It is well known that prisons are high risk settings, prone to rapid outbreaks of infectious diseases such as Tuberculosis (TB), cholera, Ebola, and now COVID-19. The specific nature of the population and environmental challenges posed by closed settings present many unique challenges in managing such outbreaks. Past experience has shown that national disease management strategies do not adequately address these specific challenges and often neglect prison populations. TB, and particularly drug-resistant TB, remains a persistent problem in many prisons largely due to late diagnosis, inadequate treatment, overcrowding, poor ventilation and regular prison transfers. People in prison also tend to come from population groups where TB infection and transmission are higher. The World Health Organization (WHO) estimates that the TB notification rate in prisons ranges from 11 to 81 times higher than in the general population.
In 2014-2016 the Ebola outbreak in West Africa was met with swift detection, early testing and rapid response in prisons. In Liberia, authorities initiated prison decongestion measures, and non-governmental organisations (NGOs) supported the improvement of sanitation measures with prison authorities, resulting in no reported cases or deaths in prisons. Similarly in Sierra Leone, there were no reported deaths among people in prison from Ebola, largely owing to timely coordinated action by the prison authorities and NGOs such as Advocaid. An observation and isolation centre was set up for newly arrived detainees, staff received training in the prevention of Ebola transmission, and Personal Protective Equipment (PPE) and hand sanitiser were distributed to people in prison and staff.
A number of cholera outbreaks have affected prisons in recent years. Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities and is often associated with humanitarian crises. A 2010 outbreak in Haiti infected at least 30 detained persons and 13 reportedly died from cholera. An outbreak at a prison in Kisumu, Kenya in July 2017 resulted in three deaths. It was reported that a breakdown of the water treatment plant had contributed to the outbreak. An outbreak in Yemen in 2016-2018, as a direct consequence of the ongoing conflict, also impacted prisons. PRI supported efforts to address the outbreak by supplying medicine to meet the treatment needs of 3,600 cases across five facilities, establishing two health clinics in prisons and medical isolation rooms for the treatment of infectious disease, and developing educational materials for people detained on how to prevent the spread of cholera through personal hygiene.
The ongoing COVID-19 pandemic has exposed weaknesses in health systems around the world and the lack of preparedness, prevention and control mechanisms in place for a health emergency of this scale (see Health in prisons, Global Prison Trends 2021).
Because they are highly controlled environments, however, prisons can achieve infection prevention and control through systematic screening on arrival at prison, regular health monitoring of all people in prison and targeted controls on movement in and out of facilities. The prison environment can also allow for identification of vulnerable individuals, early detection, rapid testing and contact tracing, as well as awareness raising and support initiatives, and vaccination and treatment programmes which can reach entire prison populations.
The Irish Prison Service, for example, received praise for its response to the COVID-19 pandemic, with its contact tracing system submitted to the WHO as a model of best practice. The Irish public health response was informed by previous experience of dealing with infectious diseases in prisons, and characterised by early planning, prevention and training in the use of PPE. The effective response was also owing to a clear recognition of the continuum between prison health and public health, and the benefits of collaboration between prisons and public health agencies.
See a complete list of references in the full report, Global Prison Trends 2021.