I was not happy there, I wanted to go out all the time.

—Pacheek, a child when released from Somsanga in mid-2010

“Do drugs control your life?” For those ready to answer “yes,” the glossy pamphlet describing the Somsanga Treatment and Rehabilitation Center in Vientiane, the capital of Laos, is reassuring. Bearing the logos of the government of the Lao People’s Democratic Republic (PDR), the United States Embassy, and the United Nations Office on Drugs and Crime (UNODC), the tri-folded brochure provides an overview of the Somsanga center as well as its contact information. The brochure also touts the center’s evolution from draconian detention facility to a more enlightened establishment—what it calls a “significant shift away from its role as a law enforcement tool towards becoming a health-oriented facility.” Lao media and the UNODC’s website echo the suggestion that Somsanga is a “reformed” detention center.

This description fundamentally misrepresents the real situation inside Somsanga.

Far from being “health-oriented,” as government officials and the center’s international supporters claim, Somsanga offers little effective, evidence-based treatment for those who need it. Confinement is still Somsanga’s central operating principle: most detainees remain in locked cells inside compounds with high walls topped with barbed wire. Somsanga still functions as a detention center, although it lacks the basic protections prisons provide: due process, judicial oversight, and mechanisms for appeals and accountability.

This report examines how people get to Somsanga and what happens to them inside. Based on interviews with12 former detainees and 8 current or former staff members of international organizations, it details how Somsanga holds most of its detainees against their will. Police or village militia (tamnaut baan) detain and bring people to Somsanga. Other detainees enter because their family members “volunteer” them out of a mistaken belief that the center offers therapeutic treatment, or because they feel social pressure to help make their village “drug free.”

Regardless of how they enter, people held in Somsanga never benefit from any judicial process to authorize their detention. Once inside, people cannot come and go. Police, who guard the facility’s main gate, are responsible for security and are a constant presence among detainees. As one member of an international organization familiar with the center observed, “A truly voluntary center does not need to be guarded by police, nor do the doors need to be locked.”

This report finds that detainees live in a punitive and heavily controlled environment. Those who try to escape may be brutally beaten by “room captains”—trusted detainees whom staff designate to play a central role in the daily control of other detainees, including serving the center’s police as guards and punishing detainees who infringe center rules. Sahm, who was released in mid-2010, reported witnessing a beating of five detainees who were unsuccessful in their escape attempt.

The room captains beat them until they were unconscious. Some were kicked, some [beaten] with a stick of wood…. The police told the room captains to punish them because the police would be held responsible for any successful escapes.

In Lao PDR, village officials are under pressure from government administrators to declare their village “drug-free.” However only a minority of people who use amphetamine type stimulants—the most common type of drug in Lao PDR—actually become dependent. Despite this, village officials and family members—anxious to be seen to comply with official policy—sometimes request and pay Somsanga to detain individuals who use drugs infrequently or irregularly.

Human Rights Watch is concerned that infrequent drug users may be subject to Somsanga’s “treatment” without having an underlying condition that actually requires treatment.

Somsanga not only detains those dependent on drugs. For Lao authorities, Somsanga functions as a convenient dumping ground for those considered socially “undesirable.” People who might have a genuine need for drug dependency treatment are locked in alongside beggars, the homeless people, children, and people with mental disabilities. In the lead up to the 25th Southeast Asia (SEA) games, held in Vientiane in December 2009, city authorities published call-in numbers for the public to report beggars to ensure “orderliness” during the games. Authorities explained they would hold people rounded up in this way in Somsanga. Former detainees held in Somsanga at the time of the games told Human Rights Watch the center did indeed detain homeless people and street children. Media reports indicate that such detentions continued during 2010.

International donors have lent more than their logos to promoting Somsanga. Indeed, over the last decade, they have constructed many of Somsanga’s buildings and fences. Donors have also paid for center staff to be trained in drug treatment. Foreign embassies in Vientiane and UNODC have funded services in the center, such as vocational training, and have donated books and sports equipment. This approach is not working. “People are angrier and more aggressive after they are there,” Ungkhan, a former detainee, said.

It’s not difficult to see why: the essence of Somsanga’s purported “treatment” remains being locked up, at risk of physical abuse for infringing rules or trying to escape. While classes or courses may be useful for some people undergoing rehabilitation when they are offered in community settings, the utility of such classes or courses for Somsanga’s detainees is obscured by the bleakness and cruelty of detention in its crowded cells.

One startling finding of Human Rights Watch’s research into the conditions inside Somsanga was the number of former detainees who reported seeing other detainees attempt or commit suicide. Of the 12 former detainees interviewed for this report, five said they had directly witnessed suicides or suicide attempts by fellow detainees during their detention. As Maesa, a child (i.e. under 18-years-old) who spent six months in Somsanga, explained to Human Rights Watch: “Some people think that to die is better than staying there.” Despondent at being locked up or demoralized by being abandoned by their families, some detainees protest their detention by the only means left to them. Former detainees spoke of suicides—both attempted and actualized—involving ingesting glass, swallowing soap, or hanging.

Human Rights Watch believes Somsanga should be shut down for three main reasons.

First, the underlying operational principle of Somsanga—long-term compulsory detention in the name of “treatment” and “rehabilitation”—violates the right to health. Compulsory drug treatment should not be routine, en masse detention that lasts for months or years. It is only justifiable in exceptional circumstances of high risk to self or others, when accompanied by a series of due process protections to prevent the abuse of such a system, and when limited to the time strictly necessary to return a patient to a degree of autonomy over their own decision making. Where compulsory treatment consists of being locked up in a detention center without due process, it violates the prohibition on arbitrary detention and the right to health of drug users.

UN agencies and international organizations have criticized centers that routinely and en masse detain people for purported “treatment” and “rehabilitation” and called for them to be closed down. In December 2010, UN agencies convened a meeting in Bangkok, Thailand, to discuss alternatives to compulsory drug detention centers. Officials from eight Asian governments that operate compulsory drug detention centers in their countries attended the meeting. However, Lao PDR chose not to attend. According to staff members of international organizations familiar with the meeting, Lao PDR took this position because it does not consider its centers compulsory.

Somsanga operates in clear disregard for the principles articulated by one of its principal supporters, UNODC, which has elsewhere clearly criticized the approach of routine, en masse detention in the name of “treatment”:

Many countries provide long term residential treatment for drug dependence without the consent of the patient that is in reality a type of low security imprisonment. Evidence of the therapeutic effect of this approach is lacking.... It does not constitute an alternative to incarceration because it is a form of incarceration.

Second, Human Rights Watch believes Somsanga should close because the center entails an unacceptably high risk of other human rights abuses, such as ill-treatment of detainees by staff or detainee guards and the arbitrary detention of populations considered socially “undesirable.” Human Rights Watch is concerned that international donors supporting Somsanga are not monitoring and reporting such issues.

In the course of researching this report, Human Rights Watch wrote to 10 international donors and implementing partners who reportedly have supported Somsanga, outlining the findings of this research and asking whether those organizations were aware of any reports of human rights abuses in Somsanga. By the time this report went to print, Human Rights Watch had not received a response from four of these donors. One donor responded to clarify that it had not provided support to Somsanga. While the responses of the remaining five organizations varied in their content and detail, all responded that they were not aware of any reports of arbitrary detention, ill-treatment, or other human rights abuses in Somsanga.

Third, international donor support for services such as drug classes and vocational training in closed centers has retarded the development of voluntary services in community settings. Despite a decade of external donor funding for the Somsanga center, the overall state of drug dependency treatment in Lao PDR is poor; there are virtually no voluntary, community-based options for those who need drug dependency treatment. The sad truth is that a person dependent on drugs in Vientiane, and who wants help in grappling with their addiction, has few realistic options. Individuals dependent upon drugs in Vientiane face a choice between trying to stop on their own and admitting themselves into a locked detention facility for months or years, where they may face physical and psychological abuse amounting to cruel, inhuman, and degrading treatment.

Classes in drug use and courses such as vocational training may benefit some people trying to overcome drug dependency, but there is no rationale for premising such services on months or years of involuntary detention. One staff member of an international organization familiar with drug issues in Lao PDR said:

The overwhelming majority of young people in Somsanga would be much better off either at school or engaged in some higher educational or vocational training initiative—or indeed working—outside of Somsanga.Even if there is drug use and sexual risk reduction education in Somsanga, it should be going on in the community.

Donors should focus on ensuring the availability of, and limit their support to, humane drug treatment options that comport with international standards. Those standards include the requirement that drug dependency treatment be voluntary (except in very limited circumstances), based on sound scientific evidence as to what is effective, and adapted to the individual needs and interests of the patient.

Beatings and suicides and other abuses in Somsanga must be addressed. But they are symptoms of the more fundamental problem that underlies them and that is the focus of this report: the functioning of a center that purports to be a health facility, but operates in reality as a detention center. This report urges the Lao government and the center’s supporters to move away from an approach of routine, long-term, en masse detention of people in the name of drug treatment. Human Rights Watch urges donors and government authorities to begin to establish voluntary, community-based options available to anyone in the community who wants them.

In many countries, the range of health services required to provide drug dependence services to the community is offered by nongovernmental organizations (NGOs). Historically, Lao government authorities have suppressed these groups, although there are some indications this situation may be changing. Support for NGOs—from the Lao government but also from donors funding drug-related issues in Lao PDR—has the potential to provide necessary services for people who use drugs (as well as other socially marginalized groups).

Lao PDR has stated its intention to make the country “drug free” by 2015, in line with an Association of Southeast Asian Nations (ASEAN)-wide political commitment. But such a goal should not blind the government to respect the human rights of Lao people who use drugs and other marginalized populations, such as beggars, the homeless people, children, and people with mental disabilities . Nor should the fact that Lao PDR is a poor country with limited infrastructure to provide social services prevent donors and implementing partners from aligning their assistance to Lao PDR in a way that reflects international standards and best practice in providing drug treatment. Indeed, failure to respect human rights and comport with international standards will only further undermine the stated goal of the Lao government to create a “prosperous society governed by the rule of law for all Lao people.”

Methodology

Lao PDR does not allow international human rights organizations to freely conduct research or monitor human rights concerns in the country. NGOs and others visiting drug detention centers are rarely, if ever, able to speak privately with detainees or see all parts of a government drug detention center. As a result, obtaining and verifying information about human rights violations in Lao drug detention centers presents great challenges. There is reluctance in Lao PDR to discuss drug use in general, and Somsanga in particular. While former detainees of Somsanga are freer to talk openly about their experiences than those still in detention, many are still fearful of being taken back to the center and are wary of the additional risk created by talking to human rights organizations.

This report is based on information collected during three weeks of field research conducted in Lao PDR in late 2010. Human Rights Watch conducted in-depth, confidential interviews with 12 people recently detained in Somsanga drug detention center.[1] All 12 had been in detention within two years of the date of their interview with Human Rights Watch. All come from Vientiane.

Of the 12 former detainees whose testimony forms the basis of this report, four were children at the time of their detention, including one who was a girl at the time of her detention.[2] All four children were adolescents, although their precise ages have not been included in the report in order to protect their identities.

All interviewees provided verbal informed consent to participate. Individuals were assured that they could end the interview at any time or decline to answer any questions without consequence. Interviews were semi-structured and covered a number of topics related to illicit drug use, arrest, and the conditions of detention. To protect their confidentiality and safety, interviewees have been given pseudonyms and in some cases certain other identifying information has been withheld.

Information from these former detainees was generally consistent in terms of the forms, severity, and frequency of abuses reported.

Human Rights Watch also spoke to two people who had been held in Somsanga prior to 2009. Their testimony, largely consistent with the testimony of more recent detainees, is not included in this report because their periods of detention fall outside this report’s timeframe.

Human Rights Watch also interviewed eight current or former staff members of international organizations who have knowledge and experience regarding the situation of people who use drugs in Lao PDR. Testimony they provided has been included in this report.

Where available, secondary sources—including official Lao media and reports from government sources or other organizations—has been included to corroborate information from former detainees and current or former staff members of international organizations.

In July 2011, Human Rights Watch wrote to the head of the Lao Commission on Drug Control (LCDC) to request information on the Somsanga center and solicit its response to violations documented in this report. This correspondence is attached in Annex 1.

In July 2011, Human Rights Watch also contacted 10 donors and implementers who have reportedly funded or implemented programs in Somsanga drug detention center. A version of this correspondence is attached in Annex 2.

n 2009, UNODC funded renovation of Somsanga treatment center building and facilities, including renovation of a dormitory for young men in order for young residents to be housed in separate dormitory from adults. UNODC does not support the construction of new centers in Lao PDR.

The UNODC correspondence notes that this renovation was “to meet basic standards of hygiene and comfort and to separate young residents from adults” and cost $95,200.[32]

The US Embassy’s public invitations for bids for contractors to carry out construction work at Somsanga have specifically included building fences.[33]

Support for Activities in Somsanga

In response to Human Rights Watch correspondence, UNODC confirmed it has supported activities to build the capacity of the center’s staff and to provide services in Somsanga. UNODC’s deputy executive director noted that the agency’s support to the Lao government between 2004 and 2006 included drug counseling training for staff at Somsanga.[34]

From 2008 to mid-2011 UNODC implemented a (separate) project whose goal was to “provide a suitable basic setting for drug detoxification and rehabilitation and to implement vocational training activities.”[35] Support totaled $242,837, funded by the US Department of State’s International Narcotics and Law Enforcement Affairs.[36]

In its correspondence with Human Rights Watch, UNODC’s deputy executive director noted that staff from Somsanga center participated in seminars and trainings on drug dependence treatment organized by UNODC’s regional office in Bangkok.[37]

UNODC has also partnered with the Singapore-based NGO, the Singapore International Foundation, in a three-year project (2009-2011) to train Somsanga staff and others in drug dependency treatment.[38] According to SIF, the aim of this project was:

[T]o train Lao officers working with recovering addicts in addressing the psychosocial aspects of addiction recovery. This approach encourages and equips them with skills to adopt a mindset of respecting the human dignity of each recovering addict and the value of mobilizing support networks, such as the family, in the addict’s recovery.[39]

In SIF’s response to Human Rights Watch’s enquiries, the executive director noted that six trainings took place over three years (2009-2011). The project also involved a study tour to Singapore in 2010.[40]

In addition to building staff capacity, UNODC has implemented a project on vocational training project in Somsanga, partnering with the German Development Service (DED), now the German Agency for International Development (GIZ).[41] Each year from 2009-2011, DED placed two volunteers at Somsanga.[42] In its correspondence with Human Rights Watch, GIZ described the main activities of these volunteers as “English teaching, IT-support for PC-lab, sports and gymnastics in a room furnished by the German Embassy, [and] support of skills training (wood works, printing, tailoring, and motorbike repair).”[43]

The US State Department’s 2010 International Narcotics Control Strategy Report (INCSR) noted that:

One of the more successful efforts using [the Bureau of International Narcotics and Law Enforcement Affairs] funding has been an innovative occupational therapy program at the Somsanga Drug Treatment Center operated in cooperation with UNODC. Several hundred previously idle youth in the rehabilitation section are now busy with a variety of training activities.[44]

In its correspondence with Human Rights Watch in mid-August 2011, UNODC noted:

The most recent project activities, which were completed at the end of July 2011, were expansion of vocational training, occupational therapy opportunity and training on drug counseling. At this moment, UNODC has no ongoing activities at the Somsanga Treatment and Rehabilitation Centre. [45]

However, as recently as April 2011, UNODC in Lao PDR publically advertised for the position of an “international project assistant at Somsanga drug treatment and rehabilitation center.” Listed tasks for the position included, among others, “mprov[ing] the existing drug rehabilitation service and strengthen[ing] the overall capacity of the Somsanga Drug Treatment and Rehabilitation Center in Vientiane.”[46]

Other international donors have provided support to Somsanga. The official Lao press agency reported in mid-2010 that the Australian government had given $9,300 “to improve the library” of the Somsanga center.[47] By the time this report went to print, Human Rights Watch had not received a response to its correspondence to the Australian ambassador in Vientiane.

In a response to Human Rights Watch, the ambassador of Singapore to Lao PDR noted that the Singaporean Embassy had supported the construction of a one-story building for a motorbike repair center in Somsanga, as well as equipment and trainers. The Singaporean Embassy helped raise $22,500 for the project. According to the ambassador, the support was “aimed at providing the young people at the Rehabilitation Center [with] a skill to help them become useful citizens of society.”[48]

In addition to the GIZ project discussed above, a chargé d’affaires at the German Embassy in Vientiane noted that in 2009 the embassy paid for the installation of gymnasium equipment in Somsanga “in an effort to supplement drug withdrawal treatments and to improve living conditions of former drug addicts.” The correspondence stated that this support cost $10,000.[49]

The head of the EU delegation to Lao PDR replied to Human Rights Watch’s enquiry:

I can now inform you that the EU does not finance any programmes supporting the Somsanga Drug Detention Center, nor are any programmes currently planned…. We are aware that there is a growing drug problem among young people in Laos and this has been reflected in the increasing numbers admitted to the Somsanga center, but we have not heard of any cases of abuse in Somsanga as outlined in your letter. However given the serious nature of the allegations, we will enquire with the government and with donor partners, and if there are grounds for concern, we will take up the matter with the appropriate authorities and in our dialogue with the Lao government.[50]

[2] The word “child” is used in this report to refer to anyone under the age of 18 and “girl” to a female under the age of 18. The Convention on the Rights of the Child (CRC) defines as a child “every human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier,” art. 1, adopted November 20, 1989, 1577 U.N.T.S. 3 (entered into force September 2, 1990). Lao PDR acceded to the CRC on May 8, 1991.

Suicides at Somsanga

The foreigners [that visit Somsanga] don’t know about the beatings or the suicides.

—Paet, a child when first detained[93]

Of the 12 former detainees interviewed for this report, five reported having directly witnessed suicides or suicide attempts by fellow detainees during their detention.

Sahm, who was released in mid-2010, told Human Rights Watch that he saw a fellow detainee who had committed suicide by ingesting glass.

Blood came out his mouth and nose. He ate glass from a sauce bottle or from a Pepsi bottle. They put him in a plastic sheet and put it in front of the building where the police stay. I saw the body.[94]

Pacheek, a child when released in mid-2010, told Human Rights Watch that a man in the same cell as him committed suicide by hanging.

[In] the room I stayed in, a man committed suicide. He hung himself in the doorway while others were sleeping. Everyone woke up and saw this. He was angry at his family and depressed because he came in at the same time as his younger brother, who left before him. I saw him. He used a cord from some shorts. He had black jeans and a red t-shirt on. He had his tongue out.[95]

Maesa told Human Rights Watch that during her six months in detention, she saw two suicides and one suicide attempt.

Some people think that to die is better than staying there. Some tried to kill themselves and their lives are saved. I saw one girl from the “lower buildings.” She ate fabric detergent because she wanted to die. She was upset her family left her in this place. She didn’t die because the doctor found her and cleaned her stomach. Then they took care of her and told her not to try and kill herself. Others they die. Two men committed suicide when I was there. They hanged themselves. Then the staff brought the bodies up to the clinic. It was two different times, the two deaths. I saw the dead bodies.[96]

Former detainees told Human Rights Watch that they believed, based on their own experiences of being detained and interactions with their fellow detainees, that people attempted suicide because of the anger and loneliness caused by detention in Somsanga. Sahm—who witnessed the suicide of a fellow detainee by ingesting glass—said:

There are many reasons people try and kill themselves. People who are there unwillingly after their families send them are depressed. Sometimes the family lies to them about the length of time in Somsanga. Others are without families so they have no one to come and visit.[97]

Tunva told Human Rights Watch that he saw one fellow detainee attempt suicide by swallowing fabric detergent in January or February 2010: “I think they try and kill themselves because they feel lonely, they have no one to come and visit them.”[98] Paet, a child when he was detained, explained that the detainees who attempt suicide “are angry because they want their families to take them out of Somsanga but their families want to give them more rehab.”[99]

States have a responsibility to account for every death in custody, including suicides. Whether the state bears responsibility for a suicide that takes place in detention will depend on the extent to which in the circumstances the authorities should have been aware of the risk of suicide and what measures were put in place to mitigate that risk. Where a risk is evident and the state did not take appropriate preventative steps, then the state will bear responsibility for that death in custody.[100]

As far as one former detainee interviewed by Human Rights Watch was aware, authorities running Somsanga have responded to suicides in the center by making infrastructural changes. Paet explained that, “Some [detainees], they jumped from the buildings. Now in the buildings you can’t jump because they have protection grills on the balconies.” Other changes were implemented after a man hung himself with a towel in a bathroom. “No one saw him do it,” said Paet. “In that time they had doors on the bathroom. After this they took the doors off the bathrooms.”[101]

The World Health Organization (WHO) has issued guidance for authorities in charge of detainees in how to screen for, prevent, and respond to suicide and attempted suicide in detention settings.[102] WHO has noted that detention itself creates a risk of suicide, as it is a stressful event that deprives even healthy people of important resources.[103] WHO’s guidance describes means to screen for suicide risk at intake, means of observation post-intake, adequate monitoring of suicidal detainees, mental health treatment, and mechanisms to review internal policies when suicides do occur.It is not apparent that the Somsanga authorities have adopted any of the recommended steps outlined in such guidance.

In its correspondence with international donors and implementing agencies, Human Rights Watch asked whether those organizations were aware of any reports of deaths in custody (including suicide), and any formal investigations into such deaths, as well as any efforts taken to prevent further suicides.

As noted above, Human Rights Watch had received no response from the US Department of State’s International Narcotics and Law Enforcement Affairs, the US Embassy in Vientiane, the Japanese Embassy in Vientiane, or the Australian Embassy in Vientiane by the time this report went to print. The Singaporean Embassy, the Singapore International Foundation, the German Embassy and the German Development Agency stated that they had not received or documented such reports. UNODC confirmed:

One case of death in custody is known and there was anecdotal information about cases of attempted suicide. UNODC staff have heard of cases of attempted suicide from the medical staff at Somsanga center.[104]

The UNODC correspondence did not identify any further information (such as an investigation by the center or any steps taken by UNODC) in response to this death in custody or incidents of attempted suicide.

To UNODC, Bilateral Donors, and International Organizations Providing Assistance to Somsanga

• Publically call for:
  • The closure of Somsanga
  • An investigation into the allegations of human rights violations occurring inside Somsanga
  • Holding those responsible for any violations to account
  • Appropriate remedy for detainees and former detainees for any harm to their physical and mental health sustained while in detention.
• Review any funding, programming, and activities that support the operation of Somsanga to ensure that no funding is being used to implement policies or programs that violate international human rights law, such as the prohibitions on arbitrary detention, and cruel, inhuman or degrading treatment or punishment.
• For those donors funding capacity building projects on drug dependence treatment for drug detention center staff, cease such projects immediately.
• Support the expansion of voluntary, community-based drug dependency treatment, including appropriate services for women and children.
• Direct support and capacity-building projects for drug dependence treatment to staff at the Ministry of Health and NGOs.

To United Nations Agencies

• Publically call for:
  • The closure of Somsanga
  • An investigation into the allegations of human rights violations occurring inside Somsanga
  • Holding those responsible for any violations to account
  • Appropriate remedy for detainees and former detainees for harm to their physical and mental health sustained while in detention
• Actively encourage the Lao government to expand voluntary, community-based drug dependency treatment and ensure that such treatment is medically appropriate and comports with international standards.
• Support and provide capacity-building projects for drug dependence treatment to staff of the Ministry of Health and NGOs.

To the UN Working Group on Arbitrary Detention, the Committee on the Rights of the Child, the Special Rapporteur on Torture, and the Special Rapporteur on the Right to Health

• Raise concerns with the Lao government regarding the allegations of arbitrary detention, cruel, inhuman or degrading treatment or punishment, and other abuses committed against people who use drugs (including children) by law enforcement officers and staff of Somsanga.
• Request an invitation to visit Lao PDR to investigate allegations of human rights abuses against people who use drugs by law enforcement officers and staff of Somsanga.
• Request further information from the Lao government in its periodic reports on the detention and treatment of people in drug detention centers in Lao PDR, including children.

To the ASEAN Inter-Governmental Commission on Human Rights (AICHR)

• Publically call for:
  • The closure of Somsanga
  • An investigation into the allegations of human rights violations occurring inside Somsanga
  • Holding those responsible for any violations to account
  • Appropriate remedy for detainees and former detainees for harm to their physical and mental health sustained while in detention
• Request information from Lao PDR regarding the allegations of arbitrary detention and cruel, inhuman or degrading treatment or punishment, and other abuses committed against people who use drugs (including children) by law enforcement officers and staff of Somsanga.
• Prepare a study on the human rights abuses against people who use drugs in drug detention centers in ASEAN member states.

http://www.hrw.org/reports/2011/10/11/somsanga-s-secrets-0