Asia’s Mentally Ill on Death Row

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Asia’s Mentally Ill on Death Row

Pakistan rules schizophrenia does not preclude the death penalty. It is far from alone in executing mentally ill prisoners.

Asia’s Mentally Ill on Death Row

A woman suffering from mental illness cries as she stands behind bars of a door at the Edhi Home, a shelter for homeless and mentally ill women in Karachi (November 15, 2012).

Credit: REUTERS/Akhtar Soomro

On October 20, the Pakistani Supreme Court ruled that schizophrenia is “not a mental illness,” once again proving the country’s judiciary is not playing with a full deck. The ruling — the result of a desperate and final appeal by the wife of death row inmate Imdad Ali — flies in the face of both Pakistan’s own laws and its obligations under international treaties.

The global uproar resulting from Pakistan’s latest human rights blunder led to the Supreme Court issuing a stay on Ali’s execution on October 31. But the dangerous and, frankly, erroneous precedent set by the case has become larger than Imdad Ali himself.

By declaring that schizophrenia is “not a mental illness” because it is “not a permanent mental disorder” due to its treatable nature, the State of Pakistan has proven once again not only how hopelessly mistaken its decision makers can be. Worse, it has also demonstrated a shockingly callous disregard toward any hope of reform for the thousands of mentally ill languishing in prisons-turned-mental wards across the country.

On paper, Pakistan has ratified all manners of obligations under international human rights law. At the turn of the millennium the UN Commission on Human Rights adopted resolutions urging countries that retain the death penalty to not impose it “on a person suffering from any form of mental disorder.” To this day, Pakistan continues to “observe” these resolutions.

In 2011 Pakistan ratified the UN Convention on the Rights of Persons with Disabilities (CRPD). The country also remains party to the UN International Covenant on Civil and Political Rights, which states that no one be subjected to torture, inhuman, or degrading treatment or punishment.

Of course, international treaties are frequently overlooked at the behest of domestic laws. Yet, even on the domestic front, there are built-in provisions for society’s most vulnerable. As an example, Pakistan’s Penal Code explicitly excludes from criminal punishment any person demonstrating “disorder of his mental capacities.”

But even though Pakistan is signatory to all the right laws and protocols, ever since the state lifted its unofficial four-year death penalty moratorium following the tragic Peshawar school attack of 2014, the list of those to be executed while mentally unsound is only growing.

Just last year Pakistan sent to the gallows Khizar Hayat, a convict whose paranoid schizophrenia had been very well-documented by jail authorities. In fact, records indicate that by 2012 Hayat had become so delusional that authorities did not know how to handle him, and so he was placed in solitary confinement for the final three years of his sentence leading up to his execution.

There are extensive jail records that clearly describe Hayat as “suffering from active symptoms of severe psychosis.” There are logs indicating that prison officials followed a schedule of dispensing antipsychotic medication to Hayat. Yet, at the end, jail authorities remained steadfast that Hayat be executed on the grounds that he had some “orientation in time and place.” And so, in July 2015, following the one-month break in executions observed during the holy month of Ramadan, Hayat was hanged. By that point, his faculties were so diminished that that until his very last moments, Hayat continued to believe he had been granted reprieve and was being prepared for release and to be sent home.

Around the same time as Hayat’s march to the gallows came the execution of Kaneezan Bibi. Convicted of murder in 1991, Bibi was Pakistan’s ninth female to be hanged. Her mental health was so deteriorated that throughout much of her lengthy imprisonment, Bibi was institutionalized at Punjab Institute of Mental Health (widely known as Lahore Mental Hospital). Much like Hayat, despite extensive records indicating Bibi suffered from schizophrenia, her execution remained inevitable.

Phelim Kine, deputy Asia director at Human Rights Watch has described “executing people with mental illness [as] a barbarous affront to decency which serves no criminal justice purpose.”

And unfortunately the practice is not confined to the borders of Pakistan.

Today, across South Asia, there are countless Imdad Alis. With ever-increasing economic and political insecurity, unemployment, poverty, and terrorism, it comes as no surprise that mental illness is on the rise across the region.

As an example, consider first the state of Pakistan. A country of 182 million, till this day the country hosts only five mental hospitals and just 27 percent of medical doctors train in mental health. And then there’s Pakistan’s war-torn neighbor Afghanistan. Home to 30 million people (of which 60 percent suffer from some form of mental illness), Afghanistan has just one mental hospital.

The list continues. Indonesia: home to 250 million people, the comparatively developed nation has just 48 mental hospitals staffed with 600-800 psychiatrists. That is one trained psychiatrist per 300,000 to 400,000 people. Like Pakistan, Indonesia has ratified the UN Convention on the Rights of Persons with Disabilities (CRPD), which guarantees equal rights for all persons with disabilities, including the right to liberty and security of the person, and freedom from torture and mistreatment. Yet it continues to be nowhere near its goal of providing security to its mentally ill.

India, home to 1.3 billion people, is reported to have 70 million people living with psychosocial disabilities (which includes schizophrenia). However, the world’s second most populous country has just 43 state-run mental hospital and records indicate there are three psychiatrists and 0.47 psychologists per million people. Ironically, amongst South Asian countries, India was the first to ratify the CRPD.

All these countries — from India to Indonesia — have the death penalty in common. And all of them have, and continue to, execute convicts diagnosed with severe mental illnesses like Imdad Ali.

In 2015 Indonesia executed Rodrigo Gularte, a 42-year-old Brazilian, who was sentenced to death in 2005 for smuggling six kilograms of cocaine into the country, sealed inside surfboards. Psychological assessments, which took place while Gularte was in prison, confirmed he was suffering from paranoid schizophrenia — the same diagnosis as Imdad Ali. However, his official diagnosis, which was commissioned by Indonesia’s attorney general, was not made public.

As is the case with paranoid schizophrenics, Gularte suffered from delusions. One of his main delusions was a steadfast belief that Indonesia had abolished the death penalty. Even when he was not granted his right to a fair trial, even when the courts failed to establish whether or not he had a mental condition, and even when Gularte was to be executed by firing squad in April of 2015, Gularte continued to have no idea he was to be killed until his final few minutes.

Returning to the present day, what has happened in light of the case of Imdad Ali and its shocking verdict is not a simple, clear-cut case of prisons becoming mental wards.

What has happened with the Imdad Ali case is far more sinister.

By denouncing schizophrenia as a mental condition, what the Supreme Court of Pakistan has done is, in effect, a lot worse than its usual practice of simply letting forgotten mentally ill inmates languish on death row. As Pakistan’s prison population continues to soar, so does its number of incarcerated offenders with mental illnesses.

But prisons were never intended as facilities for the mentally ill.

And the case of Imdad Ali confirms this single, sad truth: that rather than confront the inherent cruelty and injustice of capital punishment, Pakistan’s highest court of the land is more interested in conjuring egregious legal loopholes so that it can execute a man who most likely has no understanding of why he is being punished.

Maria Kari is a U.S.-based freelance writer and lawyer. Her work frequently appears in a variety of publications including Salon.com, The Nation, NPR, and Pakistan’s Dawn News.