Tamara Léger has worked as a researcher and adviser in human rights research, campaigns and advocacy for Amnesty International in Madagascar. Her work at Amnesty focused on criminal justice issues and the protection of natural resources. Here, Tamara draws on her previous research experience to highlight the severe impact of prison overcrowding on health and access to healthcare. She warns of major public health risks if prisoners are denied adequate care, particularly in a pandemic.
The protection of prisoners' human rights has been a priority for Amnesty International since its foundation in 1961. While we have made some great gains protecting and promoting human rights in prisons, there’s still a lot of work ahead of us. Our research on prison conditions shows that prisoners’ human rights, including their right to health, continue to be violated around the world.
Overcrowding is one of the most serious contributing factors: it is extremely difficult to uphold prisoners’ rights in a context of overcrowding. It poses security risks and places further strains on already limited human, material and financial resources. More than 102 countries have prison occupancy levels over 110%, with a significant proportion of prisoners charged with (or convicted of) non-violent crimes.
Madagascar is one of them: its prison system holds more than twice its intended capacity. On the ground, most cells I visited held between two and ten times the number of people they had been built to accommodate. More than 50% of the prison population are in pre-trial detention, meaning that they have not been convicted or finally sentenced. The overwhelming majority are from poor backgrounds. Unable to pay for a lawyer or bribes, they are forced to wait behind bars, in inhumane conditions of detention.
Improving conditions of detention in Madagascar
As a researcher covering Madagascar, I investigated the impact of such overcrowding and excessive pre-trial detention. Prisoners I spoke to - including children as young as 13 years old and pregnant women - complained about the cells being filthy and crowded, infested with rats and extremely hot. They reported not having access to adequate medical care.
The impact on prisoners is obvious, ranging from poor mental and physical health to, in the most extreme cases, death. But the lack of access to health in prisons is a problem for society at large. It poses a public health risk for families and communities in the outside world. It also undermines the confidence of the overall population in the justice system, and ultimately threatens the rule of law.
In the past three years, Amnesty International has campaigned tirelessly to improve conditions of detention and access to justice for prisoners in Madagascar, with some success. President Andry Rajoelina visited a prison following the launch of our 'Punished for Being Poor' report (2018), which highlights the impact of the country’s broken criminal justice system on human rights. The president has made bold promises to tackle the failures of the criminal justice system and there have since been and some judicial reforms and prisoner releases. Yet our work is far from over.
In August 2020, 88 detainees in the Farafangana prison in Madagascar attempted a prison escape. They had previously expressed great fear of being infected with COVID-19 given the severe overcrowding and lack of access to healthcare. They were severely impacted by the lack of access to family or lawyer visits. The Minister of Justice allegedly ordered the government security forces to ‘take all necessary measures’ to deal with the situation. They killed 23 prisoners.
What the pandemic revealed about prison health
Violations of prisoners’ right to health are commonplace, not only in Madagascar, but across the world. The COVID-19 crisis has highlighted years of underinvestment and neglect of the health services in prisons.
In March 2021, Amnesty International released a report ‘Forgotten behind bars: COVID-19 and Prisons’, produced in collaboration with Prison Insider. It exposes how prisoners around the world have been forgotten during the COVID-19 pandemic. Of the 11 million people estimated to be imprisoned globally, many struggle to access soap, proper sanitation, or personal protective equipment (PPE). Physical distancing is difficult – if not impossible – to achieve, and only limited health care is available. In addition, prisoners are often subjected to measures which can lead to further human rights violations, such as the use of excessive solitary confinement, or the prohibition of contact with family members or lawyers.
The full scale of COVID-19 infections and related deaths in prisons has been hard to assess, as governments have failed to publicly provide up-to-date and reliable information. Our report has highlighted worrying patterns of COVID-19 infections across prisons around the world. During the early phases of the pandemic, prisoners in many countries were unable to access PPE and COVID-19 testing due to shortages. This is still the case in Madagascar: Amnesty International is currently working with a local NGO to provide PPE and legal services to prisoners in two areas of the country.
A call for action
This feels like a drop in the ocean. It is time for governments around the world to respond to the need for preventive health measures and medical services for prisoners. One step would be to prioritise people in detention in the national vaccination plans. Many prisoners meet all the relevant criteria to be prioritized for vaccination, given their poor state of health aggravated by years of imprisonment. Yet, only a few countries have so far explicitly declared that prisoners and prison staff have been included in priority groups.
Neglecting the right to health of people in prisons will have catastrophic consequences not only for prisoners and their families, but for wider public health care systems too. Amnesty International is calling on all countries to ensure that prisoners at particularly high risk of COVID-19 be prioritised for vaccination in the same way as at-risk groups in the general population. This is not only the right thing to do – in compliance of states’ obligations towards international human rights instruments – but it is also key to ending the pandemic.