When the pandemic was declared in March 2020, there was immediate concern about the implications for prison systems – and with good reason. According to research we had published months earlier, drawing on our World Prison Brief occupancy data, at least two-thirds of countries worldwide were running their prison systems above their official capacity. This followed decades of unchecked growth in pre-trial and sentenced prisoner numbers.
In the face of this new, deadly, highly transmissible global virus, prison overcrowding was identified as a major public health risk. The World Health Organization, the UN Office on Drugs and Crime, and NGOs such as Human Rights Watch, among others, called for rapid action to reduce prison overcrowding, as part of a comprehensive strategy to minimise outbreaks and to avoid cross-contamination between prisons and local communities.
Many countries took steps to limit receptions into custody and increase numbers released. Prison administrations introduced highly restrictive prison regimes; from mid-March 2020, prisons across the world were placed in almost total lockdown. Visits were largely suspended. Prisons became more remote from society than ever, with inmates deprived of family contact, legal advice and visits from voluntary agencies and monitoring bodies.
In the first weeks of the pandemic, these heavy restrictions, usually imposed with lightning speed and little or no explanation, were met with protests and violence in many countries. Now, eighteen months on, with the disease still raging in much of the world, evidence is emerging of the toll Covid has taken, not only in lives and health, but also in the mental, physical and social consequences of this protracted ‘double lockdown’.
Over the past year our prison research team at the Institute for Crime & Justice Policy Research (ICPR), based in the School of Law at Birkbeck, University of London, has been researching the measures taken to control the risk of Covid in prisons, and their impact on prisoners’ health and wellbeing. Our research covers a diverse group of ten countries across five continents and is summarised in two reports published in June 2021. Keeping COVID out of prisons: Approaches in ten countries examines steps taken to manage the size of national prison populations. It also sets out available data on Covid infections and deaths among prisoners, and describes regime changes introduced to reduce contact between prisoners and others to limit infection within, and beyond prison walls.
The second report, Locked in and locked down – prison life in a pandemic: Evidence from ten countries, presents first-hand accounts from prisoners of how their daily lives were impacted by restrictions on visits, activities and social interaction.
The reports offer an opportunity to reassess policy and practice in the quest for effective and balanced responses to the challenges Covid continues to pose for prison systems. This article presents some of the key findings and recommendations.
The health risks of imprisonment: before and after Covid-19
Even before the pandemic, it was known that the typical conditions and regimes of prisons are far from conducive to good physical or mental health. Incarceration usually involves reduced access to natural light and fresh air; poor diet; limited opportunities for exercise; inadequate medical treatment; and high levels of intimidation, violence, tension, boredom and despair. It has also long been recognised that psychological harm can result from separation from family and community, removal of autonomy, and material deprivation – all factors that characterise imprisonment. All these features of prison life heighten the risk of illness.
In a time of pandemic, the risks of disease are further heightened due to the close proximity in which most inmates are detained and the higher prevalence among prison populations of underlying health conditions and vulnerabilities.
For these reasons, it was clear that Covid-19 would have serious consequences for prisoners, both as a direct threat from the disease and due to the restrictions introduced to curb risk of the virus spreading inside and beyond prison walls.
Since the pandemic was declared, the NGO Justice Project Pakistan has been collating information on the number of Covid-19 cases and deaths in prison populations around the world. Their data show that by late August 2021 there had been over 576,000 prisoners who had tested positive for Covid-19 in 122 countries, and at least 4,100 prisoners had died due to Covid-19 in 47 countries. The true figure will be higher, due to lack of testing capacity and poor data on prison infections and deaths in much of the world.
Without doubt, the health impacts of Covid-19 – and of the measures taken to contain it – have been more severe in countries with overcrowded, under-resourced prisons. The risks of infection are much greater in prisons with limited physical space and inadequate staffing levels. And overcrowded, under-staffed prisons struggle to make any provision for education, work, rehabilitation, and social interaction when they cannot ensure basic safety through social distancing, personal protective equipment and basic sanitation.
The human costs of regime restrictions
Since March 2020 prison authorities throughout the world have been operating highly restricted regimes as part of the effort to restrict the spread of Covid. They included the suspension of visits to prisons by families, lawyers, inspection bodies, NGOs and community organisations providing services in prisons; reducing prisoners’ movement inside prison buildings; and preventing prisoners leaving prisons, for example on temporary licence to work or to visit their families. Rehabilitation, work, education and other daily activities largely ceased. Prisoners have spent long periods locked up with little or no contact with others and minimal time outside their cells.
Unsurprisingly, these changes have had profoundly negative effects on prisoners and their loved ones. Almost all our research interviewees described the restrictions on visits as a real hardship, especially for prisoners and families used to regular visits before the pandemic. People experienced feelings of sadness, depression, frustration, loneliness, stress and anxiety, during what was already a worrying time. The sudden suspension of visits also meant going without essential items like medicines and extra food supplies in some countries where prison visitors would routinely bring in such items.
Visits remained suspended in most countries’ prisons for several months into the pandemic. However, at different points from July 2020 onwards, prisons in a few of the countries began introducing highly restricted forms of visits, including with limited numbers allowed, shorter visiting times, and with physical contact prohibited (with visits taking place behind glass screens, for example). These types of visit were described as difficult by some interviewees.
Alternative means of communication were made available to compensate for the lack of in-person visits In some countries, including video calls, or additional time or calling credit for phone conversations. In England and Wales, a bespoke video-calling system was introduced in some prisons but was beset by technical problems. In-cell phones were also rolled out more widely; an intervention which prisoners welcomed as a vital means to keep in touch with family, although provision is still patchy.
The pandemic severely curtailed opportunities to associate with other prisoners, spend time in the open air, take part in education, training, religious services, work or sports, access health services, or attend health, dental or eyecare appointments outside the prison.
Staff from outside agencies, such as charities, who had previously come into prisons to train or supervise prisoners at work, largely suspended their operations in prisons. Even where limited access to work remained available, social distancing requirements in work areas or the need to reduce prisoner circulation around buildings reduced the time prisoners could spend working or in recreation, and often meant more time locked in the cells. Prisoners described several adverse physical, mental and financial consequences from the resulting lack of activity.
Reduced access to activities and programmes will have robbed prisoners of the opportunity to demonstrate good behaviour or rehabilitation and made it harder to prepare for release. Unable to spend time in education, programmes, workshops, or a job on the wings, and no longer permitted temporary leave, prisoners have had almost no way to demonstrate their progress in custody. They feared this would reduce their prospects of being re-categorised, transferred to an open prison, or released on parole, because there would be nothing to inform risk assessments.
Access to legal advice and representation for prisoners was another casualty. Even before the pandemic, access to legal representation had been patchy or non-existent for prisoners in many countries. But as from March 2020, restrictions on visits generally extended to visits by legal representatives. Provision of alternative means to communicate in confidence with lawyers was far from widespread, and often not trusted. This continued for several months and will undoubtedly have led to longer periods spent on remand than would otherwise have been spent. It has also hampered prisoners’ ability to instruct or receive information from their lawyers as their cases or applications progressed.
Covid-19 measures and prison population numbers
In the weeks and months after March 2020, many national governments and justice systems took bold steps to reduce prison population size, ease overcrowding and limit ‘churn’. The measures introduced aimed to: (a) reduce entry into prisons, whether at the remand/pre-trial stage, at the point of sentence, or following violations of parole, licence or other conditions of release; and (b) increase rates of release from prisons, for example through early release schemes, amnesties or increased use of compassionate release.
Because of significant time lags in the availability of national prison population data for most countries, as well as the absence of official figures on numbers released under the various schemes, it is too soon to know what effects the various initiatives will have had on prison population sizes worldwide. It is also difficult to distinguish the impacts of these initiatives from those of other factors attributable to the pandemic, including fewer reported crimes, arrests and prosecutions and the temporary closure of many courts.
With these caveats, the available data indicate that global prisoner numbers may have declined by between five and seven per cent during the first year of the pandemic: potentially, a reduction of over half a million prisoners.
Mitigating further harm
Sustaining and building on these reductions in prisoner numbers is the single most effective strategy to contain the public health risks presented by contagious diseases without causing collateral damage to the mental and physical health of prisoners, prison staff and their families.
This will take political will. The unprecedented growth in global prison populations seen in the decades leading up to the pandemic was in large part due to the widespread introduction of ‘tough on crime’ policies pursued in many countries. Reversing such policies is harder than introducing them.
Restrictive regimes may have reduced COVID infection levels, but at high cost in social and psychological harm. With no end to the pandemic in sight, it is important that we learn from the impacts already evident. Key priorities for prison administrations include:
- Restoring a daily routine, with access to work, education and interaction with others, and a full day spent outside the cell
- Re-instating in-person family visits, in line with public health guidance
- Supplementing in-person visits with remote contact
- Ensuring decent, sanitary living conditions and promoting prisoners’ health and wellbeing
- Improving access to healthcare, screening and treatment and addressing treatment backlogs
- Ensuring prisoners and staff are vaccinated against Covid at the earliest opportunity.
If governments and prison administrations are to abide by the internationally enshrined legal principle that prisoners have an equal right to health and healthcare, the focus must be on reducing prisoner numbers. Otherwise, the ‘cure’ – in the shape of isolation, inactivity, lack of basic services and lost rehabilitation outcomes – will be worse than the disease.
Ms Catherine Heard, Director, World Prison Research Programme, Institute for Crime & Justice Policy Research, Birkbeck, University of London
 Report accessible via: https://www.prisonstudies.org/ten-country-prisons-project/prisons-and-health
 The countries are Kenya, South Africa, Brazil, the USA, India, Thailand, England and Wales, Hungary, the Netherlands and Australia. More information on the project and its publications can be found here: https://www.prisonstudies.org/ten-country-prisons-project