Yet a week ago, an X-ray examination showed that his lungs were clean of TB.

"At the beginning of my treatment, the medical examination showed that I had an acute form of the disease, which could lead to the destruction of my lungs. Nobody believed I could be cured," says Natig Akhmadov (whose name has been changed for privacy).

"At that time four to six prisoners were dying of the disease everyday," said Ali Amirov, deputy director of the TB prison facility in Azerbaijan. Nine years ago he could not believe that the situation in the penitentiary system would take a turn for the better.

In May 1995, the Ministry of Justice and the ICRC decided to start cooperation by setting up a pilot project in the central penitentiary hospital in Baku. The objective of the project was to provide correct, complete and fully supervised treatment for 300 patients. The TB facility was rehabilitated in July 1998. With a 1,000 bed capacity, it has become the primary TB treatment centre for the entire penitentiary system.

"Firstly, the ICRC trained local staff in modern methods of treatment and provided patients with anti-TB medicines. But the most important achievement is the fact that direct observation over taking medicines has become more rigorous, and so it continues," said Amirov, who witnessed the development of the programme since its launch.

Natig Akhmadov believes that correct and full treatment cures TB. "I tell other inmates that those who follow correct treatment, take medicines and regularly get fresh air, can get over this disease. A lot depends on the patient himself."

Today all prisoners in Azerbaijan have access to free-of-charge, high quality modern diagnosis and TB treatment.

"Ten years ago, not all detainees with this disease could be treated with first line anti-TB drugs. Today, if we see any TB symptoms and signs, we immediately send a detainee for treatment in order to prevent complications," said Ilyas Soltanov, chief physician of the TB prison facility.

According to the ICRC, over 7,750 TB treatments were provided to affected detainees since the beginning of the programme under the DOTS (Directly Observed Treatment Short-course) strategy recommended by the World Health Organization (WHO).

In the meantime, another key problem in the penitentiary system has been the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Patients with MDR-TB represent 50 to 60 percent of the mortality rate among TB patients in prisons. Today, there are more than 100 patients with the multidrug-resistant form of the disease in the TB prison facility.

"MDR-TB is not only a problem for penitentiary system, it is a problem for the whole country. Azerbaijan currently has one of the highest rates of MDR-TB in the world," said Faig Agayev, head of the national TB programme in Azerbaijan.

In order to take on the challenge, in 2004 the ICRC assisted the Azerbaijani authorities in submitting an application to the Green Light Committee to launch a pilot project in Azerbaijani prisons. This application was approved and will be financed by the Global Fund to Fight TB, AIDS and Malaria within the national TB programme of Azerbaijan. The ICRC will provide technical assistance for the implementation of treatment within the penitentiary system. In April 2007, the first 8 patients with MDR-TB are beginning treatment for at least two years.