Draw lessons from Covid to improve jail healthcare

LAST month, the Bombay High Court questioned the Maharashtra Government on the staff vacancies of doctor in the state’s 47 prisons. Almost one-third of the sanctioned posts are lying vacant in these prisons. Stating that there are only 32 doctors for more than 30,000 prisoners, the Bench hearing the matter stated, “We are not asking you to increase the sanctioned strength, at least fill the sanctioned posts. Once you have sanctioned, is it not your duty to fill the posts?”

This comes at a time when the country is reeling from the deadly second wave of the Covid-19 pandemic. Prisons continue to be one of the vulnerable spaces for the spread of the virus. Yet, little has changed since last year when Covid-positive cases were reported from prisons.

It was already very late last year, when concrete measures were rolled out to control its spread inside prisons. Data compiled by the Commonwealth Human Rights Initiative (CHRI) shows that between May and December 2020, more than 18,000 prisoners and prison staff had tested positive, while 17 persons lost their lives. Healthcare systems inside prisons, that were inadequate to deal with the needs of inmates and authorities, had suddenly found themselves forced to deal with the pandemic.

This trend continues in the second wave of the pandemic. In 2021, there have already been more than 4,000 positive cases and 18 deaths, both of prisoners and jail staff.

The issues of inadequate medical infrastructure, heightened concerns about staff vacancies and increasing workload in prisons has remained largely absent from public visibility. International rights bodies have emphasised the need for governments to prioritise prisons and take steps to curb the spread of the virus.

The World Health Organisation (WHO), in a joint statement with the United Nations Office on Drugs and Crime (UNODC), the Office of the High Commissioner for Human Rights (OHCHR) and the United Nations Programme on HIV/AIDS, drew international attention to the “heightened vulnerability of prisoners” and urged the authorities to take all appropriate public health measures in respect of this vulnerable population.

Terming physical distancing and self-isolation as practically impossible inside prisons, United Nations High Commissioner for Human Rights Michelle Bachelet, too, had pressed the governments to find ways to release prisoners, especially those more vulnerable to the infection.

As per the National Crime Records Bureau data in its annual report, Prison Statistics India, as in December 2019, there were only 1,962 medical staffers catering to the day-to-day medical needs of 4.78 lakh prisoners. In the same period, on an average, only Rs 5 per day was being spent on the healthcare needs of a prisoner.

Various other underlying issues that reflect the overall grim state of healthcare inside prisons include:

n Lack of specialised doctors visiting prisons

n Lack of medical escorts for transportation of inmates to hospitals outside jail premises

n Challenges with regard to procurement of medicines

n High rate of persons suffering from tuberculosis, HIV/AIDS, hepatitis C and skin allergies.

n High rate of death by suicide inside prisons also points to inadequate access to mental counseling and treatment. In 2019, the rate of death by suicide stood at 24.24 per lakh prison population, which was more than double than in the general population.

Healthcare management and medical infrastructure are crucial aspects of prison management due to the unique nature of the system of confinement: large numbers of people in close contact with each other in restricted spaces, often leading to overcrowding. As a result, prisons are bound to face constant health issues and recurring medical requirements.

Access to adequate and quality healthcare is a basic right which becomes even more crucial in spaces of confinement. It cannot be denied to any person. As observed by the Institute of Criminal Policy Research (ICPR), “a sentence to imprisonment is a sentence of deprivation of liberty, not a damage to health.”

In the ongoing pandemic, prisoners are cut off from the outside world at a time when improved public health communication and the attention and care of and by loved ones are crucial. They face severe curbs, including temporary suspension of physical mulaqaat (meetings) and delays in their trials.

The pandemic has created hindrance in the court work, with focus laid on hearing of urgent matters. This has resulted in a significant increase in the pendency of cases. According to the National Judicial Data Grid, between 2019 and 2020, the backlog of cases has increased by 18.2 per cent in district courts, 20.4 per cent in high courts, and 10.35 per cent in the Supreme Court. With an increase in the period of detention pending trial, it is bound to impact the undertrial prison population — that accounts for almost 70 per cent of the total prison population in India.

The pandemic presents an opportunity for prisons to meet the gaps in prisoners’ access to medical care. The governments should treat health as a top priority for all citizens, including those behind bars. Prison healthcare should be an integral part of the public healthcare system in India, both in letter and spirit.

Public healthcare received a meagre 1.8 per cent of the GDP in 2020-21. The National Health Policy of 2017 recommends that the expenditure on health should be increased to 2.5 per cent of the GDP by 2025. The pandemic also resulted in an increased burden on the already under-resourced prison system, both financially and in terms of human resources. It is only when the overall healthcare systems are improved in the country through adequate funding, will things start improving inside the prisons.

To start with, the focus must be on filling medical vacancies in prisons, with at least one doctor per 300 inmates as per the Model Prison Manual 2016. Prison overcrowding is one of the key issues contributing to poor health standards and hygiene. It must be kept in check. Both men and women inmates should enjoy equal access to prison hospitals, proper diet and timely referral to outside and specialist hospitals. Prison departments and state health departments must collaborate to ensure regular visits by psychologists, psychiatrists, dentists, gynaecologists and other medical specialists.