The COVID-19 pandemic has exposed the existing failure of many prison systems to meet even the most basic standards of healthcare not least due to poor conditions linked to being underfunded and understaffed. People in prison have faced a heightened risk of contracting the virus and suffering fatal effects. This is due to cramped living conditions that do not allow for physical distancing, unhygienic conditions, the typically poorer health status and higher social vulnerability of prison populations, and the regular flow of staff and others in and out of prisons. Prison staff have also faced increased risk of contracting the virus with the proportion of COVID-19 cases in prisons among staff as high as 60 or 88 per cent in some countries (see Prison staff).
Global figures for infection and deaths due to Covid-19 in prisons are limited by what is publicly available, so the true impact on people in prison and staff will be much higher than reported. Barriers to accurate data include lack of transparency in some countries and insufficient testing in places of detention, due to lack of resources or low priority given to places of detention. For example, in Argentina, less than 4 per cent of the federal prison population had been tested by August 2020. In Brazil, it has been suggested that infection and death rates in prisons could be three times the official figures due to limited testing and lack of clarity on how data is collected and what tests are used. The numbers supplied by federal and local penitentiary administrations have not matched, and by July 2020 only an estimated 3.2 per cent of the prison population had been tested.
Testing is often only carried out for people that are newly admitted in prison or showing symptoms, rather than as a preventive measure to stop the spread of the virus.
In Thailand, no national data is available, but some prisons reported regular testing for new arrivals in prison, those returning from court or hospital, and staff accompanying them. There are, however, regional variations. In most of Europe testing is widely available for prison staff, newly admitted people to prisons and those showing symptoms.
The data available suggests that while some countries avoided high infection or death rates in prisons compared to the community, like in Kazakhstan and Ireland, many others were unable to control outbreaks. As of March 2021, the highest reported rates of COVID-19 in prisons have been in Barbados (44,588 per 100,000), the US (18,616 per 100,000), Colombia (18,190 per 100,000), Guyana (15,393 per 100,000) and Sri Lanka (14,719 per 100,000).194
Analysis of COVID-19 risk factors in a prison setting by outcome found dormitory housing to be the highest for infection rates, but many prison systems with single or double cell-style infrastructure have also failed to prevent prisons becoming epicentres for the spread of the virus, including in high-income countries. By June 2020, the number of COVID-19 cases among people in US prisons was 5.5 times that of the general population, while the death rate was threefold, and by August, 90 of the 100 largest cluster outbreaks had occurred in prisons. The second wave hit prisons in some countries more severely, including in Europe. In England and Wales, figures from December show the number of people who tested positive for COVID-19 in prisons since the start of the pandemic rose by 70 per cent in a month, and deaths following a positive test rose by 50 per cent.
Many prison systems have failed to implement critical preventive measures recommended by the World Health Organization and others, such as providing personal protective equipment (PPE) for prison populations and staff, training on the use of equipment and preventive measures, and ensuring access to healthcare services. In July 2020, the Brazilian President vetoed legislation that would have made mask use mandatory in prisons. Protests were reported in many prison systems, including in Uganda, where overcrowding in the prison system is over 300 per cent and the lack of PPE and measures to prevent transmission led to escapes and protests in some facilities.
Civil society organisations and international organisations have worked to fill the gaps in many places.
For example, PRI has supported the procurement and distribution of PPE in prisons in Jordan and Uganda, and provided posters with infographics to educate detainees and staff on the virus in Kazakhstan and Tajikistan. In Central African Republic, PRI has supported capacity-building for prison staff and civil society to raise awareness on measures to prevent the spread of infection, and the distribution of protective equipment like facemasks. The International Committee of the Red Cross and UN agencies have provided support to prisons in a large number of countries.
The low levels of medical staff and resources for healthcare in prisons pre-pandemic in many countries have been further stretched over the past year impacting on the ability to meet demands from COVID-19 and other health issues. In Argentina, restrictions on movement in some cases prevented professional staff like psychologists and health workers from entering the facilities. This reduced access to healthcare which was already scarce for people in prison. There were calls to address the severe shortage of medical staff in Indian prisons due to the challenges coping with the pandemic. Records show that prior to the pandemic, one state had no medical officer, while 12 states and territories were understaffed by 50 per cent. Half of Brazil’s 1,422 prisons have no medical offices or rooms equipped for treating infected people, and those that do lack medical staff. This has led to difficulties managing quarantine systems, and many people suspected or confirmed to have the virus go back to living among others without being checked to see if they are still infectious.
In the US, 38 out of 50 states charge people in prison fees ranging from USD $2-8 to see a doctor, on the grounds that it would deter people overusing services or overstretching staff. In response to the pandemic, 11 states waived fees and others have suspended them for people exhibiting coronavirus symptoms. A 2020 report in the Republic of Korea found the demand for medical care has risen steadily in prisons, and the number of treatments has almost doubled in the past decade. However, no prison has filled the number of medical officers in that time, leaving facilities short staffed and leading to calls this year for access to universal healthcare services for people in prison.
The most common measure employed by at least 46 prison administrations globally has been medical isolation of individuals showing COVID-19 symptoms.
Various measures have been taken for dealing with coronavirus cases in prisons. The most common employed by at least 46 prison administrations globally has been medical isolation of individuals showing symptoms compatible with COVID-19 until testing can be carried out, or a positive test confirms infection. In prisons from Kosovo to Slovakia, Paraguay and Uruguay, this has involved the creation of isolation areas that allow for social distancing protocols. Prisons in Guatemala, Czech Republic and elsewhere facilitated transfers of those sick to hospital, while Turkey appointed additional doctors to minimise transfers from prisons. For asymptomatic people who have been in contact with suspected cases, some prisons like in Portugal and Bulgaria have designated spaces for quarantine where they are monitored for 14 days from the contact. Some have housed detainees with similar risk factors together while they undergo quarantine.
In regard to ailments or conditions unrelated to COVID-19, access to healthcare has been reduced in many prisons with serious effects. Many patients have waited longer for treatment or routine appointments as it has been harder to book or attend medical appointments, particularly treatment that requires escort to and from hospital. In some cases, illnesses have had to reach chronic levels before treatment can be accessed.
People who use drugs in prison faced heightened risks during the pandemic due to underlying health issues and a lack of access to harm reduction and healthcare services.
The majority of prisons globally still do not provide adequate treatment and harm reduction measures for people who use drugs, and women in particular have little to no access to available services. Furthermore, many such services that are available in prisons have been suspended during COVID-19 restrictions, for example Opioid Agonist Therapy programmes in at least certain prisons in Moldova and Kyrgyzstan. One notable exception was seen in Kenya, where civil society efforts resulted in the opening of the first Opioid Agonist Therapy programme in Africa, in the Shimo La Tewa prison facility in Mombasa.
While telemedicine was established in some countries before the pandemic, including in the US, Thailand, France and Romania, its use was not widespread. In some places, the pandemic has acted as a catalyst for digital innovation to mitigate the impacts of restrictions on movement on healthcare provision in prisons. In England, a two-year pilot telemedicine programme using secure 4G tablets for health visits and access to medical notes was launched in June 2020. In Sweden, use of the existing Skype platform was expanded to facilitate appointments between prison healthcare staff and detainees remotely. Doctors were assigned to 24 prison institutions in Morocco and new communications technology was set up to facilitate weekly remote medical consultations, and Armenia is also looking to introduce telemedicine in the penitentiary system.
Phone and internet-based services have also been used for mental health provision in a number of systems to mitigate the suspension of external visits.
In one US prison, access to tele-psychiatry was expanded to 60 per cent of all sessions, with training provided to staff and patients on how to use the equipment, which also reduced time escorting patients and helped to conserve the prison’s PPE supply. Tele-psychology was introduced on Irish prisons at the start of the pandemic, which consisted of 20-minute telephone sessions, and a national telephone line was established which allowed access to some services. In Sierra Leone and Kenya, civil society organisations are providing counselling to clients in prisons over the phone as an extraordinary measure during the pandemic.
In many other countries, however, mental health programmes and support networks, or access to psychologists and mental healthcare professionals have been suspended or cut down over the past year. Many prison systems have been unable to deliver adequate mental healthcare provisions due to a shortage – or a total lack – of mental healthcare professionals. In Colombia, mental healthcare provision in prisons has been problematic and women in prison have less access than they did previously. The suspension of family visits in Argentina resulted in an increase in requests for mental health consultations in prisons, straining capacity.
These shortages are particularly of concern given the serious mental health impacts of COVID-19 measures on people in detention, the full impact of which is yet to be understood. Increased isolation, use of solitary confinement and the suspension of family visits, education, treatment and rehabilitation programmes – all factors which contribute to good mental health – have impacted all people detained, and especially those with an existing mental health condition. In Italy, there were 61 suicides reported in prison in the year 2020, a rise from the year before. A report on the experience of people in isolation in Irish prisons found that the lack of social contact and purposeful activity, inconsistency and uncertainty in regime delivery, and feelings of being punished for being vulnerable contributed to deteriorating mental health.
At least 13 countries have prioritised prisons in vaccination plans or roll-out; a further 11 countries have explicitly included, but not prioritised, prisons in their planning or roll-out.
See a complete list of references in the full report, Global Prison Trends 2021.