In 2019, the UN reported that mortality rates are up to 50% higher for people in prison than for people in the wider community. With the exception of high-profile deaths or large incidents, deaths in prisons globally remain under-reported and under-investigated.
New research by PRI and the prisonDEATH initiative published in 2022 found that the leading causes of death in prisons vary significantly between countries and regions, as do the methods of classifying causes of deaths. So-called ‘natural causes’, cited as a leading cause of prison deaths in many higher income countries including Australia, Canada, Italy, and South Africa, continue to be used in some cases as a catch-all term conflating different causes of death between old age, illness, and cardiovascular diseases. On the other hand, many countries in Latin America and South Asia cite ‘illness’ and ‘old age’ as the main causes of death, such as Argentina, Chile, Ecuador, India, and Pakistan. In 2020, among 33 European countries that reported to WHO, the most common cause of death in prisons was suicide, followed by COVID-19 and drug overdose.
Violence among people in prison remains a common cause of death in prisons globally, often due to the presence or activities of gangs or criminal subcultures in prisons, chronic levels of overcrowding, and self-governance structures. While fatalities from prison unrest are quite rare in Europe, some Latin American countries report comparatively high proportions of deaths in prison due to violence, particularly related to gangs and organised crime groups (see Prison subcultures and Security and violence). In Ecuador alone, in the 18 months to October 2022, more than 400 people died in prison violence which the government attributes to clashes between gangs. An attack by a cartel on a prison in Mexico in January 2023 left 19 people dead: 10 prison staff, seven detained persons and two attackers.
People in prison have also died as a result of violence or ill-treatment by prison authorities.
A report by Amnesty International in 2022 details consistent denial or delay of transfers to hospital for lifesaving treatment by Iranian prison authorities. Among 96 recorded deaths in custody since January 2010, only 26 (29%) were transferred to hospital, with some families of the deceased told by hospital staff that their loved ones could have been saved if brought to hospital earlier. In Scotland, the Prison Service is being investigated by police for corporate responsibility, including corporate homicide, following the death of a man in 2015, four days after he was violently restrained by up to 17 prison officers. While a decision on charges is pending, this is the first time that proceedings have been initiated against a public or government body in the UK for corporate homicide.
A lack of data collection and transparency continues to be a key problem which, among other issues, contributes to a poor understanding and response to deaths in prisons globally. For instance, only 11 out of 25 countries surveyed by PRI in 2022 publish official information relating to deaths. In a positive move, the Australian Government in 2021 hastened its reporting on deaths in custody; adding to its annual report, it now provides a quarterly dashboard on deaths in prison and police custody.
Data on deaths in prison can be totally absent or highly unreliable and often this is due to lack of transparency or poor or complex data management systems which lead to inaccuracies and undercounting. This frequently happens where different authorities are responsible for different facilities or regions and may not collect the same information or be effectively centralised. For example, an academic review of deaths in custody between 2009–2018 in one Brazilian state found that the actual number of deaths was 2.2 times higher than officially reported for the period. Another academic review in India found that, despite a legal requirement to report every custodial death to the National Human Rights Commission, in 2015 ‘only 31 out of 97 custodial deaths were reported, and only 26 of them were submitted for autopsy’.
Where information is available on the ethnicity of people who die in prison, the causes and circumstances of death reveal trends of systemic discrimination and racial disparities across many parts of the prison system, from access to healthcare to experiences of violence. For example, in Canada’s federal prisons, 83% of suicides in 2020–21 were Indigenous people, who make up 32% of the prison population. Disparities and systemic failures in cases of minorities’ dying in custody were also reported elsewhere, including in England and Wales.