COVID-19 has created unprecedented challenges for criminal justice systems worldwide. This challenge is compounded by the complex healthcare needs of many people in prison – both physical and mental – some which pre-date imprisonment. Poor health amongst people in prison is often also due to poor conditions and a lack of adequate healthcare services, which has seen outbreaks of COVID-19 in places of detention and continues to risk millions of people.
As countries across the world battle to contain COVID-19, people in prison are at particular risk because of the difficulties of containing the virus in often overcrowded settings with little fresh air, poor sanitary conditions and limited access to healthcare. We have called for urgent measures to reduce prison populations to reduce overcrowding, among others, to help prevent the spread of COVID-19 in places of detention.
The high risk of mass outbreaks of COVID-19 in prison is exacerbated by the likelihood of existing health conditions of people in prison having been ignored or neglected. Health problems can also develop easily within prisons due to unhealthy and unhygienic conditions and inadequate control of infectious diseases.
The likelihood of infection with HIV/AIDS, tuberculosis (TB) and other diseases in prisons is high due to rates of drug dependency as well as overcrowding. Addressing the needs of people in prison who use drugs is a critical challenge for successful rehabilitation for both public health and preventing re-offending. This includes providing harm reduction measures. Unfortunately, many countries take a criminal justice approach, rather than a public health approach, to healthcare in prisons. There are even cases of people in prison being denied basic healthcare as further punishment.
Healthcare provision in prisons in many countries is inadequate and underfunded. In some countries that lack healthcare staff, sometimes non-medical staff, or even people detained, undertake medical duties.
Healthcare in prisons should be sensitive to the needs of people in prison. For example, women in prison often do not have access to free sanitary products or reproductive healthcare as required by the UN Bangkok Rules. For transgender individuals, access to hormones and medicines are needed in order to ensure sound mental and physical health.
Research suggests that around one in seven prisoners has a serious mental health condition. The UN Nelson Mandela Rules state that people with severe mental health issues should receive treatment rather than imprisonment. Where people with mental health issues are detained, prisons should seek to protect their mental health from further deterioration through a holistic response. In reality, in many prison systems, the mental healthcare needs of the population are yet to be addressed.
International law requires the rights for all people, including those deprived of their liberty, to enjoy the highest attainable standard of physical and mental health. In practice, the healthcare services many people in prison receive is of an inferior standard to that available in the wider community, and some do not receive treatment at all.
People with disabilities
Working conditions of staff
Rehabilitation and reintegration