Are Assam’s correctional homes equipped to fight COVID 19?
As the nation prepares to go into the second week of lockdown, the news cycle remains dominated by the COVID 19 pandemic that is fast gripping every corner of the world. But the correctional homes or prisons remain absent from both the public and media consciousness. The prisons in the country and more particularly, Assam, are in an especially vulnerable position in the fight against COVID 19. It is true that Assam’s correctional homes or prisons are better placed nationally with respect to several parameters, such as the perennial problem of overcrowding that afflicts most Indian correctional homes  . But with a dilapidated health infrastructure and heavy shortage of medical personnel, correctional homes in Assam are potentially among the most vulnerable institutions when it comes to health crises.
With a larger number of undertrial prisoners, (placed at 6571 as on 31.08.2019) and 3224 convicts apart from 1032 declared foreign nationals, Assam’s correctional homes have a large floating population and therefore, a higher rate of ingress and egress of people. Added to this, is the number of inmates who return from leave and parole, general movement of correctional staff and other visitors who frequent the prison. This naturally implies a correspondingly increased risk at times of epidemics and outbreaks of infectious disease. The challenge before the correctional homes has been manageable till now because the number of detected cases of COVID 19 in the State itself has been low. However, it will only deepen now as 25 new cases have been detected in the State in rapid succession since the first case was declared positive on March 31(as on 1:30 pm IST on April 4, 2020).
Our interactions over the last few days with officers in the various districts tell us that both the Assam Prison Headquarters at Guwahati and the correctional homes in the districts, have worked with indomitable spirit and enterprise, inspite of limited resources, in ensuring that the basic protocols such as social distancing, hand hygiene, special arrangements for quarantine etc are provided to inmates.
However, Assam’s correctional homes are faced with larger systemic challenges related to healthcare which policy makers will have to navigate through as they prepare a long-term strategy to fight COVID 19 in the coming months. The primary challenge is the fact that correctional homes in Assam have deficient medical infrastructure and personnel which is not adequate in the best of times, let alone in the face of a pandemic. For example, most correctional homes are limited to basic medical facilities and functional in-house hospitals are conspicuous by their absence. In fact, records accessed through applications under Right to Information Act, 2005 by Studio Nilima show that one Central Jail in the state reported availability of “only first aid facilities” and atleast two District Jails reported that there were no medical facilities and doctors in the jail hospital. On the other hand, the Central Jail in Guwahati is much better equipped with X-ray facilities, ECG machines and lab facilities.
Apart from insufficiency and inequity in physical infrastructure, the larger issue afflicting the delivery of basic medical services within the correctional homes is the lack of permanent doctors and medical staff. In districts where a medical officer is not posted in the correctional home, a makeshift arrangement exists by which doctors from the state medical service are deputed on a temporary basis. Often these doctors hold additional charges and can only visit the jail for a few hours in certain days of the week. The systemic strain also means that the number of visits doctors make to the correctional homes vary disproportionately between correctional homes. Apart from doctors, even other key medical personnel such as pharmacists, nurses etc are not available in the required capacity. For example, our research reveals that 12 correctional homes have been operating with only one pharmacist and only 2 district jails in the State report availability of both a pharmacist and nurse.
Table 1: Analysis of RTI replies regarding availability of key medical personnel in the 31 correctional homes of Assam (replies are available on file with Studio Nilima)
Table 2: Analysis of RTI replies to a query regarding visits made by doctors to the 31 correctional homes of Assam (replies are available on file with Studio Nilima)
The data available and our field experience indicates that there is an overwhelming reliance on the medical infrastructure outside the prison, such as the medical colleges of the State or the civil hospitals in the districts. This will become an increasingly inaccessible option for the inmates and staff, as the COVID 19 pandemic progresses. With the State Government bracing for a sudden upsurge in COVID 19 cases, most medical colleges of the State and portions of district civil hospitals have been reserved for COVID 19 patients. While other arrangements in the form of subsidizing and reserving private hospitals and clinics have been made, it is plausible that in case of heavy local transmission, the health system will come under stress and access to treatment will have to be prioritized. This will entail that the general health needs of inmates which cannot be taken care of in-house in the correctional home will suffer in the coming months. This state of affairs only strengthens the case for more robust in-house medical infrastructure in the state’s correctional homes in the long term; as over-dependence on the state medical services can become a liability in times of health crises.
Apart from such infrastructural issues, there are also several intrinsic features of Assam’s correctional homes which make them vulnerable to infectious diseases. Data which we have gathered during the period from January 2018 to August 2019 show that some of the most commonly reported illnesses in Assam’s correctional homes were viral diseases such as influenza, skin diseases, respiratory tract infections and chronic gastritis. Several correctional homes also have inmates who have underlying health conditions which make them especially susceptible to COVID 19 such as Type 2 diabetes, renal problem, hypertension etc. Apart from the fact that these diseases indicate co-morbidity for COVID 19, they also indicate deficiencies in terms of sanitization and general health standards  .
It is also important to note that the diet in the correctional homes is provided as per the Assam Jail Manual and is not especially protein rich, which is essential for a healthy immune system. Taking these issues into account, the Model Prison Manual, 2016 which has been adopted by the Supreme Court, provided a revamped diet chart, which unfortunately has not been implemented in the State as yet . In addition, the rules stipulate that food be served only in certain periods of the day and no food can be served after the lock up hour which is quite early in the evening.
While the correctional homes of Assam are not the most overcrowded in the country, with six of them now containing detention centres for declared foreign nationals, the occupancy rate of the correctional homes in the States stand at a high 122% as on 31.08.2019. With large common wards, where inmates sleep next to each other on the floor and share overburdened common toilets, social distancing is not an option which can be carried out in its actual spirit.
On the other hand, while prisons may be isolated environments in themselves, correctional staff who work in the homes, often interact with outsiders in the course of their duty and many are not accommodated within the campus of the home. Apart from this, one of the challenges which most institutions with limited human resources face is providing for reserve personnel in case of exposure or infection. Security and logistical considerations in administering correctional homes require that a certain number of officers and staff, be present on site at all times. This is also one of the reasons why correctional services (prisons) have been exempted from the national lockdown by the Ministry of Home Affairs . But with the limited human resources available in each correctional home, exposure within the correctional home staff may lead to a security and management crisis, as it will necessitate that all the exposed officers and staff be quarantined.
Crises situations can lead to a perpetuation of pre-existing inequities in the correctional homes. Among the findings in Studio Nilima’s consolidated report on the correctional homes of Assam, Parked in Lot, was the observation that women and children, who are lodged in women’s divisions or wards are essentially limited to a “jail within a jail” . The space available for them is extremely limited and brings along with it an additional set of restrictions. Unfortunately, in many correctional spaces, with the adoption of social distancing norms, it will become even more difficult for women inmates and children to access common areas such as multipurpose halls or libraries within the prison. It is in recognition of gender specific challenges, such as this, that guidance documents from international agencies such as the World Health Organisation and the International Red Cross Committee, recommend that women must be involved in decision making in relation to outbreak management and mitigation policy . In this situation, it is necessary that policy makers keep in mind that any pandemic management and mitigation strategy in Assam’s correctional homes must be inclusive and representative in nature.
While the Assam government has been working with alacrity, some of the policy recommendations in international guidance documents such as a complete site-specific epidemiological assessment would not be practicable in addressing COVID 19 in Assam’s context, given the shortage of human resources. What would be practicable, however, is to ensure that the measures being taken are inclusive and sensitive to the needs of vulnerable inmate population such as women and children and even members of the community who are in a minority, such as female correctional staff.
In acknowledgement of the precarious condition in which the country’s prisons are placed, faced with the COVID 19 pandemic, the Supreme Court of India through Suo Moto Writ Petition (Civil) No. 1/2020, issued notice to the States and asked them to file replies as to the measures being taken in prisons to combat COVID 19 on 16.03.2020 . The Supreme Court noted in its order that several factors such as overcrowding, high rates of infection transmission etc make prisons highly susceptible to the spread of COVID 19. When the matter was next heard on 23.03.2020, the Supreme Court issued several directions to the States which included setting up a High-Powered Committee in each State/Union Territory to determine which class of prisoners can be released on parole or on interim bail so as to free up space within the prisons . Following this, the Assam Prison Headquarters and the state judiciary have ensured that 722 undertrial inmates (as on 31.03.2020) of the eligible category are released to ease the burden on the correctional homes .
As Assam deals with the first wave of COVID 19 positive cases, it is opportune time for stakeholders in Assam’s correctional homes to assess our preparedness for a situation which can be countervailed only by obsessive preparation. While the correctional homes themselves are naturally involved in executing preparedness plans, it is imperative that other stakeholders analyse systemic limitations and prepare to mitigate them within our respective roles and limitations. It is increasingly being pointed out that vulnerability in terms of COVID 19 does not merely mean people with co-morbidity or only people who are medically vulnerable . But it also means those sections of the population who are disadvantaged in socio-economic terms such as inmates of prisons. It has also been recommended by public health experts that it is high time that correctional homes, detention centres and other such custodial institutions are integrated into the larger public health response of the government to the pandemic . This has a two-fold advantage in that apart from providing a chance of ensuring better preparedness to the correctional homes, it also reduces the pressure on the tertiary healthcare facilities such as medical colleges.
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