Healthcare For The Prisoners

Reading time : 12 minutes

Introduction

“If people get sick, we take them to the hospital and give them the right medicine to get better. If people’s behavior is sick, we bring them to the prison, but we forget the medicines.”

– Sri Sri Ravi Shankar

People assume that inmates are sent to jail as punishment, not for punishment. This means that imprisonment in a closed space enforces the loss of an individual’s right to freedom. Nevertheless, keeping the individual in the custody of the state should not have a negative impact on him. Yet this is, sadly, the case with many of the world’s jails, to some degree or another. Is it then possible to describe in a jail what a safe atmosphere is? Let alone, to speak about a prisoner’s right to health care to be given to him by the prison authorities?

The response to this question is that prisoners have the inalienable rights bestowed on them by international treaties and agreements, are entitled to health care, and are most probably entitled not to contract prison illnesses. Prison jurisprudence acknowledges that, because of incarceration, inmates do not forfeit all their rights. There is, however, a loss of rights within custodial institutions that continues to occur. Public health policies are intended to ensure that all members of society have the best possible living environments, so that everybody can be safe. Prisoners in this equation are frequently forgotten. All sorts of people who come in and out of jail every day are in direct touch with them. This continuous movement in and out of jail makes it all the more crucial that any infectious infection inside the prison is monitored so that it does not spread to the outside world. In India, the issue of hygiene has been made worse by overcrowding. Conditions are appalling in many jails. Even rudimentary conveniences are not given at the Tehsil level jails. Prisoners in India are not even tested for particular infectious diseases, although when they begin serving their sentence, all prisoners undergo a medical examination. At the national level, no studies have been done on the prevalence of viral infections among prison inmates. The prison manuals of India provide for the segregation of inmates suspected of having contagious illnesses. In order to prevent the spread of infections, a few jails have established informal contacts with medical and social organizations to counsel inmates. From the beginning of the present system in the middle of the last century, the issue of health hazards in Indian prisons has been felt intensely. To begin with, the death rate among prison inmates was so high that in one decade, the 1864 Jails Committee estimated the number of people who died in jails to be 46,309. The key causes were due to the following factors[1]: 1) overcrowding, 2) inadequate ventilation, 3) poor preservation, 4) poor drainage, 5) clothing insufficiency, 6) sleeping on the ground, 7) lack of personal cleanliness, 8) bad water, 9) labor extraction from unfit citizens and 10) insufficient medical examination.

Human Rights In Context Of The Prisoners

Abuse has multiple causes in prison settings. Clashes may have racial triggers, or clan or gang rivalries. Closed living conditions, often vastly overcrowded, also contribute to hostilities between prisoners. The tedious prison atmosphere, lack of mind and body occupation, and just plain boredom contribute to cumulative dissatisfaction and tension. This atmosphere paves the way to high-risk activities, such as drug use and male sex. To counter boredom, some engage in these sports. Others, however, are compelled to participate in them, in a manipulative play for influence or financial benefit. Risky lifestyles can lead to disease transmission from one inmate to another and, if unchecked, pose a significant public health risk. It is not part of a prisoner’s punishment to contract any illness in jail. When the illness is potentially fatal, this fact becomes much more important, as is the case with HIV/AIDS.

The food provided to the prisoners is the other component of the problem. The dilemma here is that the quality and quantity of food supplied must be linked to the prison purpose. The current policy is that a standard diet adequate to maintain health and strength should be provided to prisoners. And how much of the prescribed food and what consistency actually reaches the inmate is a matter of speculation, since it is common knowledge that corruption is prevalent in the administration of the prison. In India, the main issue of hygiene has been exacerbated by overcrowding and extreme workers crunch. Prison inmates in India are also not even screened for particular infectious diseases, but before they begin completing their sentences, all prisoners undergo a medical examination. The NHRC also took note of the insufficient medical services in the country’s numerous jails. While prison laws made it necessary for an inmate to have a medical examination at the time of entry, it remained a mere formality in most cases. All States were ordered by the commission to screen all the prisoners in custody for tuberculosis.[2]

Indian Prisons & Their Status

The All India Jail Manual Committee, an Indian government board, reported in the late 1950s: overcrowding in jails has become a common problem almost throughout India. The cells and barracks originally built to house prisoners have been turned into storage spaces, godowns, workshops, etc. in some prisons. Therefore, the original approved accommodation is diminishing, although a steady rise is shown by the daily average population and total admission. As a result, the proportion of a major concern for the Correctional Administration has been presumed by overcrowding. According to INBA[3],

  • There is an increase or spurt in the number of prisoners in India lodged in detention centers and jails.
  • In addition, in the report, some 4.12 lakh inmates, including pre-trial detainees, were lodged in various jails in India. Many of these inmates, however, come from the under-privileged parts of society, disadvantaged or socially backward classes, and they do not have much knowledge of health and ultimately unhealthy lifestyles.
  • A decent number of almost one-third of them remained in detention facilities for an average period of almost three months, it was observed. There is a generally positive connection between inmates in various detention facilities, between inmates and the outside world, and between inmates and health centers.
  • There was an excessive incidence among the inmates of diseases such as Sexually Transmitted Infections (STIs), HIV-AIDS, Hepatitis B and Hepatitis C etc.
  • Around 10 percent of the detainees in Indian prisons suffered from HIV in a study carried out between 2007-2010.

According to the Prison Statistics India 2015 Report:[4]

  • At 14 percent more than capacity, Indian prisons are overcrowded. Undertrials account for more than two-thirds of the prisoners. Chhattisgarh and Delhi are among the top three in the list, with more than twice the capacity for prisoners.
  • 77.9 percent of the prisons in Meghalaya, 68.8 percent in Uttar Pradesh, and 39.8 percent in Madhya Pradesh are overcrowded. UP had the highest number of sub-trials, followed by Bihar (23,424) and Maharashtra (62,669). (21,667).
  • 82% of prisoners in Bihar were sub-trials, the highest among states.
  • More than 25 percent of underground prisoners were detained for more than one year in 2014 in 16 out of 36 states and union territories; Jammu and Kashmir are at the top of this list with 54 percent, followed by Goa (50 percent) and Gujarat (50 percent) (42 percent ). In the absence of any efficient systemic intervention, jails across the country will remain overcrowded as there are a huge number of cases pending.
  • By international standards, the proportion of the prison population awaiting trial or sentence in India is exceptionally high; for instance, it is 11 percent in the UK, 20 percent in the US and 29 percent in France.
  • Nearly 43 percent of the undertrial population, which accounts for nearly 1.22 lakh, remains in detention for more than six months until more than five years by the end of 2014. In fact, many of the under-trials spent more years in jail than if they had been convicted, the actual sentence they would have served.

Analysis

In its landmark judgment in Parmanand Katara v. Union of India (1989) and others, the Supreme Court of India ruled that the state has a responsibility to protect life, whether it is an innocent individual or a convict responsible for punishment under the law. With special regard to health, the Universal Declaration of Human Rights has already recognised the right to conditions which are sufficient for the health and well-being of everyone. In addition, the International Covenant on Economic, Social and Cultural Rights (ICESR) states that inmates have a right to the highest level of physical and mental wellbeing that can be attained. The provision of health care for them is governed by the minimum quality rules for inmates. Apart from civil and political rights, the so-called economic and social human rights of the second generation, as set out in the ICESCR, are also applicable to prisoners. For prison health conditions and health services, the right to the highest attainable quality of health should also apply. This right to health care and a safe environment is specifically related to other rights of the first generation, such as non-discrimination, privacy and confidentiality, in the case of HIV in particular. In their situation of incarceration, inmates can not protect themselves, and it is the duty of the state to provide health care and a safe climate.

Human rights instruments call for inmates to receive at least equal health services to that provided to the outside community. Equivalence rather than equality has been called for, on the one hand, since a jail is a closed facility with a custodial function that does not necessarily allow the same treatment available outside to be given. When they reach jail, inmates are more likely to still be in a poor state of health, and the adverse circumstances therein exacerbate the health situation. Thus, in a prison, the need for health care and treatment would always be greater than in an external setting. However, it has proved extremely difficult in India to provide even basic health care to inmates, as the health system is continuously insufficient. The human atmosphere in prisons is always one of brutality and high-risk lifestyles, either willingly participated in by those inmates with positions of authority or placed upon the poorer inmates. Prisoners have the right to live in conditions which guarantee their individual protection. A detailed understanding of how HIV is likely to be transmitted in a given prison is paramount for the prison administration. If the key concern is sexual coercion and/or abuse, it is important to implement stronger monitoring and prompt intervention to protect targeted prisoners. Access to recreation, schooling or access to the outside world should not be refused to HIV-positive inmates. There is no reason for segregation from a purely medical point of view, as long as the inmate is safe. Solitary isolation should be forbidden for HIV-positive prisoners. Any limitations, such as mandatory testing for especially dangerous conditions, such as inmates working in hospitals or dental clinics as medical orderlies, should be exceptional. Personal protection issues may also occur where, for instance, inmates considered to be HIV-positive seek to be held in a secure unit as they fear for their own safety.

If the many issues facing Indian prisons are to be overcome, both jail reform and penal reform are essential components. Improving the physical and working conditions in prisons and helping to ensure the safety of all people in detention would allow a reduction in the total prison population. Evidently, the prison facilities would still continue to have financial resources dedicated to them. Offering alternatives to imprisonment for non-violent and civil prisoners will be one successful way to reduce the increase of prison populations.


[1] Indian Jails Committee Report (1864) 10. 

[2] 1997-1998, NHRC Report. 

[3] State of Hygiene in Indian Prisons, INBA Viewpoint, 2019.

[4] Why We Need to Talk About the Condition of India’s Prisons, The Wire, https://thewire.in/uncategorised/india-prison-conditions. 

Author: Rehan Ahmad

Editor: Kanishka VaishSenior Editor, LexLife India.

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