HRW Submission to UN Committee on Rights of Persons with Disabilities in Ghana

Human Rights Watch welcomes the opportunity to provide input to the Committee on the Rights of Persons with Disabilities (the Committee) ahead of its consideration of a List of Issues for the upcoming review of Ghana. This submission highlights areas of concern that Human Rights Watch hopes will inform the Committee’s consideration of the Ghanaian government’s compliance with its obligations under the Convention on the Rights of Persons with Disabilities (CRPD). The submission draws primarily on Human Rights Watch’s research and ongoing monitoring of abuses faced by people with psychosocial disabilities from 2012-2021, and relates to Ghana’s compliance with the CRPD, including articles 5, 7, 9, 12, 13, 14, 15, 16, 17, 19, 25, and 26. It proposes issues and questions that Committee members may wish to raise with the government of Ghana.

Human Rights Watch is an independent, international human rights organization that monitors, reports, and conducts advocacy on human rights in more than 90 countries globally. Partnering with people with disabilities and their organizations across the globe, we work to ensure that the voices of people with disabilities are heard, in line with the disability movement’s motto “Nothing About Us, Without Us.”

Executive Summary

Human Rights Watch documented abuses against persons with psychosocial disabilities in prayer camps and psychiatric hospitals in Ghana between 2012 and 2019 and continues to monitor the situation through engagement with the government and local partners. Focusing on the southern regions of the country, Human Rights Watch examined the experiences of persons with psychosocial disabilities in Ghana in the three main environments in which they receive care: the broader community, the country’s three public psychiatric hospitals, and residential prayer camps. Human Rights Watch found that persons with psychosocial disabilities in Ghana often experienced a range of human rights abuses in prayer camps and psychiatric hospitals, including stigma and discrimination, shackling, involuntary admission and arbitrary detention, overcrowding and poor hygiene, seclusion and restraints, and denial of food.

Human Rights Watch also found that there were few government-supported, community-based services-including housing, healthcare, medical care, and mental health services. Lack of such services, combined with pervasive negative community attitudes towards psychosocial disability, made integration of persons with psychosocial disabilities into community life extremely difficult, and some were abandoned by their families entirely once they entered a mental health facility or prayer camp.

In two prayer camps Human Rights Watch visited in Ghana in November 2019, dozens of people were chained either inside fully built and semi-permanent structures, or to a tree or concrete floor outside.[1] In another prayer camp, which Human Rights Watch visited regularly from 2011 to 2019, people with real or perceived psychosocial disabilities were confined in cages and rarely allowed to leave. Most cages were so narrow that the men could not even stretch out their arms. In these camps, people had to bathe, defecate, urinate, change sanitary towels, eat, and sleep on the spot where they were chained. Human Rights Watch found that many individuals were chained 24 hours a day; some said they had been restrained for several months.

In October 2020 Human Rights published a report, “Living in Chains: Shackling of People with Psychosocial Disabilities Worldwide,” documenting the practice of shackling of people with psychosocial disabilities worldwide, including in Ghana.[2] The report found that around the world, hundreds of thousands of men, women, and children with psychosocial disabilities have been shackled-chained or locked in confined spaces-at least once in their lives. Many are held in overcrowded, filthy rooms, sheds, cages, or animal shelters and are forced to eat, sleep, urinate, and defecate in the same tiny area. The inhumane practice of shackling exists due to inadequate support and mental health services as well as widespread beliefs that stigmatize people with psychosocial disabilities.

Abuses Against People with Psychosocial Disabilities

Individuals with psychosocial disabilities in Ghana who receive treatment generally have three main care options: psychiatric hospitals, residential prayer camps, and traditional healers. Community care providers are another, albeit limited, option.[3] Most people utilize more than one option and sometimes more than one at a time.

Ghana has three public psychiatric hospitals: Accra Psychiatric Hospital, Pantang Psychiatric Hospital, and Ankaful Psychiatric Hospital.[4] Some regional hospitals also have psychiatric wards.

Like many developing countries, Ghana faces staff shortages within the public health system. The problem is particularly acute when it comes to mental health. As of 2017, Ghana had a total of 2,572 mental health professionals and 0.06 psychiatrists per 100,000 inhabitants.[5]

Prayer camps are privately owned Christian institutions with roots in the evangelical or pentecostal denominations, run by prophets, many of them self-proclaimed. In addition to conducting normal church activities including prayer and counseling, and supporting charitable activities, such as homes for orphans and older persons, some prayer camps also have special sections for persons with psychosocial disabilities, who are treated through prayer and other non-medical techniques, such as the application of various herbs. The prophets, or pastors, and staff at these camps have virtually no mental health care training.[6] In one of the eight camps that Human Rights Watch has been monitoring since 2011, a nurse from the regional hospital visits regularly to administer medications.[7]

In its initial report to the Committee, submitted in 2018, the government of Ghana acknowledged that “[p]rayer and healing camps [had] also become centres where Persons with disabilities [were] subjected to inhumane treatments.”[8]

Human Rights Watch documented severe cases of physical and verbal abuse against persons with psychosocial disabilities in the family, community, and prayer camps in Ghana.[9] Interviewees said they faced threats of abuse, and actual physical and verbal abuse, for trying to escape, when they complained, or for failing to follow instructions.

The Mental Health Authority has repeatedly committed to establishing Visiting Committees, as called for the 2012 Mental Health Act, tasked with conducting investigations to ensure enforcement of the act. As of February 2022, these mechanisms have yet to be set up or function.

Human Rights Watch encourages the Committee to ask the government of Ghana:

• What has the government done to investigate abuses against people with psychosocial disabilities?
• What steps has the government taken to regulate mental health service providers including prayer camps? In particular, has the government formulated and implemented a national policy that ensures that people in prayer camps are not involuntarily admitted or detained, are not abused, and are not given treatment without their consent?
• What efforts is the government making to set up and adequately fund the monitoring system described in the law as Visiting Committees, tasked with conducting investigations to ensure enforcement of the ban on shackling?

Human Rights Watch asks the Committee to consider including the following recommendations in its concluding observations on Ghana:

• Comprehensively investigate state and private institutions in which people with psychosocial disabilities live, including prayer camps, with the goal of stopping chaining and ending other abuses.
• Conduct regular, unannounced monitoring visits to government and private social care institutions as well as prayer camps and faith healing centers, with unhindered and confidential interaction with both staff and patients. Findings of these visits, redacted to protect privacy rights, should be publicly reported.
• Establish independent and confidential complaints systems that receive and investigate complaints, including ill-treatment of persons with psychosocial disabilities in institutions.

Stigma and Discrimination Associated with Psychosocial Disabilities (art. 5)

People with psychosocial disabilities in Ghana endure stigma and discrimination in the health sector, at home, and in the community.[10]

Many people in Ghana-even persons with psychosocial disabilities themselves-believe that psychosocial disabilities are the result of possession by evil spirits, demons or witchcraft. Some of the religious leaders interviewed by Human Rights Watch described persons with psychosocial disabilities as incapable, hostile, demonic, controlled by spirits, helpless, useless, and anti-social.[11] These beliefs often prevent families from taking relatives with psychosocial disabilities out for events or social occasions and lead them to first consult faith or traditional healers and only seek medical advice or psychosocial support, such as counseling, as a last resort. Such stigma also causes family members to often abandon persons with psychosocial disabilities in psychiatric hospitals and prayer camps, neither visiting them nor picking them up after discharge. Some give a false address so they cannot be traced.

People with psychosocial disabilities interviewed by Human Rights Watch since 2011 identified stigma in their families as one of their main worries about being discharged from a psychiatric hospital or prayer camp.[12] Some also expressed fears of hostility or lack of acceptance when they go back to their respective communities. As a result, some people even opted to live in institutions or prayer camps, where they were not questioned about their mental health status. Some family members also considered psychosocial disability as a disgrace to the family, as they faced discrimination from community members and feared ostracism.

The stigma attached to psychosocial disabilities extends to the mental health profession, which often discourages doctors from specializing in psychiatry and causes many general physicians and other health care workers to resist mental health training. This, in part, contributes to the shortage of mental health professionals.[13]

In a recent case, the municipal authorities in Accra did not approve transfer to a Covid-19 treatment center for a patient at Accra Psychiatric Hospital who tested positive for Covid-19 in April 2020.[14] The head of Ghana’s Mental Health Authority, Dr. Akwasi Osei, said they refused because she was a mental health patient and added, “This is obvious discrimination…If this person didn’t have a mental health condition, she would have been allowed to go to the treatment center. They are just afraid. But people with psychosocial disabilities should have the same access to Covid-19 treatment as anyone else.”[15]

In February 2019, the World Health Organization (WHO) launched its QualityRights initiative in Ghana, a training program for mental health professionals that promotes attitudes and practices that respect the dignity and rights of people with psychosocial and intellectual disabilities.[16] As of December 2021, 17,401 people had completed the QualityRights e-training and received a WHO certificate.[17]

Based on interviews with seven mental health professionals and advocates in November 2019, most of whom had completed the training, Human Rights Watch believes that there has been a marked positive shift in the attitudes and practices of staff in Accra Psychiatric Hospital and among mental health professionals who administer medication to people in some prayer camps.[18]

Health care workers acknowledged the importance of respecting the rights of people with psychosocial disabilities and noted a reduction in restraints, isolation and forced medication, yet these practices were still used in Accra Psychiatric Hospital, according to the staff nurses with whom we spoke in November 2019 (detailed in the section on seclusion and restraints below). Ghanaian organizations of persons with disabilities (OPDs) and other organizations working in the mental health space have conducted sensitization workshops and trainings for mental health professionals, traditional healers and spiritual leaders.

The government has carried out public information campaigns, including this most recent one in February 2022 focused on the importance of love and compassion.

Human Rights Watch encourages the Committee to ask the government of Ghana:

• What has the government done to reduce stigma and discrimination against people with psychosocial disabilities, challenge discriminatory beliefs and practices, and train and sensitize health workers, mental health professionals, and staff in faith-based and traditional healing centers on the rights and needs of people with psychosocial disabilities?
• Has the government conducted any public information campaigns to raise awareness about the rights of people with disabilities?

Human Rights Watch asks the Committee to consider including these recommendations in its concluding observations on Ghana:

• Further train and sensitize government health workers, mental health professionals, and staff in faith-based and traditional healing centers to the rights and needs of people with psychosocial disabilities.
• Conduct rights-based public information campaigns, especially among alternative mental health service providers and the broader community to raise awareness and empower people with psychosocial disabilities, in partnership with people with psychosocial disabilities, faith leaders, and media.

Shackling of Persons with Psychosocial Disabilities (art. 5, 14, 15, 16, 19, 25, 28)

In Ghana, due to prevalent stigma and inadequate support and mental health services, people with psychosocial disabilities can be shackled. Shackling is a rudimentary form of physical restraint used to confine people with real or perceived psychosocial disabilities by either:

• Using metallic chains, iron manacles or spreader rods, metal leg or hand cuffs, or wooden stocks;
• Tying or binding them with rope or makeshift cloth;
• Locking them in a confined space such as a room outside or within a house, shed, hut, or cage.[19]

Shackling is often used in church-affiliated prayer camps, traditional or religious healing centers, as well as in state-run or private social care institutions as a form of restraint, punishment, or “treatment,” often based on the belief that the person is possessed by evil spirits or may run away or might hurt themselves or others. Men, women, and children with psychosocial disabilities can be shackled for periods ranging from days and weeks, to months, and even years.[20] Some families use shackling as a temporary measure to restrain a person for short periods while they go out to work, when the person is having a crisis, or as a way to prevent or control a certain behavior they find disruptive. People end up living shackled in prayer camps for long periods in part because their relatives do not take them home and the prayer camp has nowhere to send them.[21] In the case of private institutions and healing centers, the management may have an incentive to detain people as they are paid by the family. In many countries, including Ghana, it is a profitable business.

The UN Special Rapporteur on torture, Juan E. Méndez, explicitly noted following his 2015 visit to Ghana that shackling “unequivocally amount[s] to torture even if committed by non-State actors under conditions in which the State knows or ought to know about them.”[22]

The nature of shackling means that people live in very restrictive conditions that reduce their ability to stand or move at all.

In June 2017, in an effort to enforce the law, the Mental Health Authority freed 16 people, including two girls, at Nyankumasi Prayer Camp in central Ghana.[23] Those freed, some of whom have psychosocial disabilities, were taken to nearby Ankaful Psychiatric Hospital. On a visit to the camp in September 2018, Human Rights Watch spoke with Felix, an educated 46-year-old man who was among those freed. He was chained to a tree for five years, and continued to live there, free of chains, in a room on his own. He said, “When I was under the tree, it [was] very difficult there, very much difficult, and… we couldn’t do anything about it.” When asked what it felt like when the chains were removed, he simply said, “We were very much happy.”[24]

Despite the head of Ghana’s Mental Health Authority, Dr. Akwasi Osei, announcing in October 2017 that the government would enforce the 2012 Mental Health Act provision that people with psychosocial disabilities “shall not be subjected to torture, cruelty, forced labour and any other inhuman treatment,” including shackling, and stating that it was “illegal to put anyone in chains,” faith-based and traditional healing centers in Ghana continue to hold people with psychosocial disabilities in chains in inhumane conditions.[25] Of the six prayer camps or traditional healing centers Human Rights Watch visited in Ghana in November 2019, dozens of people were chained in two facilities, either inside fully built and semi-permanent structures, or to a tree or concrete floor outside.[26] Of the approximately 30 people who were staying at Adwumu Woho Herbal and Spiritual Centre in Senya Beraku, a center run by a herbal healer who learned her trade from her mother, at least half were shackled. Several men who were shackled and arbitrarily detained there shouted out to a Human Rights Watch researcher: “Help us get out of the chains. Help us! Help us! We are suffering. They are abusing our rights over here.”[27] At Edumfa Heavenly Ministry Prayer Camp in Cape Coast, people with real or perceived psychosocial disabilities are confined in cages that they are rarely allowed to leave, based on regular visits between 2011 and 2019.[28] Most cages are so narrow that the men cannot even stretch out their arms.

Shackling affects a person’s mental as well as physical health. A person who is shackled can be affected by post-traumatic stress, malnutrition, infections, nerve damage, muscular atrophy, and cardio-vascular problems.[29] The majority of people with psychosocial disabilities admitted to prayer camps are often chained around the clock, for several weeks until the pastor or prophet declares them “healed” and they can be discharged.[30] Prayer camp personnel consistently told Human Rights Watch they used such restraints because most people in the camp were aggressive or would otherwise try to escape.[31] Those in chains were not only unable to join prayers or other activities in the camp but had no movement beyond the length of the chains-usually about two meters: they had to bathe, defecate, urinate, change sanitary towels, eat, and sleep on the spot where they were chained.[32]

Human Rights Watch encourages the Committee to ask the government of Ghana:

• What steps has the government taken to enforce the 2017 ban on the practice of shackling of people with psychosocial disabilities?
• What steps has the government taken to develop adequate, quality, and voluntary community-based support and mental health services?
• What official data is available on the number of people who are or have been subjected to shackling in Ghana?
• What steps has the government taken to align the provisions of its mental health law with the CRPD, in particular those allowing for forced admission, involuntary treatment, and guardianship?
• What steps has the government taken to establish the levy for mental health?
• What steps has the government taken to ensure meaningful consultation with people with psychosocial disabilities?

Human Rights Watch asks the Committee to consider including these recommendations in its concluding observations on Ghana:

• Implement the existing ban on shackling.
• Develop a time-bound plan to shift progressively to voluntary community-based mental health, support, and independent living services.
• Ensure that people who have been released from state and private institutions have access to psychosocial support and social services. Children should have access to child psychologists and specialist support services.
• Progressively develop voluntary and accessible community-based mental health and support services, in consultation with people with psychosocial disabilities and with the support of international donors and partners. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system.
• Create and carry out a deinstitutionalization policy and a time-bound action plan, based on the values of equality, independence, and inclusion for people with disabilities.
• Undertake community support programs and independent and supported living arrangements for people with psychosocial disabilities, particularly those who have been freed from shackling.
• Improve quantitative and qualitative data collection at the local and national levels on the current number of people shackled, the reasons families continue to practice shackling, and the support or services they would need to discontinue the practice.

Involuntary Admission and Arbitrary Detention (art. 14, 19)

Human Rights Watch found in its research between 2011 and 2019 that individuals with psychosocial disabilities in psychiatric hospitals and prayer camps in Ghana were routinely institutionalized, and therefore detained, against their will by family members or police, and denied the opportunity to refuse or appeal their confinement.[33] Some of them were involuntarily admitted because they were perceived to be a danger to themselves, property, or others, and some had problems of drug abuse and addiction.[34] Others were outcasts in their communities or families, and were perceived as being “different” or “difficult.”

Families at times called or paid the police to take relatives with psychosocial disabilities to psychiatric hospitals, and the police, working with local government assemblies, also rounded up persons with actual or perceived psychosocial disabilities when Ghana hosted important visitors.[35] Some of the people with psychosocial disabilities Human Rights Watch interviewed reported that they did not know where they were being taken until they got to a camp or hospital.

Some individuals, especially those taken to hospitals by police on court order, remained even after discharge because their families had abandoned them, and they could not return to their home communities. During a November 2019 visit to Accra Psychiatric Hospital, Human Rights Watch documented 106 people sent to the forensic ward by court order, according to hospital staff. The staff reported that lawyers and police inspectors do not come to the hospital to follow up on the cases. As of that time, one man still in the ward had been detained for more than 20 years. They had only one discharge in the last six months (details about prolonged and arbitrary detention in the children’s ward are provided in the section below).

In none of the hundreds of cases that Human Rights Watch documented worldwide, including in Ghana, were people with psychosocial disabilities allowed or given the opportunity to challenge their detention.[36] In Ghana, the 2012 Mental Health Act established a tribunal mandated to hear complaints of people with psychosocial disabilities detained, under the Act, in psychiatric hospitals against their will, thus enabling them to challenge their admission and treatment.[37] Nearly a decade later, and the tribunal has not yet been set up.[38]

The Act makes provision for the appointment of a guardian with full powers to make decisions on behalf of an individual, as opposed to a support person, on the basis that a person for whom a guardian is appointed is presumed, by a clinical team of mental health professionals, as lacking capacity.

Additionally, whilst the Act foresees voluntary patients’ right to seek release by filling out a Discharge against Medical Advice Form (DMAF), patients who are forcibly “committed” to the hospital do not have such a right under the 2012 Mental Health Act.

Furthermore, the law does not expressly cover persons with psychosocial disabilities detained in other settings such as prayer camps, where no formal discharge procedures existed at the time of Human Rights Watch’s visits: people were allowed to leave only when the prophet considered them ready to be discharged. However, relatives of persons with psychosocial disabilities admitted to prayer camps could ask for their discharge at any time.[39]

Human Rights Watch encourages the Committee to ask the government of Ghana:

• What efforts has the government made to ensure the free and informed consent of people held in psychiatric hospitals and prayer camps?
• What is the government doing to end arbitrary and other forms of unlawful detention in hospitals and prayer camps?
• What steps has the government taken to ensure timely discharge of people with psychosocial disabilities from the psychiatric hospital, including cases in the forensic ward and children’s ward?

Human Rights Watch asks the Committee to consider including the following recommendations in its concluding observations on Ghana:

• Amend or repeal all domestic legislation that is contrary to the CRPD to ensure that persons with psychosocial or intellectual disabilities are guaranteed legal capacity, equal recognition before the law, supported decision-making as opposed to guardianship (plenary and limited), freedom from discrimination, and protection from involuntary detention and treatment.
• Set up a tribunal mandated to hear complaints of people with psychosocial disabilities detained in psychiatric hospitals against their will, as established by the 2012 Mental Health Act.

Overcrowding and Poor Hygiene (art. 25, 28)

People who are shackled are forced to live in extremely unsanitary and degrading conditions, often eating, sleeping, urinating, and defecating in the same tiny area.[40] In Ghana’s psychiatric hospitals and prayer camps, overcrowding has long been a major concern, leading to a host of problems, such as supply shortages and health and sanitation hazards such as bed bug infestations and scabies.[41]

Conditions in psychiatric hospitals have improved steadily, with patients being released to reduce overcrowding.[42] In 2020, Accra Psychiatric Hospital renovated the men’s forensic ward, which previously had filthy toilets and holes in the roof of the dormitory-style rooms.[43]

Overcrowding remains an issue, with some individuals in the forensic ward sleeping outside, often in the hot sun.[44]

In some of the prayer camps Human Rights Watch visited between 2011 and 2019, most people interviewed did not have mattresses, blankets, or mosquito nets.[45] At Mount Horeb Prayer Camp, small rooms that could reasonably accommodate only about eight people had over twenty. People spent all day and night chained in small, hot rooms of about six by four meters, with little to no ventilation. Facilities stank of urine and feces, and there was inadequate water for drinking or bathing. Toilets were broken, overflowed, or nonexistent.[46] In Mount Horeb and Edumfa Prayer Camps, individuals urinated and defecated in buckets in each room or cage. While prayer camp administrators said they emptied the buckets multiple times a day, residents said that the buckets were emptied once daily, usually early in the morning, leaving a pungent odor in the room for most of the day.[47]

Furthermore, women and girls were not supported to manage their menstrual hygiene, for example through the provision of sanitary pads.[48]

On a 2018 visit to Mount Horeb Prayer Camp in Mamfi, jointly with the Mental Health Authority, Human Rights Watch found dozens of people with psychosocial disabilities chained and detained in overcrowded and congested conditions.[49] During that visit, Human Rights Watch found more than 140 people with real or perceived psychosocial disabilities detained in unsanitary and dark rooms, with little ventilation or opportunities to go outside. The stench of urine was overwhelming. One room housed 60 men, some of whom had been there for more than five years. In a November 2019 visit to Mount Horeb, dozens of men were locked up in this room.

A 63-year-old man who had been there since 2012 said, “When I go outside, I feel good. But we don’t get to go outside.”

At Adwumu Woho Herbal and Spiritual Centre in Senya Beraku, Human Rights Watch found 16 men in a dark, stifling room, all of them with short chains, no longer than half a meter, around their ankles. When laying down on thin mats, the men were lined up in the room like sardines in a can, with barely any room between them.[50]

Seclusion and Restraints (art. 14, 15, 17, 19)

Seclusion is one of many forms of solitary confinement. When Human Rights Watch last visited the Accra Psychiatric Hospital in 2019, staff said that they still use the seclusion room, yet the practice was not used often.[51] A nurse in the acute women’s ward at Accra Psychiatric Hospital told Human Rights Watch that they first try to speak with the person, but if they are upset, they use the isolation room on the ward. “If the person is not aggressive, we can hold their hand and take them gently to the seclusion room. If they do not cooperate, we hold their hands and feet, and make sure no body part is injured.” When asked about the conditions in the isolation room, the nurse explained, “It is not a nice place. The last thing is to isolate.”

According to staff nurses in the acute women’s ward, a person is held in isolation for no more than 30 minutes and checked on every 5 minutes. “If the person is not doing well, then we want to make them calm.”[52] The nurse explained that they are then administered antipsychotics and/or sedatives (specifically, 5-10 milligrams of haloperidol and 10-20 milligrams of diazepam).

Human Rights Watch also observed the seclusion room in the forensic ward at Accra Psychiatric Hospital, most recently in November 2019. During that visit, a man was held in seclusion for 1 week because he had a tendency to abscond, according to the staff. The forensic ward staff reported that they use seclusion on average for two people per day, about three days per week. While in seclusion, staff monitor the person every 5-10 minutes.

Former UN Special Rapporteurs on torture Juan E. Méndez and Manfred Nowak have regarded as torture any prolonged isolation of an inmate from others (except guards) for at least 22 hours a day, and have stated that seclusion or solitary confinement in psychiatric hospitals as a form of control or medical treatment “cannot be justified for therapeutic reasons, or as a form of punishment.”[53]

While the 2012 Mental Health Act limits the use of restraints on persons with psychosocial disabilities, it does not abolish restraints completely.[54] An act by one person to restrain another person is generally criminalized, and in such extreme instances where restraint is permitted, specific compliance criteria should be defined, including who has the authority to restrain another person. All acts of restraint that do not meet these criteria, for example assault or unlawful detention, clearly amount to a crime.[55]

Human Rights Watch encourages the Committee to ask the government of Ghana:

• What efforts has the government made to ensure an end to seclusion and use of restraints?
• Has the government taken steps or planned to take steps to reform the 2012 Mental Health Act in line with the CRPD?

Human Rights Watch asks the Committee to consider including the following recommendations in its concluding observations on Ghana:

• Amend the Mental Health Act so as to explicitly prohibit the use of seclusion and the use of prolonged restraint and all restraints as a form of punishment, control, retaliation or as a measure of convenience for staff.

Denial of Food (art. 28)

Many interviewees spoke of persistent, gnawing hunger from forced fasting in prayer camps or inadequate food in hospitals, and many looked hungry.[56] Prophets and pastors in prayer camps told Human Rights Watch that fasting was a key component of “curing” a psychosocial disability as it would help to starve evil spirits, “making it easier for the spirit of God to enter and do the healing.”[57] Some pastors also used fasting as a means to force patients to confess past sinful acts, which are presumed to be responsible for their psychosocial disabilities, and those who refused to confess were forced to fast for up to four days.

Even when they were not forced to fast, people interviewed said there was too little food, sometimes only one meal a day, and some individuals in Hebron Prayer Camp, north of Accra, were denied food for up to seven days.[58] Faith healers reported sharing the little food available among all the residents, especially because some families did not provide food for their relatives, and prayer camps and institutions said they did not have the resources to buy enough food for everyone. While the expectation was that families would regularly bring food for relatives, this rarely happened. Many interviewees appeared undernourished and complained of hunger.[59]

In two facilities Human Rights Watch visited in 2019, people with psychosocial disabilities were not chained, but the head of each camp explained that they were denied food for up to seven days, based on the belief that “fasting” would enable them to use worship and prayers to heal them.[60]

Violations against Children with Disabilities (art. 7)

Children with psychosocial disabilities in Ghana experienced similar conditions to adults in psychiatric hospitals and prayer camps.[61] Some children that Human Rights Watch saw in Accra Psychiatric Hospital had multiple disabilities, which put them more at risk of human rights violations. Despite its name, the children’s ward at Accra Psychiatric Hospital housed people ranging from 14 to 40 years of age. At the time researchers last visited in 2019, there were 14 patients, 7 of whom were children, the other 7 adults. The staff reported that the ward had 14 beds so it was full at that time. At the time of Human Rights Watch’s visit (November 2019), they did not have any admissions since 2014, nor did they have anyone discharged.

Most patients in the ward had been diagnosed with epilepsy, attention deficit hyperactivity disorder (ADHD) or cerebral palsy. Children and adults in the children’s ward were administered psychotropic medications, including antipsychotics, but not all who did so needed it. Dormitories in the ward were dirty, and patients slept on thin mattresses on the floor.

All but two of the 14 people detained in the children’s ward attended a special school on the hospital premises. They also went to the playground just outside the ward (still on the premises) twice per week. The staff confirmed that those living in the children’s ward “never leave”.[62]

In the prayer camps visited by Human Rights Watch, the situation was even worse for children, who were subjected to restraints and other abuses.[63] Victoria, a 10-year-old girl, shoeless and covered with dirt, had been chained to a tree at Nyakumasi Prayer Camp in 2012. She had a serious skin disorder with crusting and bumps on both arms. When asked about this condition, the prophet said it was up to Victoria’s mother to buy medication. Children in prayer camps were subjected to the same regime of fasting as adults and they were chained in the same conditions. Solomon, 9, who lived in Edumfa Prayer Camp and was often chained in the same room with about 20 other males, told Human Rights Watch, “I have been fasting for 21 days… I feel pains in my stomach, my head, and my whole body.”[64]

In 2017, Human Rights Watch documented the case of a 12-year-old girl who did not speak, chained in Nyankumasi Prayer Camp, who had been freed by the Mental Health Authority. She did not attend school nor have any family members with her. The camp authorities reunited her with her family, but reported that she was not yet attending school.

Human Rights Watch asks the Committee to consider including the following recommendation in its concluding observations on Ghana:

• Prohibit admission and treatment of children with psychosocial disabilities in prayer camps, and other forms of inhumane treatment, which would compromise their development and enjoyment of rights as children. Investigate and prosecute those who do not adhere to these principles.
• Ensure access to psychosocial support for children detained in chains.
• Increase efforts to make sure children with disabilities have access to an education, especially children in rural communities and those detained in psychiatric hospitals.