Healthcare of Prisoners

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Prisoners are confined for the protection of the public but that does not reduce them to a non-person. Prison walls do not take away the basic fundamental rights but they are subject to some legal restrictions. In D.B.M.Patnaik v. State of Andhra Pradesh, The SC asserted that the mere detention does not deprive the convicts of all the fundamental rights enshrined in our constitution. One of these rights available to an inmate includes the right to healthcare.

All these rights have been conferred upon the prisoners because he does not cease to be a human being. Sadly, the reality is very different and there is a loss of rights within custodial institutions, which continue to occur. As per the World Prison Population List-2013, there is a general trend of growth in the prison population in the majority of nations, including in India. More importantly, prisoners do not represent a homogenous cross-section of society. The majority of prisoners in India are uneducated, poor, and belong to marginalized or socially disadvantaged groups and have limited knowledge about health, and practice unhealthy lifestyles. Thus, they represent a distinct and vulnerable health group needing priority attention but are often forgotten in the equation of Public Health policies. The basic healthcare amenities are not available to a convict and it is an issue of basic human rights concern. In 2018, 1,845 people died while incarcerated. That's the highest number India has seen so far. In 2019, 1544 people died of natural death and 165 people died of unnatural death. Prisoners’ rights activists, scholars, and government hospital doctors say most of these natural deaths could have been avoided if proper medical care was made available on time. Some of the reasons behind the deaths in imprisonment are 1) overcrowding, 2) bad ventilation, 3) bad conservancy, 4) bad drainage, 5) insufficiency of clothing, 6) sleeping on the ground, 7) deficiency of personal cleanliness, 8) bad quality food and water, 9) extraction of labor from unfit persons and 10) insufficient medical inspection 11) corruption and extortion

The Supreme Court in its landmark judgment of Parmanand Katara Vs Union of India (1989 AIR 2039) ruled that the state has an obligation to preserve life whether he is an innocent person or a criminal liable to punishment under the law, thus laying a robust precedent for prisoners’ rights in India, especially the very fundamental right to health included under Article 21 of the Indian Constitution. In a recent case of Dr. Kafeel Khan who was lodged in Mathura prison in January 2020 for a speech where he allegedly criticized the government during the anti-Citizenship Amendment Act (CAA) protests wrote a letter in which he described the shameful state he was living in. Relaying the dangerous prison conditions, Dr. Khan wrote, “With just one attached toilet, 125-150 inmates, the smell of their sweat and urine mixed with unbearable heat due to electricity cuts makes life hell over here: A living hell indeed. I try to read but cannot focus due to suffocation. It sometimes feels that I might fall due to dizziness caused by that suffocation. So, I keep on drinking water. In a jail made for 534 inmates, there are 1,600 people kept with one barrack holding at least 100-125 of us. There are just 4-6 toilets.” The report on “Prevention of the spread of HIV amongst vulnerable groups in South Asia” from the United Nations office on drugs and crimes revealed that 63% of prisoners in India had a history of drug abuse. The prevalence of drug abuse varies between 8% to 63% among Indian prisoners. Continuance of high-risk behaviors such as unprotected sex and substance abuse after release from prison is also very common. Lack of conjugal life in prisons has also led to prisoners engaging in male-to-male sexual acts. A study conducted in a North Indian jail revealed that 28.8% were homosexual or bi-sexual, 68% had multiple partners, and 80.6% engaged in unprotected sex. Intravenous drug abusers generally have a criminal history (mostly for minor crimes), and they too avoid utilizing health services for fear of persecution, ostracism, and discrimination. The co-infection rates between tuberculosis and HIV are very high in India. There is no clear policy on testing for HIV in prisons in general, nor is there a uniform policy on access to voluntary counseling and testing. Mental illness is yet another significant public health problem and its prevalence among prisoners is very high. The women in prison have to face problems during their periods since in most prisons, women do not get menstrual products at all, or they get a limited number irrespective of one’s need. Since women’s menstrual cycles vary in length and frequency, limited access forces them to wear sanitary pads for extended hours leading to the risk of infections.

Many acts like The Prisons Act, 1894 provide guidelines regarding prisoners' rights like Provisions relating to the mental and physical state of prisoners. Separation of prisoners for male, female, criminal, civil, convicted, and under trial prisoners. Provisions for treatment of undertrials, civil prisoners, parole, and temporary release of prisoners. Examination of prisoners by a qualified medical officer. Unfortunately, the gap between stated policy and actual practice is far too wide. For example, the prison policy in India emphasizes ensuring proper standards for ventilation, sanitation, and hygiene. Yet Indian prisons have consistently been rated poorly by human rights activists for not being able to provide these basic living standards. Earlier, because of the abundance of laws, there was no uniformity in prison laws. Consequently, the Ministry of Home Affairs brought in the Model Prison Manual aimed at ensuring some uniformity in laws relating to prisons. Many committees like Krishna Iyer Committee,1987, and Justice Amitava Roy Panel,2018 have been formed to look into the matters of the situation of women prisoners in India and to tackle the issue of overcrowding in jails. On an international level, The UN Human Rights Committee has stated that under the Covenant on Civil and Political Rights stated that to be compliant with obligations under the right to life, health care must be available to diagnose and treat prisoners when they are ill or otherwise in need of attention, as anything less than this does not constitute a ‘‘properly functioning medical service’’ within the terms of Article 6(1) of the covenant.

Policymakers as well as the general public need to understand that the prison and the community are at continuum. The much-needed overhaul of the prison health system by linking it with public health cannot be achieved without a sustained campaign aimed at changing these principles. To improve the prison conditions does not mean that prison life should be made easy, it means, it should be made humane and sensible.