Pre-empting COVID 19: Reviewing nutrition in Assam’s correctional homes
Anubhab Atreya
Over the last two weeks, the COVID 19 pandemic has continued to spread across the country. Till this evening (as of 7:00pm), Assam has reported 37 cases with 9 being currently active [1]. While the figures and the preparations on a war-footing which have been carried out by the State’s Health Department in the State has rightfully inspired confidence, it must be seen in view of the fact that it is still early days for India in the fight against COVID 19.
In the last post in this series, we discussed the implications of an ailing healthcare delivery system in Assam’s correctional homes in the fight against COVID 19 [2]. In it, we had pointed out that the diet available in the correctional homes is provided in accordance to the diet chart under the Assam Jail Manual [3]. In many states, including Assam, these charts had not been comprehensively updated or subjected to scientific review for many years. Taking these issues into account, the Model Prison Manual, 2016 which has been adopted by the Supreme Court in the Re: Inhuman Conditions in 1382 prisons case, provided a revamped diet chart, which unfortunately has not been implemented in the State as yet [4]. However, the diet chart in Assam has been modified in some respects to maintain parity with the Model Prison Manual. In addition, the rules have always stipulated that food be served only in certain periods of the day and that no food can be served after the lock up hour which is quite early in the evening.
As a result, one of the many policy issues which needs to be explored in depth in the face of COVID 19, is the state of nutrition in our correctional homes. Apart from the infrastructural and human resource issues which prove an impediment for the preparation against COVID 19, an important pre-emptive measure could lie in addressing the quality of nutrition available to inmates.
The quality of food served in jails has often attracted media attention but mostly for the wrong reasons [5]. Fortunately, that is not the case in Assam. Food which is served in correctional homes in Assam is generally of a standard quality and adhere more or less to the norms set by the Assam Jail Manual. However, as they say, we must not let any crisis go to waste [6]. The COVID 19 pandemic is an opportunity for action which lets us examine and draw both public and state attention to systemic issues which are plaguing our correctional system. The systemic improvement of nutrition levels in our correctional homes is certainly one systemic issue which should occupy prime place in this effort.
With the COVID 19 lockdown moving into its second phase, the supply chain crisis in the country has deepened. Food supply in various domains has already become a challenge in the last few days. On the other hand, the importance of nutrition in the fight against COVID 19 has been underlined through the many advisories on the subject from the World Health Organisation (WHO) apart from pre-existing standards laid down by national bodies such as the National Institute of Nutrition. The International Committee for the Red Cross (ICRC) has noted that often places of detention imply limited access to health care and also access to lesser food than would be nutritionally ideal. Added to this, are the chances of higher transmission through overcrowding, lack of ventilation etc. which make prison health a particularly challenging area. In an interview, Elena Leclerc, the coordinator of the ICRC’s health in detention program, refers to the fact that one of the interventions vis-à-vis the Ebola outbreak had been to introduce malnutrition treatment programmes in detention centres as nutrition is a determinant of health [7].
In various documents, WHO Europe refers to the fact that nutrition helps in preventing development of infections and that vulnerable population groups within the correctional set-up have specific dietary requirements [8]. Weak immune defence systems among inmates due to poor levels of nutrition has also been noted by the WHO. This, along with several other factors of incarceration, make inmates more susceptible to infections of various kinds. WHO Eastern Mediterranean, on the other hand, has gone a step further, by introducing advisories on nutrition for COVID 19 with specified diet recommendations for adults and children [9].
The still emerging scientific literature on the subject reflects a finding that nutrition has relevance in determining the outcomes of COVID 19 patients. For example, a high Body Mass Index or malnutrition has been identified as a negative prognostic factor in patients [10]. It also outlines the importance of taking care of nutritional habits and following balanced nutrition practice with high amounts of minerals, antioxidants and vitamins in the diet [11].
On the ground in Assam, the average person residing in rural areas consumes 2170 kcal of calories (per day per day capita) in a day while the average person in urban areas of the State consumes 2110 kcal of calories (per day per capita) [12]. The Model Prison Manual, 2016, too formulates a diet chart which also provides a standard on the basis of calorie estimation (Chapter VI: Maintenance of Prisoners). Some states like Odisha have taken the cue from this and moved towards a calorie estimation for diet instead of continuing with the colonial era weight-based determination, based on the recommendations of the Indian Council for Medical Research (ICMR) [13]. Unfortunately, this is not available for the diet chart which is used in Assam’s correctional homes. This essentially means that it is not possible for an independent observer to gauge accurately if the nutrition norms are being met in accordance with the guidelines.
Diet Scale for C-Division Convicts and 2nd Class Undertrials in Assam’s Correctional Homes
While the amount of food available to the average inmate is almost in accordance with the standards set out in the Model Prison Manual, the problem is one of quality as opposed to quantity. In our experience, we have occasionally found grievances about the quality of the food available and also the raw materials such as rice, meat etc. It is also quite difficult to comprehend if variety in vegetables and other raw materials, which is essential in ensuring adequate minerals, antioxidants and vitamins, is ensured.
In addition to this, there is a larger systemic issue with regard to the budget allocations for diet in the district jails. An analysis of the budget allocation for diet in jails in the State Budget from 2015 onwards reveals a trend of consistent under budgeting which apart from hinting at systemic gaps such as lack of communication, also carries the potential of directly affecting living conditions in the correctional homes. Similar patterns have been found in Open Air Jails; and district jails in Karbi Anglong and North Cachar.
Assam Budget for Diet in District Jails
The data as to the most commonly reported illnesses accessed by us through applications under the Right to Information Act, 2005 (available with Studio Nilima on file) reveal that the highest numbers of cases across correctional homes was by far, gastrointestinal diseases such as gastritis and peptic ulcers. It hints at the fact that it is might be necessary to have a thorough relook at the mode and means by which nutrition is provided across the correctional homes in the State. Deficient levels of general health which our data indicates, can be worrying when faced with a pandemic of the present scale.
Prevalence of Gastritis across Correctional Homes in Assam
Our experience and the data indicate that there are inherent issues with the diet being provided in the correctional homes. While it may be adequate for sustenance and survival, it is certainly not equipped with the capacity to strengthen immune systems and fight infections. At this stage, it is in the public interest to contemplate introducing supplements or new elements to the diet in our correctional homes so that the inmates who are at higher risk to infections like COVID 19 have a fighting chance against the disease. Apart from ensuring improved levels of general health among the inmates, it will also ensure that the correctional services are better placed to combat COVID 19 when the need arises as it will lead to stronger immune responses.
References
[1] Government of India, COVID 19 tracker, available at: https://www.mygov.in/covid-19/
[2] Anubhab Atreya, “Are Assam’s correctional homes equipped to fight COVID 19?”, Studio Nilima Blog, published online on April 7, 2020, available at:
[3] Diet Scales of Prisoners, Assam Prison Headquarters, Home & Political Department, Government of Assam, available at:
https://prisons.assam.gov.in/information-services/diet-scale-of-prisoners
[4] Assam Jail Manual, available at:
https://prisons.assam.gov.in/frontimpotentdata/assam-jail-manual
Model Prison Manual, 2016, available at:
https://mha.gov.in/sites/default/files/PrisonManual2016.pdf
[5] Zeeshan Shaikh, “On the plate: What jail inmates really get to eat”, The Indian Express, Published online on November 14, 2016, available at https://indianexpress.com/article/explained/on-the-plate-what-jail-inmates-really-get-to-eat-biryani-in-jail-4373624/
[6] The expression “Don’t waste a crisis” has been attributed to Winston Churchill and also M.F Weiner’s article in Medical Economics titled “Don’t Waste a Crisis- Your Patient’s or your Own”. Most recently, it has been famously attributed to Rahm Emanuel, who served as Chief of Staff to President Barack Obama.
[7] Elena Leclerc, “COVID-19: Protecting prison populations from infectious coronavirus disease”, Published online on March 11, 2020, available at:
https://www.icrc.org/en/document/protecting-prison-populations-infectious-disease
[8] World Health Organisation Regional Office for Europe, Health Topics, Nutrition, available at:
[9] World Health Organisation Regional Office for the Eastern Mediterranean, “Nutrition advice for adults during the COVID 19 outbreak”, available at:
[10] Alessandro Laviano et al, “Nutrition support in the time of SARS-CoV-2 (COVID 19)”, Nutrition. 2020 Apr 2 : 110834, doi: 10.1016/j.nut.2020.110834, available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132492/
[11] Giovanna Muscogiuri, “Nutritional recommendations for COVID 19 quarantine”, Eur J Clin Nutr(2020), available at: https://doi.org/10.1038/s41430-020-0635-2
[12] National Sample Survey 68th Round, Nutritional Intake in India, 2011-12, Ministry of Statistics and Implementation, National Sample Survey Office, October 2014, (p.22, Table T3)
[13] Express News Service, “No compromise on food nutrition for jail inmates in Odisha”, The New Indian Express, Published online on March 26, 2018, available at https://www.newindianexpress.com/states/odisha/2018/mar/26/no-compromise-on-food-nutrition-for-jail-inmates-in-odisha-1792600.html