Prisons are communities too | Pursued by the University of Melbourne

On a given day, over 11 million people waking up in jail or detention around the world. And during each year some thirty million people are released into the community.

Within the walls of prisons and detention centers, there are overcrowding, poor ventilation, inadequate sanitation, and substandard health care services – creating the perfect environment for the transmission of infectious diseases like COVID-19.

Prisons are perfect environments for spreading infection due to poor ventilation and inadequate sanitation. Image: iStock

This is all the more worrying given that prisons and places of detention concentrate marginalized populations with disproportionate rates complex and concurrent health problems, which puts them at increased risk of serious infection with COVID-19.

And these risks extend to the entire community as infectious diseases are easily transmitted by staff, visitors and as people are released.

Despite the consensus of experts on what needs to be done to minimize the impact of COVID-19 in these contexts, the global response has been inadequate.

A recent review identified testing capacity shortages, a lack of prevention and protection measures, insufficient release rates, inhumane use of solitary confinement and a lack of baseline data collection on the number of cases and deaths .

In March 2021, it was estimated that more than 527,000 people detained have been infected with COVID-19 at the World level.

The search for the United States and the UK calculated an infection rate in prisons and other places of detention which is 4.7 and 1.6 times higher, and a case fatality rate which is 2.5 and 3.3 times higher, respectively, than the general population.

However, the real impacts can be much worse due to limited data collection and lack of access to testing in these locations.

Recognizing these challenges and their implications for public health, we have brought together global experts in six webinars to help us answer the question: HHow can we build a sustainable and comprehensive global response to COVID-19 in places of detention?

Here is what we learned.

An example of extreme overcrowding in a prison in El Salvador, in September 2020. Photo: Getty Images

COVID-19 reveals urgent need for reform

The COVID-19 pandemic has exposed an existing humanitarian crisis in prisons and places of detention.

Marginalized populations with complex health needs are overrepresented, yet a lack of investment in health and rehabilitation services means their needs are often overlooked.

These circumstances have led to several murderous incidents of unrest because those detained feared for their safety and human rights. In the wake of COVID-19, the urgent need to reform prison systems has never been greater.

Key elements of the reform needed in the COVID-19 era include focusing on the upstream causes of prison overcrowding, such as the excessive use of custodial sentences; reinvest in improving basic prison conditions and health care; and re-establishing the rehabilitation goals of incarceration to help reduce incarceration in the first place.

Reduce prison overcrowding

Overcrowding makes physical distancing and other infection prevention and control measures almost impossible, severely impedes access to health care, and undermines the intended rehabilitative function of incarceration.

The prison systems of 124 countries are overpopulated, with 22 countries reporting that their prison exceeds its capacity by more than 200%.

Non-custodial alternatives to detention and early release policies have been promulgatedemergency response to reduce overcrowding early 2020. However, reductions in the prison population were not sufficient or supported.

Ongoing efforts to reduce prison overcrowding must be combined with adequate transition planning to help people with complex health and social needs re-integrate safely into the community.

Prisoners await COVID-19 vaccination before appearing in court in Russia in March 2021. Photo: Getty Images

Better collaboration between the health and justice sectors

The long-standing division between the health and justice sectors between jurisdictions has hampered the ability of prison systems to respond quickly to COVID-19.

The management of epidemics, the medical management of cases in prison and community health services, as well as the deployment of immunization are all key issues for which the two sectors must work together.

Incarceration systems have never had a greater need to work closely with community health and social services, especially to support the safe reintegration of people leaving detention in communities facing ongoing epidemics of cancer. COVID-19.

In the long term, better integration of the health and justice sectors will protect detainees and the public from COVID-19 as well as future health crises.

Respect human rights standards

Measures that restrict individual freedoms, including lockdowns of facilities, medical isolation and the suspension of in-person visits, can have profoundly negative effects on those detained, especially those suffering from pre-existing mental illness.

Unfortunately, inappropriate use of punitive segregation and segregation regimes had devastating effects during the pandemic.

The United Nations Standard Minimum Rules for the Treatment of Prisoners stress that detained persons have an established right to safety and security. According to these rules, when a state deprives a person of their liberty, it undertakes to protect their physical and mental health and well-being.

Measures that counteract restrictions, such as increased access to remote viewing, education and entertainment, are vital to supporting mental health and human rights.

Appropriate and consistent levels of independent monitoring and inspection must be put in place to ensure accountability and respect for human rights standards.

Barriers between prisons and health systems need to be better overcome. Image: Getty Images

Better data

The biggest obstacle to protecting the health of those detained during the pandemic is the widespread lack of data collection on health in prisons and places of detention.

Basic information on tests, cases, deaths, vaccinations and measures taken are rarely collected and made public.

This data is the cornerstone needed to monitor and assess the impact of COVID-19 in these contexts, maximize transparency and hold governments and detention authorities accountable for the health of all those in detention.

Research is urgently needed to understand the effectiveness of recommended actions in reducing the COVID-19 disease and its wider impacts on people in detention. These data will improve our understanding of how to optimally respond to COVID-19 and future health crises in these settings.

Listening to people in custody

Last, and certainly not the least, is the need to listen to the voices of those in detention.

Providing detainees with the opportunity to share their experiences is an essential step in respecting their fundamental rights. This information can ensure that we are meeting the broader physical, mental and social needs of those in detention.

Initiatives are already underway in some jurisdictions but must be extended globally.

The pandemic continues to highlight the importance of prisons and places of detention in the public health response to COVID-19.

An effective response to COVID-19 not only protects the health and human rights of vulnerable people in detention, but simultaneously protects the community at large.

The recordings of the six webinars are available on the website Office of Health and Justice website.

Banner: Automated doors at a refugee camp in Samos, Greece, September 2021 / Getty Images


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