doctors and nursing staff. This means that the staffing table is not filled—some positions for doctors, including specialists, and nurses remain vacant. In essence, the administration of the detention center does not provide the minimum necessary staffing to provide medical care to all detainees.

The staff shortage leads to weaker health monitoring of prisoners and delays in access to medical services. For example, mandatory initial medical examinations of newly admitted prisoners are not always carried out because some doctors are not available. According to the Ukrainian order “On the organization of medical and sanitary care for persons serving sentences of imprisonment,” a general practitioner, psychiatrist, and dentist should participate in the initial medical examination. 

However, monitoring checks have established that in many institutions (including the Odessa SIZO), these positions are vacant, as a result of which a full medical examination is not carried out and convicts do not receive the proper amount of medical care.

The shortage of staff also violates international standards. The European Committee for the Prevention of Torture (CPT) explicitly states that prison medical services must be provided by sufficient numbers of doctors, nursing and technical staff, as well as the necessary premises and equipment. The goal is to provide prisoners with the same level of medical care as they would receive outside of prison. The chronic understaffing of medical unit No. 21 clearly does not meet this standard. Moreover, the ECHR has repeatedly emphasized that the state's references to a lack of resources do not exempt it from its obligations under the Convention. Thus, in the case of Dykebu v. Albania and a number of others, it was established that a lack of resources or a difficult economic situation cannot justify conditions of detention that violate the absolute prohibition of inhuman treatment. Therefore, Ukraine cannot cite financial difficulties or staff shortages as an excuse for failing to comply with minimum standards of medical care in pretrial detention centers.

The consequences of staff shortages for prisoners are obvious. Reductions in the number of medical staff lead to delays in examinations, insufficient monitoring of chronically ill patients, and an inability to respond to acute cases in a timely manner. This poses a real threat to the life and health of people in custody. In effect, the state is placing vulnerable individuals—who are completely dependent on the system—in a position where they are not guaranteed basic medical care. In legal terms, this situation can be seen as a failure to fulfill the state's positive obligations to ensure the health and well-being of prisoners, as required by both national law and Article 3 of the ECHR (see the section on legal classification below).

Lack of rapid tests for hepatitis B and C (violation of Ministry of Health Orders No. 49, No. 51, and No. 504)

The second egregious violation is the lack of rapid tests for the diagnosis of viral hepatitis B and C. The monitoring group found that on the day of the visit, such tests were completely absent in medical unit No. 21. This fact directly violates the standards approved by the Ministry of Health (Ministry of Health). In 2021, the Ministry of Health, by Orders No. 49 and No. 51 of January 15, 2021, approved the Standards of Medical Care for Viral Hepatitis B and C in Adults, which provide for the timely testing of persons at risk and suspected of being infected. In addition, the lack of testing contradicts the Procedure for the Provision of Primary Medical Care (Ministry of Health Order No. 504 of March 19, 2018), which requires screening for socially significant infections at the primary health care level, including in places of deprivation of liberty.

The need for such tests is dictated by the extremely high risk that viral hepatitis poses to human health. Viral hepatitis B and C are the leading causes of chronic liver disease and hepatocellular carcinoma (liver cancer) worldwide. According to the World Health Organization, hundreds of thousands of people die each year from the effects of hepatitis, primarily from cirrhosis and liver cancer. Untreated chronic hepatitis C infection often leads to the development of cirrhosis, liver failure, and malignant tumors. At the same time, modern treatments (in particular, direct-acting antiviral drugs for hepatitis C) can cure most patients and prevent such serious consequences. However, without timely diagnosis—that is, without testing—prisoners are denied the chance of treatment.

In the medical unit under consideration, the situation is exacerbated by the fact that prisoners with viral hepatitis remain unidentified. Neither rapid tests nor laboratory diagnostics (PCR tests) are performed. This not only jeopardizes the health of those infected (who do not receive treatment and may develop liver cancer), but also creates a risk of spreading the infection to other prisoners and staff. As noted in the 2024 human rights analysis report, in many institutions of the penal system, individuals suspected of having hepatitis C do not undergo PCR testing and do not receive treatment, which leads to the deterioration of their health and the spread of infection. In fact, prisons are becoming hotbeds for the uncontrolled spread of dangerous diseases, which is unacceptable from the point of view of sanitary and epidemiological standards.

The lack of rapid tests is not just an organizational shortcoming, but a violation of specific legal norms.

Orders No. 49 and No. 51 (2021) of the Ministry of Health directly oblige healthcare institutions to have the means to screen for hepatitis and to examine risk groups. Failure to comply with these orders entails liability for officials under Ukrainian law. Moreover, such neglect of diagnosis indicates a systemic problem with the provision of medical care to prisoners. The state, knowing about the prevalence of hepatitis in places of deprivation of liberty, is effectively removing itself from control over this situation, which can be regarded as negligence or a violation of prisoners' rights to health protection.

From the perspective of European standards, the lack of adequate diagnosis of serious illnesses in persons in custody is equivalent to inadequate medical care. The ECHR has emphasized that the authorities are obliged to keep proper records of the health status of detainees and to make timely diagnoses. In the case of Melnik v. Ukraine (2006), where a prisoner suffered from tuberculosis and did not receive timely treatment, the Court found a violation of Article 3 of the Convention precisely because of shortcomings in diagnosis and treatment. By analogy, ignoring the diagnosis of viral hepatitis—a serious, potentially fatal disease—calls into question Ukraine's fulfillment of its positive obligation to protect the health of prisoners.

Furthermore, it should not be forgotten that in the 2020s, Ukraine embarked on a course of integration with European healthcare systems and approved national programs to combat hepatitis. It is regrettable that these programs are not being implemented in prisons. In the context of combating infectious diseases, prisons should not become a “blind spot.” European bodies (such as the Committee of Ministers of the Council of Europe in supervising the execution of ECHR judgments) will inevitably draw attention to such systemic problems, especially if complaints are filed by affected prisoners.

Inability to diagnose and prevent liver cancer

This point follows directly from the previous one. The lack of testing and treatment for viral hepatitis means that prisoners are deprived of the opportunity to prevent such a serious complication as liver cancer. Chronic hepatitis B or C, persisting for years, can lead to malignant degeneration of liver cells without the patient noticing. Under normal conditions, high-risk groups (e.g., patients with cirrhosis or hepatitis) undergo regular examinations—ultrasound, tumor marker tests—for the purpose of early tumor detection, and are vaccinated against hepatitis B, etc. 

In the Odessa SIZO, however, it is not possible to identify virus carriers, let alone monitor their liver function.

Thus, medical unit No. 21 does not perform the function of preventing liver cancer in the persons held there. This contradicts both national clinical protocols and international approaches to the health protection of prisoners. It should be recalled that the European Prison Rules (Recommendation Rec(2006)2 of the Council of Europe) require that prisoners be provided with the same quality of medical care as those who are free, including preventive care and disease screening. Moreover, in its 1993 decision in Hurtado v. Switzerland, the European Commission of Human Rights stated that the state has a special positive obligation to protect the physical integrity of persons deprived of their liberty, and the lack of adequate medical care in such situations should be classified as inhuman treatment. The need to identify and prevent serious illnesses, such as cancer, is undoubtedly part of this positive obligation.

A parallel can be drawn with the ECHR's decisions in cases involving seriously ill prisoners. In the case of Vlasov v. Russia (2008), the applicant suffered from viral hepatitis and did not receive proper treatment;

The Court found a violation of Article 3, pointing to the failure of the state to fulfill its obligation to ensure the health and well-being of the prisoner. Similarly, if the Ukrainian prison system fails to identify a dangerous disease in a prisoner that could potentially lead to death (e.g., hepatocellular carcinoma as a result of untreated hepatitis), this may be interpreted as a violation of the right to life (Article 2 of the ECHR) in conjunction with Article 3, or as inhuman treatment in itself, since the person is subjected to prolonged suffering and risk that could be avoided with proper medical supervision.

It should be emphasized that cancer prevention is not an abstract task, but a specific duty of medical services, including in prisons. Ukrainian legislation (e.g., the Fundamentals of Health Protection Legislation) declares the right of everyone to disease prevention. However, as long as there are no basic conditions for the diagnosis of chronic viral infections in places of deprivation of liberty, there can be no talk of preventing their consequences. As a result, prisoners are effectively excluded from the national strategy to combat cancer, which constitutes a discriminatory gap. This situation may be of interest not only to the ECHR, but also to the UN Committee Against Torture or the UN Special Rapporteur on the Right to Health, as it concerns the systematic denial of vital medical services to a specific category of persons (prisoners).

Thus, the inability to diagnose and prevent liver cancer in pretrial detention centers is a direct consequence of shortcomings in the organization of medical care. This exacerbates the suffering of patients and leads to cases where the disease is detected at a terminal stage (possibly post factum, during the autopsy of the deceased). From a legal point of view, this cumulative effect of inaction by the authorities can be regarded as a violation of the prohibition of inhuman and degrading treatment guaranteed by Article 3 of the ECHR (this issue is discussed in more detail below).

Lack of access for doctors to the ESOS (electronic health care system)

Another violation identified is the complete information isolation of medical unit No. 21 from the general health care system of Ukraine. The report indicates that doctors at this medical unit do not have access to the Electronic Health Care System (ESOZ). ESOZ is a national electronic database of patients, prescriptions, and medical services, which has been implemented in Ukraine since 2018. The lack of connection between the penitentiary medical facility and ESOZ has a number of negative consequences:

• Medical staff cannot create electronic medical records for prisoners, enter data on diagnoses, prescribed treatment, test results, etc. All information remains scattered on paper, which makes it difficult to maintain medical records.
• It is impossible to issue electronic prescriptions and referrals for tests/consultations. In civilian medicine, many drugs (in particular, narcotic analgesics and substitution therapy) are dispensed using electronic prescriptions, which are controlled through the system. In prison, however, doctors cannot do this, which either deprives patients of necessary medication or forces them to resort to outdated bureaucratic procedures.
• There is no access to data on the previous health status of prisoners before their admission to the detention center. Prisoners often have a history of illness and records of treatment while at liberty. Without the ESOS, prison doctors cannot see patients' outpatient records from civilian hospitals and do not know what diagnoses they have received in the past or what medications they have taken. This leads to treatment starting from scratch, repeated examinations, or important aspects being overlooked (e.g., allergies, chronic diseases).
• There is no possibility of exchanging medical information with civilian healthcare institutions in real time. If a prisoner is transferred to another colony or sent for treatment to a civilian hospital, their medical data cannot be quickly transferred – again, due to the lack of digital integration.

All of the above seriously complicates the provision of adequate medical care to prisoners. Doctors are effectively working “blind,” deprived of modern tools for recording and exchanging data. In the 21st century, when electronic healthcare has become the norm, such isolation of prison medicine seems anachronistic. Moreover, it contradicts the very meaning of Ukraine's healthcare reform, one of the principles of which is the continuity of medical supervision of patients at all stages.

The patient's rights to maintain and store medical information are also violated. Ukraine's Law “Fundamentals of Health Care Legislation” and the Law “On the Protection of Personal Data” stipulate that medical information about a patient must be properly stored, updated, and used for their benefit, while remaining confidential. In the case of prisoners, the absence of the ESOS means that their data is either not kept at all or is stored in a fragmented manner. As the ECHR notes, the guarantee of protection of prisoners' medical data is of paramount importance, since without it, patients may lose trust in medical staff and refuse to disclose information about their health. In our case, we see the opposite situation: it is not that the data is not protected, but rather that it is simply not collected systematically, which also undermines the interests of the patient.

From a practical point of view, this omission can lead to medical errors and even tragedies. For example, if a prisoner was diagnosed with epilepsy while at liberty and was taking certain medications, but the doctor in the detention center is unaware of this due to lack of access to the database, serious consequences are possible (seizures without treatment).

Or, for example, a person has HIV infection and was receiving antiretroviral therapy, but this information is lost in prison, which will lead to interruption of treatment, development of virus resistance, etc. 

Thus, the barrier between the prison and civilian healthcare systems directly affects the health of prisoners and can be considered a systemic violation of their right to medical care.

From the perspective of international human rights law, the lack of exchange of medical information may fall under the concept of inhuman treatment in cases where it leads to serious damage to health. The ECHR has pointed out in several cases (e.g., Szuluk v. the United Kingdom, 2009) the critical importance of medical information and continuity of treatment in prison. If the state creates conditions in which a doctor does not have access to a patient's medical history, this can be classified as failure to provide conditions for adequate medical care. Combined with other factors (lack of staff, medicines, etc.), such a gap exacerbates the suffering of prisoners and increases the risk of errors, potentially falling under Article 3 of the ECHR on the prohibition of inhuman treatment.

In the context of national responsibility, it should be noted that the integration of prison medicine into the national health care system is not only a matter of convenience but also a legal requirement. Back in 2018–2019, the Cabinet of Ministers of Ukraine adopted decisions on the phased connection of all departmental medical institutions to the eHealth system (ECHO). Failure to implement these decisions entails internal responsibility on the part of officials. However, for international human rights organizations, it is not so much the formal violation of Ukrainian regulations that is important, but rather the real consequences for human rights. In this case, the consequences – a deterioration in the quality of treatment and possible harm to the health of prisoners – are evident, which strengthens the argument that Article 3 of the Convention has been violated, should the case be brought before the European Court of Human Rights in Strasbourg.

Non-functioning dental X-ray machine: violation of dental care standards

Dental care is an integral part of medical care for prisoners. However, in medical unit No. 21, the only dental X-ray machine is out of order. According to the report, the non-functioning X-ray machine prevents in-depth dental examinations of prisoners and does not ensure the timely provision of adequate dental care. In other words, the prison dentist is deprived of one of the key diagnostic tools – X-rays, without which it is impossible to detect hidden caries, granulomas, jaw fractures, perform high-quality tooth canal filling, etc.

This fact directly violates industry standards for equipping medical facilities. Order No. 158 of the Ministry of Health of Ukraine dated April 11, 2005, approved the list of equipment for a dentist's office and dental technician. The presence of a dental X-ray machine is included in the minimum required list of equipment for a dental office. Thus, the absence of a working X-ray machine means that the medical unit does not meet the basic standard. In fact, the medical unit would not have been licensed to practice dentistry in such a condition if it were a civilian clinic.

For prisoners, this violation has tangible consequences. Quality dental care becomes unavailable. At best, the doctor can only perform superficial examinations and temporary treatment (relieve acute pain, place a temporary filling). There is no question of full root canal treatment or complex tooth extraction without an X-ray. This leads to chronic toothaches, infections (like abscesses and facial cellulitis), and premature tooth loss. A bad tooth in prison is a serious source of suffering, and without proper care, it can even lead to systemic septic complications.

From the point of view of prisoners' rights, denial of access to dental care is equivalent to denial of medical care in general. European standards do not distinguish between “more important” and “less important” medical care – a person in custody must receive treatment for all conditions requiring intervention, including dental disease. Moreover, pain that is deliberately not alleviated by the authorities can reach the threshold of inhuman treatment. The ECHR, for example, in the case of McGlinchey v. UK (2003), found a violation of Article 3 when prison doctors failed to alleviate a prisoner's suffering, leaving her without help or supervision despite severe symptoms. In the case of dentistry, if a prisoner is forced to endure toothache for weeks due to a lack of equipment or treatment, this can also be considered unnecessary suffering for which the state is responsible.

In addition, the malfunctioning of equipment in the medical unit indicates insufficient funding and oversight by the competent authorities (the Ministry of Justice and the Ministry of Health, which oversees prison medicine). According to the CPT's recommendations, the state must ensure that medical equipment in prisons is in good working order and modernized. In 2018, for example, the CPT already drew Ukraine's attention to the need to equip prison hospitals with modern equipment (CPT/Inf(2018)41). Failure to comply with these recommendations strengthens the position of potential applicants to the ECHR: the existence of international warnings that have been ignored demonstrates the systemic nature of the problem and may lead to more severe conclusions about violations of the Convention.

In summary, the lack of a working X-ray machine is not a private technical malfunction, but a symptom of a serious failure in the system of providing medical care to prisoners. This is a violation of national equipment standards, which directly affects people's rights and health. If such a case is brought before international courts, Ukraine will have to explain why it has failed to provide even the minimum required level of dental care in places of deprivation of liberty. Most likely, there will be no convincing excuses for the long-standing malfunction of the equipment, and this will place an additional burden on the overall assessment of the conditions of detention as potentially degrading (within the meaning of Article 3 of the ECHR).

Failure to comply with accessibility standards for people with reduced mobility

An important component of the assessment of conditions of detention is the accessibility of infrastructure for persons with disabilities and reduced mobility. In medical unit No. 21, gross violations of building standards for ensuring a barrier-free environment were recorded. In particular, there are no ramps for wheelchair access, there is no contrasting marking on steps (important for the visually impaired), and there are high thresholds in the medical unit's premises, making it difficult for wheelchairs to pass or for people on crutches to move around.

Ukrainian building standards DBN V.2.2-40:2018 “Inclusiveness of buildings and structures” require that all public buildings (including medical facilities) be equipped with means for unimpeded access for persons with disabilities. Since April 1, 2019, these standards have been mandatory for construction and renovation. In the Odessa pretrial detention center, it is clear that either the necessary adaptations to the premises were not carried out, or they were carried out poorly. The absence of a ramp is in itself a violation of DBN and endangers the life and health of persons with disabilities: evacuating a wheelchair user in case of fire or transporting them to the medical unit in an emergency is difficult or impossible.

It should be noted that the right of persons with disabilities to accessibility is enshrined not only in national regulations but also in international law. Ukraine is a party to the UN Convention on the Rights of Persons with Disabilities, Article 9 of which obliges states to ensure that persons with disabilities have access to buildings and services, including medical facilities, on an equal basis with others.

In our case, these obligations are clearly not being fulfilled. Prisoners with musculoskeletal disorders (e.g., wheelchair users, people who have suffered a stroke or amputation, etc.) are effectively deprived of equal access to medical services in pretrial detention centers. They cannot independently get to a doctor's appointment or get to the medical unit from their cell, or they have to overcome humiliating obstacles (ask for help to be carried, crawl up stairs, etc.).

From the perspective of Article 3 of the ECHR, refusal to make reasonable accommodations for persons with disabilities may be considered degrading treatment. The case law of the ECHR contains illustrative cases. In the case of Price v. the United Kingdom (Price v. UK, 2001), the applicant, a disabled woman suffering from the absence of limbs, was held in conditions that did not take her condition into account (a cold cell, an unsuitable bed, lack of necessary amenities), as a result of which she suffered greatly. The court found that such treatment was degrading and violated Article 3. In the Ukrainian context, we can recall the case of Kudla v. Poland, in which the ECHR formulated a general principle: the state is obliged to ensure that prisoners are held in conditions compatible with respect for human dignity and, if necessary, to adapt the general conditions of detention to the specific needs of their health. If a person cannot walk and is placed in an environment with stairs and thresholds without any adaptations, this is a clear violation of the specified standard.

Moreover, the issue of accessibility is also linked to medical considerations: an inaccessible environment can directly affect access to medical care.

For example, if a wheelchair user cannot get to the medical unit on their own, they will be less likely to seek help, enduring pain and discomfort, which means their health will deteriorate. There is also an increased risk of injury (falling on awkward thresholds or steps). All of this together creates conditions for disabled defenders that are significantly worse than for other prisoners, which can be interpreted as discrimination and cruel treatment.

It is no coincidence that the Ukrainian Ombudsman pointed out in his recommendations the need to ensure accessibility of medical facilities for the free movement of people with limited mobility. This requirement is on a par with the need to staff and provide testing—that is, it is recognized as equally important for the observance of human rights. It is clear that without fulfilling this condition, Ukraine will continue to violate not only its own building codes, but also the basic principles of humane treatment of prisoners, taking into account their particular vulnerability.

Violation of Article 3 of the ECHR: signs of inhuman treatment

Article 3 of the European Convention on Human Rights states: “No one shall be subjected to torture or to inhuman or degrading treatment or punishment.” This rule is absolute—no exceptions or derogations from it are permitted under any circumstances. The European Court of Human Rights (ECHR) has developed extensive case law on the application of Article 3 to conditions of detention. In general, poor prison conditions, especially if they cause suffering, may qualify as inhuman or degrading treatment, even if there is no intention to torture prisoners. 

Such conditions include the lack of adequate medical care.

With regard to medical care for prisoners in particular, European standards are clear: the state is obliged to protect the health and well-being of persons deprived of their liberty and to provide them with the necessary medical care. In a landmark decision by the Grand Chamber of the ECHR in the case of Kudla v. Poland (2000), it was stated that, under Article 3, the state must ensure that prisoners are held “in conditions compatible with respect for their human dignity,” that the manner of execution of the sentence does not subject them to suffering and hardship exceeding the unavoidable level inherent in the deprivation of liberty, and that their health and well-being are ensured, including by providing the necessary medical care. This quote from §94 of the Kudla decision has become the cornerstone for assessing medical conditions of detention.

In our case, the problems listed above—staff shortages, lack of medicines and equipment, and disregard for accessibility requirements—clearly go beyond the “inevitable hardships” inherent in imprisonment and cause additional suffering for detainees. This suffering is not dictated by necessity or security, but arises solely from the inaction or wrongful actions of the authorities. Accordingly, there is enforcement of punishment in a manner that causes prisoners unnecessary suffering and hardship beyond the permissible threshold.

The cumulative effect of all the violations should be particularly emphasized. In a number of cases, the ECHR has assessed the totality of the conditions of detention when ruling on compliance with Article 3.

Even if any one deficiency in the conditions might not reach the threshold of inhumanity, their combination may lead to a violation of the Convention (see, for example, Morguninas v. Lithuania, 2012, where the combination of unsatisfactory hygiene, nutrition, and medical care was found to violate Article 3).

In the Odessa SIZO, the combination of factors is as follows: prisoners do not receive proper treatment due to a lack of doctors and tests; they suffer from painful symptoms (unreceived dental care); they live in fear for their health (no diagnosis, no certainty that they will receive help if they fall ill); and disabled persons are also physically isolated due to an unsuitable environment. Taken together, this presents a picture of serious humiliation of human dignity and is tantamount to treatment that can be described as inhuman.

It is noteworthy that the Ukrainian state body itself – the National Preventive Mechanism (NPM) under the Ombudsman – saw signs of potentially cruel treatment in the violations identified. The report recommends measures to eliminate human rights violations and prevent torture and other cruel, inhuman, or degrading treatment in the activities of Medical Unit No. 21. Thus, even national experts have recognized that the current state of medical care in the SIZO may fall under the prohibition of Article 3 of the Convention. The report explicitly states: “According to the practice of the European Court of Human Rights, the lack of adequate medical care may constitute conduct contrary to Article 3 of the Convention.” This statement is based on established case law of the ECHR, including cases against Ukraine.

For example, the aforementioned case of Melnik v. Ukraine (2006) was one of the first cases in which Ukraine was found to have violated Article 3 due to the inadequate treatment of a prisoner with tuberculosis. This was followed by the judgments in Ilaşcu v. Moldova and Russia (2004), Aleksanyan v. Russia (2008, concerning an HIV-positive prisoner), Uhan v. Ukraine (2010, concerning a disabled prisoner), and many others, which form a clear approach: the state is responsible for the life and health of prisoners, and serious omissions in medical care in places of deprivation of liberty lead to liability under Article 3 of the ECHR. Our situation in Odessa essentially falls into the same category of cases.

Moreover, it is more complex than many individual cases considered by the ECHR, as a number of violations here mutually exacerbate each other. In the case of Hajiusseinovic v. Bosnia and Herzegovina (2019), the ECHR noted that systemic problems in prison healthcare require a systemic solution, otherwise they will inevitably lead to numerous complaints. This systemic nature is evident: the problems are not isolated, but typical (characteristic not only of the Odessa SIZO, but also of other institutions, according to human rights activists). This is an important point, since the European Convention provides for a mechanism of “pilot judgments,” whereby a decision is made against a country in an exemplary case, obliging it to carry out comprehensive reform. 

The violations listed above could lead to a pilot judgment being issued against Ukraine for inadequate medical care in places of detention if the authorities themselves do not take decisive action.

In summary, the condition of medical unit No. 21 of the Odessa SIZO most likely does not meet the requirements of Article 3 of the ECHR. Prisoners are subjected to suffering that could be avoided with proper medical care. Their conditions of detention are degrading to human dignity, as they are denied basic needs (treatment, pain relief, access to health information). In European legal discourse, all of the factors listed above—lack of treatment, pain, fear for one's life, humiliation of persons with disabilities—are unequivocally considered indicators of inhuman and degrading treatment. Consequently, Ukraine, as the respondent state under the Convention, bears full responsibility for such treatment.

Risks of Ukraine's international legal liability

Based on the above analysis, it is clear that the situation in the medical unit of the Odessa SIZO not only violates national standards, but also puts Ukraine at risk of international legal liability. There are several levels and mechanisms through which this liability can be realized.

1. European Court of Human Rights (ECHR). Every prisoner who has suffered from a lack of medical care in a detention center, after exhausting domestic remedies (which in Ukrainian reality often boils down to fruitless complaints to the penitentiary service and the prosecutor's office), has the right to file a complaint with the ECHR, citing a violation of Article 3 of the Convention. The likelihood of success of such complaints is very high, given the extensive case law on similar cases. The Ukrainian government will most likely be unable to justify the lack of treatment for hepatitis, the shortage of doctors, and even more so situations where disabled prisoners were unable to get an appointment. There are already precedents against Ukraine: the aforementioned case of Melnik v. Ukraine, as well as Krivolapov v. Ukraine (2018) and others, where the Convention body recognized violations due to poor medical care. New complaints will only add to this list. Each ECHR verdict is a moral condemnation of the state on the international stage and, as a rule, an award of compensation to the victims. Moreover, as mentioned above, if the problems are systemic in nature, the ECHR may issue a pilot judgment, obliging Ukraine to carry out reforms. Failure to comply with such a judgment may result in political sanctions within the Council of Europe.

2. The Committee of Ministers of the Council of Europe. This body supervises the implementation of ECHR decisions. If Ukraine does not take measures to improve the situation (for example, does not equip detention centers with ramps, does not staff them, does not provide tests and medicines), the Committee of Ministers may raise the issue of non-compliance with Article 3. As part of this oversight, critical resolutions, periodic reports, and demands for a “road map” of reforms are possible. For a country seeking European integration, having unresolved issues regarding the implementation of ECHR decisions is a serious reputational disadvantage.

3. European Committee for the Prevention of Torture (CPT). This is a preventive mechanism of the Council of Europe that conducts regular inspections of places of deprivation of liberty. The CPT has visited Ukraine several times and pointed out medical problems (for example, the 2020 visit report noted a shortage of medical staff in prisons).

If the next visit (and Ukraine is expecting a CPT visit in the coming years) reveals such clear violations as those in the Odessa pretrial detention center, the Committee will make harsh conclusions in its report. Practice shows that ignoring CPT standards is an aggravating factor when cases are considered by the ECHR. In addition, a critical public report by the CPT could negatively affect Ukraine's international image and complicate dialogue with the EU on justice and human rights issues.

4. Universal UN mechanisms. Although the ECHR bears the main legal responsibility, we should not forget about the UN Convention against Torture, to which Ukraine is a party. Repeated documentation of facts close to inhuman treatment may lead to the Ukrainian issue being considered by the UN Committee Against Torture (for example, in the form of a periodic report or an individual communication, if the applicants prefer this procedure). Similarly, the UN Human Rights Council, within the framework of the Universal Periodic Review, may make recommendations to Ukraine on improving medical care for prisoners.

5. Political and legal implications for European integration. The Ukrainian government at the highest level declares its commitment to European values and its desire to join the EU. One of the criteria for compliance is respect for human rights, including conditions in prisons. Identified violations can be used by opponents of Ukraine's accession to the EU as evidence of non-compliance with the Copenhagen criteria (section “human rights and protection of minorities”). Thus, without addressing these issues, Ukraine risks delaying its path to the EU. At best, the EU may make improvements in prison healthcare one of the conditions or recommendations on this path.

It should be noted that all of the above-mentioned accountability mechanisms are interrelated. For example, complaints to the ECHR are often based on reports by the CPT or the Ombudsman, and the supervision of the Committee of Ministers stimulates systemic reforms, which will be verified by the CPT during its next visit.

Ukraine is currently under increased scrutiny from its European partners due to both the war and the reform process. Demonstrating inaction in the area of the prohibition of torture means undermining confidence in the sincerity of reformist statements.

In conclusion, it is important to emphasize that international legal responsibility will inevitably follow if urgent measures are not taken. Even if there are no effective means to remedy the situation at the national level, the victims have an alternative recourse: international justice. And based on the facts described above, it is likely to rule against Ukraine. This prospect should encourage the authorities to take proactive steps, otherwise the price of inaction will be expressed not only in moral costs, but also in very specific amounts of compensation, obligations to implement decisions, and missed political opportunities.

Conclusions and recommendations: the need for independent European oversight

An analysis of the situation in medical unit No. 21 of the Odessa pretrial detention center revealed deep structural problems leading to human rights violations. The chronic shortage of medical staff, the lack of key diagnostic tools, and the inaccessibility of the environment for persons with disabilities are not isolated cases, but signs of a systemic crisis in prison medicine. Taken together, these shortcomings can be classified as inhuman and degrading treatment of prisoners, which puts Ukraine in violation of Article 3 of the ECHR and other international obligations. Moreover, failure to address these issues creates the risk of the state being held accountable in the international arena, primarily in the European Court of Human Rights.

It must be acknowledged that the problem is complex and requires urgent and comprehensive measures. The official NPM report formulates basic recommendations to the Ukrainian authorities: to eliminate the identified violations, to recruit staff, to ensure testing for hepatitis, to connect the medical unit to the ESOS, to repair the X-ray machine, and to make the premises accessible. However, domestic control and goodwill may not be enough, given that similar recommendations have been made before. This requires impetus and monitoring from external partners, primarily from Europe, whose authority and expertise will help bring the system into line with civilised standards.

An extremely important conclusion of this analysis is the need to establish independent expert supervision by the European Union over prison medicine in Ukraine. This refers to a mechanism that would allow for regular assessment of the state of medical care in prisons and pretrial detention centers, issuing recommendations, and monitoring their implementation. Such oversight could be carried out in the format of a joint EU-Ukraine working group on prison reform, or by involving European experts (e.g., from the European Commission, the World Health Organization's European office, and human rights NGOs) in monitoring visits and staff training. The independent nature of the monitoring is particularly important: internal audits, as practice shows, often suffer from bias or bureaucratic inertia, while external auditors are able to point out problem areas impartially.

Why the EU? First, Ukraine is officially a candidate country for EU membership. This imposes a moral obligation on it to comply with the high standards of treatment of prisoners adopted in the European community.

The EU already oversees many reforms in Ukraine, from judicial to anti-corruption. The inclusion of prison medicine in this list is long overdue, because without health and human dignity in places of deprivation of liberty, it is difficult to talk about full commitment to human rights. Secondly, the EU has the resources and expertise. European prison rules, Council of Europe recommendations, and best practices from member states can all be brought into the Ukrainian context through consultation and monitoring. Finally, European oversight will carry weight with the Ukrainian authorities, encouraging them to take action in order to meet EU expectations (especially in the context of future membership negotiations).

In practical terms, independent oversight could take the following forms:

• Regular monitoring and reporting. International experts, together with the Ukrainian Ombudsman and EU representatives, visit selected institutions (including Detention Center No. 21 in Odesa), record progress or lack thereof, and publicly report on the results.
• Roadmap for reforms. Development of a detailed plan to address shortcomings in collaboration with the Ukrainian Ministry of Justice, specifying deadlines (e.g., by the end of the year – connect all prison hospitals to the ESOS; within 6 months – purchase rapid tests and medicines; conduct certification and additional recruitment of personnel, etc.). The European side could provide technical assistance and monitor the implementation of this roadmap.
• Advisory and training mission. Send European doctors and prison medical administrators to share their experience and train Ukrainian staff in modern treatment protocols (including treatment of hepatitis, HIV, and tuberculosis), management of medical facilities in the prison system, ensuring patients' rights, etc. This would increase staff competence and could partially compensate for the shortage of specialists if foreign doctors were involved in remote consultations.
• Conditional funding.
• The EU could link financial support for the prison system (e.g., grants for prison renovation, medical equipment) to the achievement of specific indicators: elimination of certain violations, reduction of morbidity, compliance with ECPT requirements. This “aid in exchange for reform” approach has already been used in other areas and has proven effective.

Ultimately, the goal of independent European monitoring is to ensure that prisoners' rights to life, health, and human dignity are truly protected, rather than remaining on paper. This is in the interests of both the prisoners themselves and Ukrainian society as a whole (since most of them will eventually be released, and it is important that they do not leave prison disabled or carrying dangerous diseases). It will also strengthen Ukraine's international image as a country that takes its human rights obligations seriously.

It can be said that a situation such as that found in the Odessa SIZO is a test of the maturity of the legal system and the humanity of the state. A cold, objective legal analysis points to an unambiguous conclusion: without outside help and oversight, Ukrainian prison medicine risks continuing to flounder, putting people's lives and the country's reputation at risk. Therefore, the creation of a mechanism for independent European expert supervision of prison medicine should be an urgent measure to ensure the progressive correction of identified violations and the prevention of inhumane treatment of prisoners in the future. Only in this way will Ukraine be able to fulfill its national and international obligations, driven not by fear of sanctions, but by an awareness of the value of human dignity as the highest legal and European value.