MOSCOW -- "I have trouble breathing. I can't catch my breath and have trouble understanding things," said businessman Boris Shpigel, who is suspected of bribing the former governor of Russia's Penza region, at a court hearing on April 6. "I'm in great pain…. My stomach hurts and I can't catch my breath."
"I don't have long left, a few days," Shpigel, 68, predicted. "I haven't slept for six days because I can't find a comfortable position. I hurt all over and my right leg is numb…. Every day is torture for me. I can't take anymore. I can't stand it."
Such allegations are nothing new for Russia's opaque prison system. For years, activists, lawyers, and former prisoners, have drawn attention to the poor quality of medical care in Russian prisons and pretrial detention centers and have alleged that, in many cases, medical treatment is withheld to pressure suspects, to extract false confessions or accusations, or simply as a form of punishment.
"As for medical care overall, often a prison will only have a paramedic and no real schedule for when specialists will visit," said Asmik Novikova, director of research at the nongovernmental legal aid organization Public Verdict. "This is, of course, a very serious problem."
Now attention across Russia and around the world has turned to the plight of opposition political leader Aleksei Navalny, who is serving 2 1/2 years at a prison in the town of Pokrov in the Vladimir region based on a conviction that he says was politically motivated. Navalny and his attorneys have alleged that he is being subjected to a "deliberate campaign" to undermine his health.
He has said he has two herniated disks and is losing sensation in his arms and legs. His lawyers have said Navalny has not fully recovered from a nerve-agent poisoning that nearly killed him in August and that he blames on Federal Security Service (FSB) operatives working at the behest of President Vladimir Putin.
Navalny has lost 13 kilograms since his imprisonment and continues a hunger strike aimed at forcing prison officials to allow him to be treated by his own doctor.
In addition, Navalny has said at least three prisoners in his ward have been diagnosed with tuberculosis and he himself was moved to the prison sick ward on April 5 with symptoms of respiratory illness.
Prison authorities have said they were monitoring Navalny's health, which they evaluated as "satisfactory."
Novikova said there is no real way of finding out what the real situation is in the prison where Navalny is being held because "all information about what goes on in prisons is monopolized" by the Federal Penitentiary Service (FSIN).
"We have to settle for whatever they indicate from time to time in public records," she said. "But from what I am seeing, it's clear there is basically no medical help there."
Despite Navalny's high public profile, his story is all-too-familiar to prisoners' rights advocates, said Oleg Dubrovkin, who spent 24 years in Russian prisons and now works at the Prisoners' Rights Defense Foundation. He says assisting prisoners who complain of health and health-care issues is one of his main duties.
'Mechanism For Pressuring Inmates'
The prison system, he said, has strict rules for the provision of medical care, but they are applied chaotically.
"Whether or not they are applied in the institution where Navalny is being held, I don't know," he told RFE/RL. "To me all the prisoners are the same, whether it is Navalny or just some average Petrov. It doesn't matter."
Sergei Shunin is a lawyer for the NGO Committee Against Torture who formerly served on a public oversight commission (ONK) that theoretically is able to inspect and monitor prisons, agrees that the opacity of the prison system is a major problem that could conceal many others.
"In my experience, I have seen many complaints from prisoners who say that people suffering from tuberculosis have been placed in their wards," Shunin said. "They often believe that this is done to pressure them and that the refusal to provide medical care is often a mechanism for pressuring inmates."
"It's impossible for me to evaluate the situation with Aleksei Navalny," he added. "As a lawyer and as a former ONK member, I have to proceed from facts. The first thing I would do would be to examine his medical file and speak with the doctors. As far as I understand, the members of the Vladimir region ONK have not done this and that itself is rather strange."
Shunin adds that a persistent problem for Russia has been the lack of qualified medical personnel in the prison system, which he argues is caused primarily by the low wages they are paid.
"A doctor in a prison, as I have been told, earns about 10,000 rubles ($130) a month, including bonuses," he said. "With wages like that, this problem isn't going to go away and, unfortunately, no one is doing anything about it."
Shunin said the most common complaint he dealt with during his ONK service from 2016 to 2019 was about the lack of medical care.
Yevgeny Yenikeyev served on an ONK commission in Moscow and he told RFE/RL that the prison's refusal to allow Navalny to consult a private physician was illegal.
"Under the law, any civilian doctor can come to a prison at the request of an inmate," Yenikeyev said. "However, only a prison doctor can order an inmate's transfer to a civilian hospital, since that requires a special escort and additional labor. But when the doctor is ready to come to the prison at his or her own expense and there are no additional costs, then it must happen if the prisoner desires it."
"In the case of Aleksei Navalny, the refusal to allow him to be examined by a doctor is illegal," he added. "We can talk forever about the motives for the prison administration's refusal. It is very hard to know what is going on in their heads."
On March 26, when Navalny's health complaints were becoming increasingly serious, Kremlin spokesman Dmitry Peskov dismissed them out of hand and added: "We don't know about any systemic problems in the Federal Penitentiary Service."
The same day, Navalny posted on Instagram that he had once been given prison tips from former oil tycoon Mikhail Khodorkovsky, who served a decade in Russian jails and prisons from his arrest in 2003 to his release under pardon in December 2013.
"He told me the main thing is not to get sick," Navalny wrote. "No one is going to treat you. If you fall seriously ill, you will die."