Prison health during the COVID-19 era in Africa.

The world is facing a dreadful outbreak of a novel disease, COVID-19, that has claimed the lives of thousands. African countries have recorded the least number of COVID-19 cases despite their weak healthcare systems. However, African prisons could be an hotspot for the spread of the virus. In this article, we focused on describing certain possibilities of an uncontrollable outbreak of this pandemic in African prisons considering the overcrowding, poor access to healthcare among inmates, and already existing abuse of human rights. We hypothesized that negligence to prison health in Africa during this pandemic could lead to devastating events. It is therefore important that inmates are not forgotten in COVID-19 responses.

Background

COVID-19 is an infectious disease that has been ravaging the world since its first case in Wuhan, China. It remains a major threat to global health in the 21st century. This disease triggers chronic respiratory difficulty which is caused by the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) [1]. As of 23 January 2021, globally, over 96 million cases have been recorded with over 2 million deaths and more than 53 million recoveries. Africa has shown to be the continent with the least infection despite its feeble healthcare systems. However, the emergence of COVID-19 in Africa has aroused global concerns, several studies, and conversations on media. Unfortunately, there is insufficient information on prison health amid COVID-19 outbreak in Africa [2]. Without generalization, the deplorable state of prison health services and status in Africa’s 54 countries calls for comparative investigation and immediate reformative actions to remedy the situation. There are virtually eleven million people in prison globally out of which about one million are in African prisons [3]. With the ongoing pandemic in African countries, it is essential to have an insight into the possible conditions faced by inmates, who are supposed to be under reform, in African prisons.

Overcrowding in African prisons

Overcrowding is a major challenge in prisons. In Africa, it has been a norm and a nightmare. Problems relating to prison overcrowding in Africa have long been studied but there has been a dearth of specific or accurate data on the capacity of each prison, following the overpopulation, which largely varies from one region to another and from one country to another within a region in Africa. Morocco, Nigeria, Ethiopia, and Algeria have experienced a significantly higher increase in the prison population. Approximately, Ethiopia is said to have doubled its prison population [3].

One of the major reasons for the escalated population in African prisons is the large population of inmates who are awaiting trials. This has accounted for nearly 42% of the population of inmates in Africa which is higher than 27% of the global average [3]. However, this menace could serve as a major zone for the spread and proliferation of infectious diseases like COVID-19 among inmates. As of 26 May 2020, there were confirmed cases of COVID-19 observed among inmates and/or prison staff in Algeria, Cameroon, Democratic Republic of Congo, Ghana, Guinea, Egypt, Kenya, Morocco, Sierra Leone, and South Africa [4]. Amidst the mayhem of the COVID-19 pandemic, physical distancing plays a vital role in reducing and flattening the curve in many infected nations around the world and the overcrowded state of African prisons would make it difficult to observe physical distancing.

Nigeria, being the most populated country, is one of the topmost hit countries in Africa by COVID-19. With an overly congested prisons, there is a higher tendency of the spread of COVID-19 among inmates. This could be possible through the apprehension of offenders amid the pandemic. The massive congestion of inmates is a violation of physical distancing which will only serve as a medium to facilitate the spread of the virus. COVID-19 associated death cases have, to a greater extent, been as a result of co-morbidity. In Sub-Saharan Africa, different age groups are not allocated separate confinement and a part of the hidden prison population which have been deprived of the basic needs of the prison resource allocation includes the elderly [5]. Therefore, they are often incarcerated, with other inmates, which have placed them in systemic abuse and neglect [6]. They are adversely affected considering the congested sleeping area, poor hygiene, and sanitation, poor quality of food and water. This ruthless environmental condition serves as an enclosed system of respiratory, gastrointestinal diseases, tuberculosis, and malaria [5]. Many inmates have various kinds of pre-existing disease conditions [7] (like diabetes, hypertension, and chronic respiratory diseases among others) due to the poor and life-threatening circumstances in the prisons. Therefore, any possible confirmed case of COVID-19 will lead to an outnumbered series of deaths among inmates during jail terms or even before litigation.

Poor healthcare of inmates

Generally, health issues are always an upheaval in prisons. In Africa, poor access to healthcare amongst inmates has led to the pervasive spread of communicable diseases. The spread of infectious diseases in prisons could be worse than the disease condition in the net population of a country [3]. Although, In Africa, the rate of COVID-19 infection is low considering its general population despite its weak health systems.

There has been an elevated level of concerns about how Africa is controlling and managing the pandemic in the absence of vaccines and drugs. Lack of access to healthcare professionals for consultation, an insufficient supply of medications, and other fundamental issues have led to aggravated health problems in prisons [3]. However, the quality and quantity of food are also not sufficient to build strong immunity against the ravaging virus by the inmates. Additionally, there is possibly little to no evidence of COVID-19 testing among inmates to checkmate the spread of COVID-19 in African prisons.

The prevalence of mental health problems across most prison systems is likely worsened by confinement. It is evident that healthcare facilities are facing challenges in managing prison inmates who are in need of psychological and psychiatric care during this pandemic because routine consultation of clinical psychologists, psychiatrists, and social workers is discouraged so as to curb the spread of this infection [8]. Hence, the need for properly drafted and enforceable measures to ensure continuous provision of psychological and psychiatric care for mentally challenged inmates. Access to medical care and immunization are often under restriction by the prison workers who do not understand the importance of professional healthcare service [5]. However, due to the various forms of morbidities in prisons which may weaken inmate’s immune system, there is a higher possibility of severe illness due to COVID-19 [6]. Considerations for rehabilitation and reintegration of vulnerable groups including children, women, and the elderly with mental problems should be made to keep them out of prison [3] Does this mean that the health of inmates is not considered important if they are excluded from COVID-19 response? Is it not inhumane to treat living beings in such a terrible manner? Therefore, it is important to know that an infringement on prison health is a threat to public health [2].

Violation of the human right

Abuse of human rights among inmates is a typical view of an African prison which has attracted the attention of the international community. International Human Rights of inmates remain overlooked and abused in various forms [5]. Being an inmate does not mean loss of human rights. However, in most case scenarios, the implication of being an inmate suggests that they have no right, choice, and privilege of their own. These inmates are humans and citizens of countries that legally support human rights. In developed countries, animals have legal rights; how much more human beings? These inmates have the right to good quality food, access to quality healthcare especially in severe conditions, education, skills, and good livelihood. There are several features to measuring the violation of the rights of inmates in Africa which include poor healthcare infrastructure, lack of adequate medication, and poor quality food [3,5]. Due to the incarceration and marginalization of inmates, they are limited in choosing their living and environmental conditions. These inmates depend solely on the prison administration and staff for their complex needs considering how vulnerable they are exposed to these factors causing an alarming increase in mortality and morbidity rates [9]. This inhumane act makes inmates vulnerable to COVID-19 infection. In times of the pandemic, it is important to make available personal protective equipment for inmates like face masks and gloves. These inmates have the right to be tested for COVID-19 and protected from the devastating infection. COVID-19 pandemic, therefore reifies the need to strenghten human rights in African prison systems.

Poor care for the prison staff

Prison staff are people employed in the prison system to ensure control and orderliness in the prison yards. These staff are exposed to poor conditions of living, violence, and traumatic experiences. In Africa, there are no sufficient prison workers and the few on duty are poorly paid. Prison workers are over-burdened with the issue of overcrowding coupled with the poor health status of inmates and violence in prison. Due to their contact with the public, there is a risk of prison workers serving as a transmission medium. Hence, the safety of prison workers should be of great concern. The COVID-19 pandemic is likely to have a huge impact on the prison workers who are also exposed to other infectious diseases in African prisons. It is difficult for workers, who do not have access to paid sick-leave for adequate treatment and as such could lead to the spread of the virus and also have an effect on their families [1]. Care for the prison worker should therefore be prioritized as well as other fundamental issues facing their operation.

Interventions/recommendations

Overcrowding has resulted in several waves of abuse in African prisons. In tackling these abuses, the inmate’s right to sufficient space must be enforced. Prisons should be restructured to increase prison capacity and avoid the consequences of overcrowding. On 25 March 2020, the UN High Commissioner for Human Rights urged countries to decongest the prison population. Some African countries have responded to this statement in order to curb the spread of the pandemic. Lack of access to medical personnel, adequate medical care, and medicines have worsened prison health problems [3]. Hence, this era of COVID-19 pandemic poses a clarion call for focused attention on health-related human rights issues within the prisons including the provision of reliefs such as good quality and quantity of food allocation, adequate supply of medicines, clothing, and other social amenities.

Good governance is necessary to maintain public health-related matters within African prisons [3]. Adequate staffing and more efficient methods are needed to ensure waste disposal, good quality, and quantity of food. Measures such as the implementation of adequate training programs, recruiting additional staff, building intra-staff camaraderie, increasing staff pay and benefits, adequately supervising, directing, and disciplining staff will help improve outcomes. These targets towards better outcomes will not only solve staffing problems and promote better prison governance but build a climate of respect for inmates’ rights as well.

There is also a need for prison reform in Africa. Prisons reform should be channeled towards joint planning, risk management, information sharing, and inclusion of the human rights approach to prison management [10]. It calls for the involvement and active participation of Non-Governmental Organizations (NGOs) and government agencies in the process of reform and safety. So far, there have been supports from international communities and NGOs in some African prisons. More support is needed to control the spread of the infection especially in countries with the most confirmed cases and low-income countries. Governments should allocate adequate testing kits and medical professionals to probe inmates early before it becomes severe. Prisons should be adequately disinfected and personal safety equipment should be made available for the inmates. Development and implementation of guidelines to better regulate environmental health conditions should be prioritized in order to secure the health of inmates and prison staff.

Conclusion

In this moment of a gruesome impact that threatens the world, African prisons deserve the needed attention in order to curb this virus from further outbreak across the continent. An outbreak in this setting can overwhelm prison health services and increase the overall demands on already overburdened healthcare facilities. African prisons may likely become the epicenter of this pandemic in Africa if preventive measures for discharged inmates are not enacted as soon as possible. Focus on certain areas (such as overcrowding, violence, poor sanitation, the transmission of diseases, scarce amenities, and human rights of inmates) that affect prison health should remain paramount.

Authors contribution

All the authors contributed equally to the manuscript. All authors read and approved the final manuscript.

Funding

None.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.