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Gaol Fever: What COVID-19 tells us about the War on Drugs

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This Health and Human Rights Journal Viewpoint explores the link between prison overcrowding, punitive drugs laws and the COVID-19 response. Using historical cases of 'gaol fever' in British prisons as a reference point, it makes the case that the COVID-19 pandemic should lead to a radical rethinking of the drug laws that drive mass incarceration. The commentary includes a table that documents for the first time COVID-19 related prisoner releases in over 50 countries. https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
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Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Gaol Fever: What COVID-19 tells us about the War on Drugs
Rick Lines, Naomi Burke-Shyne, and Giada Girelli
“In every situation, where a number of people are crowded together, whether in ships, hospitals, or
prisons, unless the strictest attention be paid to cleanliness, and to a free ventilation or circulation of
air, a fever soon or later breaks out amongst them, of a very contagious nature, and attended with very
fatal effects”.
1
So begins the account of Dr James Carmichael Smyth of an outbreak of jail distemper
(typhus) in Winchester prison in England in 1780. Over the course of three and half months, 268
Spanish prisoners of war died, with Smyth himself surviving two separate bouts of the disease while
caring for the sick men.
The rapid spread of contagion and death among prisoners was not a new phenomenon. The first
documented outbreak of ‘gaol fever’ in England took place in Newgate and Ludgate Prison in 1414,
resulting in the deaths of 64 prisoners and gaolers.
2
Almost 50 recorded outbreaks of fever in British
prisons predate the Winchester events described by Dr Smyth, resulting in the deaths of thousands.
3
Nearly 250 years later, the prisons of the world are struggling to address a new ‘gaol fever’ that
threatens to dwarf the impacts of previous historic contagionsCOVID-19. With physical distancing
core to the COVID-19 responsean impossibility in most places of detention the health risks of
congested prisons have again come to the fore. Poor and overcrowded conditions of detention,
coupled with a detainee population that often suffers from multiple heath vulnerabilities, have long
made prisons susceptible to rapid spread of disease and death. The highly contagious nature of the
COVID-19, its global spread, and the worrying levels of mortality associated with it, have therefore
raised widespread concern.
The relationship between prison health and public health is well established. In many of the historic
cases of gaol fever the contagion spread beyond the prison walls into surrounding towns and villages.
4
In more recent years, transmission of both HIV and TB has been documented in prisons, raising wider
public health concerns about the role of incarceration in sustaining those epidemics.
5
For this reason,
protecting people in detention from the spread of COVID-19 must form an integral element of the
global response to the virus.
Adding to this challenge is the fact that there are more people incarcerated in penal institutions around
the world than ever before. It is estimated that 10.7 million people are in detention worldwide.
6
Few,
if any, of these institutions are equipped with the type of intensive care facilities needed to treat acute
COVID-19 symptoms, and the pressure on overall medical capacity created by the virus means that
simply transferring sick detainees to the hospital is not a viable solution.
The emerging prison health crisis highlighted by COVID-19 has wider human rights implications. In
late March, the Office of the UN High Commissioner for Human Rights and World Health
Organization published joint guidance on people deprived of their liberty during the COVID-19
pandemic, highlighting their unique vulnerabilities and the need for states to continue to provide
essential health services, including HIV treatment and harm reduction measures, during the
pandemic.
7
In April, the European Commissioner for Human Rights issued a statement expressing concern that,
‘detention facilities are not adapted to face large-scale epidemics, and the basic protective measures
such as social distancing and hygiene rules cannot be observed as easily as outside, exposing
prisoners to greater health risks.’
8
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Highlighting the standards established by the European Committee for the Prevention of Torture, the
Commissioner stated, ‘the resort to alternatives to deprivation of liberty is imperative in situations of
overcrowding and even more so in cases of emergency. Particular consideration should be given to
those detainees with underlying health conditions; older persons who do not pose a threat to society;
and those who have been charged or convicted for minor or non-violent offences.’
9
As with society as a whole, the risk of rapid COVID-19 spread among prisoners has prompted
governments to respond in unprecedented ways. In the space of just a few weeks, more than 50
countries (see table) have taken steps to reduce prison populations through the release of detainees. In
some countries, the numbers are relatively small. However, in otherssuch as Indonesia, Brazil,
Nigeria, Iran, and Turkeythe detainees released, scheduled for release, or diverted to home arrest
number in the tens of thousands. While this situation is fast moving, and much of the available
information relies on media sources, the total number of detainees to be released to fight the spread of
COVID-19 is over 300,000, and is likely to increase.
These actions are welcome and highlight the public health risks of poor and overcrowded prison
conditions worldwide. They also call attention to the huge number of people in detention for non-
violent offences, and to the punitive policies that drive incarceration generally.
With the European Commissioner urging states to reduce overcrowding as a human rights-based
response to the pandemic in prisons, the role of punitive drug laws in fuelling this crisis must come
under scrutiny. Close to half a million people are incarcerated worldwide for mere drug possession.
An additional 1.7 million are incarcerated for other drug offences, many of which are non-violent.
10
Overall, almost one in four people in detention globally is locked up on a drug charge, a figure that
excludes a further 450,000 people estimated to be held in overcrowded compulsory drug detention
centres in various parts of Asia.
11
The geographic diversity of the COVID-19 release schemes points
to the excessive use of detention all over the world.
If a blanket release of prisoners is a common response to COVID-19 in so many countries, it begs the
question, ‘Why were these individuals in prison in the first place?’ Indeed, a considerable number of
prison release schemes specifically target the release of people charged with low-level drug offences.
Much has been written about the role of the drug war, and the incarceration of people who use drugs,
in driving the HIV epidemic in prisons worldwide.
12
COVID-19 offers another reminder of how
quickly new, frightening public health threats can emerge in the context of mass incarceration.
In his 1857 history of gaol fever in England and Wales, Dr Francis Webb wrote, ‘We know not,
perhaps may never know, what the materies morhi of typhus may be ; but we do know that it
invariably appeared in our prisons when human beings were crowded together, living in their own
filth, without air, food, and water, and subjected to every depressing influence.
13
Dr Webb’s words
describe prison conditions in most countries of the world today, environments that make physical
distancing impossible, and the spread of COVID-19 inevitable.
Unravelling the carceral state must be a key goal for both health and human rights advocates, one in
which drug policy reform must play a critical role. In Britain, the role of prisons in mass contagions
drove legislative reforms that dramatically improved conditions for people in detention, to the point
that by the early 1800s gaol fever was ‘entirely stamped out of our prisons, and they ceased to be
centres of infection for surrounding districts, and a source of alarm to the nation at large.
14
The
current pandemic must similarly serve as an impetus for states across the world to implement law
reforms that address the crisis of prison overcrowding, and the punitive drug laws that drive it.
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Only through a radical rethinking of our current approach to drugs, crime, and punishment through the
lenses of human rights and public health will we achieve a 21st century solution to an 18th century
problem.
Rick Lines, PhD, is Associate Professor of Criminology and Human Rights, Swansea
University, UK
Naomi Burke-Shyne is Executive Director, Harm Reduction International
Giada Girelli is a human rights analyst at Harm Reduction International
References
1
James Carmichael Smyth, Description of the Jail Distemper as it appeared amongst the Spanish Prisoners, at
Winchester, in the year 1780, London, 1803, p. 7.
2
Francis C Webb, An Historical Account of Gaol Fever, Read before the Epidemiological Society, on Monday,
July 6th, 1857, p. 1.
3
Arthur Durant Willcocks, Alexander Popham, M.P. for Taunton, and the Bill for the Prevention of the Gaol
Distemper, 1774: A Hygienic Retrospect, London, 1894, appendix.
4
Willcocks, appendix.
5
Gen Sander, HIV, HCV, TB and Harm Reduction in Prisons. Human Rights, Minimum Standards and Monitoring
at the European and International Levels, Harm Reduction International, 2016. Available at
https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf
6
Roy Walmsley, World Prison Brief, 12th edn, Institute for Criminal Policy Research, Available at
https://www.prisonstudies.org/sites/default/files/resources/downloads/wppl_12.pdf
7
Interagency Standing Committee, IASC Interim Guidance COVID-19: Focus on Persons Deprived of Their
Liberty, 27 March 2020. Available at https://interagencystandingcommittee.org/system/files/2020-
03/IASC%20Interim%20Guidance%20on%20COVID-19%20-
%20Focus%20on%20Persons%20Deprived%20of%20Their%20Liberty.pdf
8
Commissioner for Human Rights, COVID-19 pandemic: urgent steps are needed to protect the rights of
prisoners in Europe, Council of Europe, 4 April 2020. Available at https://www.coe.int/en/web/commissioner/-
/covid-19-pandemic-urgent-steps-are-needed-to-protect-the-rights-of-prisoners-in-europe
9
Ibid.
10
UN system coordination Task Team on the Implementation of the UN System Common Position on drug-
related matters, What we have learned over the last ten years: A summary of knowledge acquired and
produced by the UN system on drug-related matters, March 2019, Available at
https://www.unodc.org/documents/commissions/CND/2019/Contributions/UN_Entities/What_we_have_lear
ned_over_the_last_ten_years_-_14_March_2019_-_w_signature.pdf.
11
Lunze K, Lermet O, Andreeva V, Hariga F, Compulsory treatment of drug use in Southeast Asian countries,
International Journal of Drug Policy, 2018 Sep;59:10-15.
12
Global Commission on Drug Policy, The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use
Fuels the Global Pandemic, 2012, Available at https://www.globalcommissionondrugs.org/wp-
content/uploads/2012/03/GCDP_HIV-AIDS_2012_EN.pdf
13
Webb, p. 11.
14
Willcocks, p. 13.
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
TABLE 1
Country
Criteria/Elements considered
(Expected) impact
PARDON/REMISSION
Afghanistan
Age (over 55, minors)
Offence (not serious)
Preexisting conditions
Women
10,000 prisoners released
Algeria
Not specified
"Drugs" prisoners (not better defined) excluded
N/A
Azerbaijan
Sentence left
200 prisoners released
Bahrain
Not specified
"Drugs" prisoners (not better defined) excluded
900 pardoned, including over 150
Bangladeshi detained for drugs
Burkina Faso
Age
Preexisting conditions
Sentence left (half)
1207 prisoners released
Ethiopia
Sentence (max 3 years for minor crimes)
Sentence left (one year)
Pregnant women
Mothers with children
4011 prisoners released
Germany -
North-Rhyne
Westphalia
Sentence left
1000 releases expected
Ghana
Criminal history (First-time offenders)
Sentence left (half)
Preexisting conditions
Age ("very old")
808 prisoners released
Guyana
Sentence left (3-4 weeks)
Drug possession offences
Age
Preexisting conditions
n/a
Iran
N/A
Almost 10,000 prisoners pardoned
Myanmar
Detained Rohingya
128 prisoners released
Morocco
Age
Preexisting conditions
Offence (e.g. prisoners convicted of drug
trafficking excluded)
Sentence served
Conduct in prison
5654 prisoners pardoned
Saudi Arabia
Foreign nationals held on non-violent
immigration/residency offences
Those imprisoned for debt offences
Over 250 prisoners released
Somaliland
Offence ('petty')
574 prisoners pardoned
Togo
N/A
1407 prisoners pardoned
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Trinidad &
Tobago
Sentence left (<1 year)
Imprisoned for failure to pay fines/child
maintenance
Imprisoned as unable to access bail
Offence - incl. possession of <30 gr marijuana ,
possession of smoking device, marijuana
cultivation
380 prisoners consdiered for release
Tunisia
Sentence left (half)
Around 2000 prisoners released
Turkey
N/A
Up to 45,000 pardons expected
Uganda
Sentence left (1/4)
Age (over 60)
Breastfeeding prisoners
2000 pardons expected
UK - Northern
Ireland
Offence
Sentence left (to be released by 30 June)
Less than 300 releases expected
Zimbabwe
Offence (non-violent)
Sentence served (1/2, or 1/3 for children)
Sentence (<36 months if served half)
Age (over 70) if served half sentence
1700 - 5000 releases expected
DIVERSION (home arrest, parole,..) OR SUSPENSION OF SENTENCE
Albania
Offence (e.g. prisoners convicted of drug
trafficking excluded)
Sentence left (under three years)
Sentence (under five years)
Age (>60)
Preexisting conditions/chronic illnesses that put
life at risk
600 prisoners temporarily released
Argentina
Pregnant women
Women with children
Age (over 65)
Preexisting conditions (incl HIV, TB, kidney
disease)
Prisoners routinely released after
individualised assessment
Australia (New
South Wales)
Offence
Age
Preexisting conditions/Vulnerability
Others, including availability of suitable
accommodation
Risk assessement
Over 1700 releases expected
Bahrain
Not specified
"Drugs" prisoners (not better defined) excluded
890 prisoners given non custodial
sentences
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Belgium
Offence
Conduct in prison
Accommodation available outside
Sentence (<`10 years)
323 prisoners temporarily released
Brazil
Age
Pregnant women
Preexisting conditions (incl chronic illnesses,
immunisuppressed, respiratory, diabetes, TB,
kidney diseases, HIV and coinfections)
High-risk of infection
Indigenous
Detained in institutions with inadequate
healthcare
Others depending on status
Prisoners routinely released after
individualised assessment
Canada -
Ontario
Sentence left
Low risk of reoffending
Offence (non serious)
Over 2000 prisoners released
Colombia
Offence (drug trafficking and organised crimes
exluced, among others)
Pre-trial detention
Sentence served (40%)
Sentence (<5 years)
Age (over 60)
Mothers breastfeeding or with <3 kid inside
prison
Preexisting conditions (incl. HIV, cancer, kidney
disease, Hep B, Hep C, autoimmune disease,..)
Persons with physical disabilities
Delitos culposos
"
4000 releases expected
DRC
Offence
1200 prisoners released
India
Varying
3000 prisoners released, , more expected
[Tihar Jail]
Up to 11,000 releases expected [Uttar
Pradesh]
650 released, 900 more expected [Delhi]
2000 prisoners released [Karnataka]
Indonesia
Sentences left -(1/3 or half for minors)
Offence
Age
Preexisting conditions
5500 prisoners released, 30,000 to 50,000
releases expected
Iran
N/A
75,000 prisoners released
Ireland
Offence (Non-violent)
Sentence left ("close to end")
Sentence ("short")
Over 200 prisoners released
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Israel
Sentence (<4 years)
Offence
Around 400 prisoners released
Italy
Sentence left (18 months)
Semi-liberty
Offence (some excluded)
Adequate accommodation available
50 prisoners released, more expected
Netherlands
unclear
Unclear
Sri Lanka
Offence ('minor')
Preexisting conditions
Sentence served ('better part')
Bail denied or imprisoned for failure to pay
fine/bail
2961 prisoners released
Thailand
Offence (minor)
Conduct in prison
Other
8000 prisoners released since October
2019
Turkey
N/A
Up to 45,000 releases expected
UK
Offence
Sentence served
Pregnant women
Women with children in prison
'Low risk' prisoners
Up to 4000 releases expected
USA - Federal
Individualised assessment, including:
- Age
- Vulnerability to COVID-19
- Security level of facility
- Conduct in prison
- Offence
- Danger posed to the community
unclear
USA - State
(incl. New
Jersey, Ohio,
Pennsylvania)
Individualised assessment changing by state,
including:
-Serving for violation of probation
-Offence ('petty, non-violent)
- Sentence served
Over 2000 releases completed or planned
OTHER MEASURE/CONSEQUENCE UNCLEAR
Bangladesh
Sentence served
Up to 3000 releases expected
Canada - nova
Scotia
Pre-trial
70 prisoners released, more expected
Croatia
Preexisting conditions
Delayed start of execution of sentence
Cyprus
n/a
50 releases expected
France
Sentence ('short term')
Delayed start of execution of sentence.
Decrease in prison population of 6266
units
Rick Lines, Naomi Burke-Shyne and Giada Girelli
Health and Human Rights Journal
Viewpoint 19 April 2020
https://www.hhrjournal.org/2020/04/gaol-fever-what-covid-19-tells-us-about-the-war-on-drugs/
Kenya
Offence ('petty')
Sentence ('short')
Sentence left (< 6 months)
4800 prisoners released through 'expedite
procedures'
Libya
Pre-trial
Meeting criteria for conditional release
466 prisoners released from "correction
and rehabilitation institutions", more
expected
Nigeria
Not finalised yet
Up to 52,000 releases expected
Norway
Individualised assessment
unclear
Sudan
N/A
4217 prisoners released
USA - State
(incl. California,
Kentucky,
Maryland, New
York, Texas(
Varying by state, including:
Offence (minor, incl. drug offences)
Sentence left
Preexisting conditions
Pregnant women
Age
Over 12,000 releases completed or
planned, more expected
... to their release date, while others have included low-risk PIP, such as pregnant women and older adults. 84 Whatever approaches are used, a wider discussion is required on how to balance public safety with public health, which may include economic modelling, 85 and ethical and legal considerations. 86 87 Other gaps were in relation to protective equipment-only one study recommended all individuals entering AII rooms wear special masks. ...
Article
Full-text available
Background: There are reports of outbreaks of COVID-19 in prisons in many countries. Responses to date have been highly variable and it is not clear whether public health guidance has been informed by the best available evidence. We conducted a systematic review to synthesise the evidence on outbreaks of highly contagious diseases in prison. Methods: We searched seven electronic databases for peer-reviewed articles and official reports published between 1 January 2000 and 28 July 2020. We included quantitative primary research that reported an outbreak of a given contagious disease in a correctional facility and examined the effects of interventions. We excluded studies that did not provide detail on interventions. We synthesised common themes using the Synthesis Without Meta-analysis (SWiM) guideline, identified gaps in the literature and critically appraised the effectiveness of various containment approaches. Results: We identified 28 relevant studies. Investigations were all based in high-income countries and documented outbreaks of tuberculosis, influenza (types A and B), varicella, measles, mumps, adenovirus and COVID-19. Several themes were common to these reports, including the public health implications of infectious disease outbreaks in prison, and the role of interagency collaboration, health communication, screening for contagious diseases, restriction, isolation and quarantine, contact tracing, immunisation programmes, epidemiological surveillance and prison-specific guidelines in addressing any outbreaks. Discussion: Prisons are high-risk settings for the transmission of contagious diseases and there are considerable challenges in managing outbreaks in them. A public health approach to managing COVID-19 in prisons is required. PROSPERO registration number: CRD42020178827
... to their release date, while others have included low-risk PIP, such as pregnant women and older adults. 84 Whatever approaches are used, a wider discussion is required on how to balance public safety with public health, which may include economic modelling, 85 and ethical and legal considerations. 86 87 Other gaps were in relation to protective equipment-only one study recommended all individuals entering AII rooms wear special masks. ...
Article
Purpose: The first prison system case in Zimbabwe was notified in July 2020 shortly after State declaration of disaster. A legal-realist assessment was conducted of the Zimbabwean correctional system response to COVID-19 during state disaster measures, with a focus on assessing right to health, infectious disease mitigation and the extent to which minimum state obligations complied with human and health rights standards. Design/methodology/approach: The Zimbabwean correctional system operations during COVID-19 disaster measures are scrutinized using a range of international, African and domestic human rights instruments in relation to the right to health of prisoners. This study focused particularly on standards of care, environmental conditions of detention and right of access to health care. Findings: Systemic poor standards of detention are observed, where prisoners experience power outages, water shortages and a lack of access to clean drinking water and water for ablution purposes, a severe lack of safe space and adequate ventilation, poor quality food and malnutrition and a lack of sufficient supply of food, medicines, clothing and bedding. Whilst access to health care of prisoners in Zimbabwe has greatly improved in recent times, the standard of care was severely stretched during COVID-19 due to lack of government resourcing and reliance on non-governmental organisation and faith-based organisations to support demand for personal protective equipment, disinfection products and medicines. Originality/value: Prison conditions in Zimbabwe are conducive to chronic ill health and the spread of many transmissible diseases, not limited to COVID-19. The developed legal-realist account considers whether Zimbabwe had a culture of respect for the rule of law pertinent to human and health rights of those detained during COVID-19 disaster measures, and whether minimum standards of care were upheld.
Article
Purpose: The first case of COVID-19 in the Malawi prison system was reported in July 2020. Human rights organisations raised concerns about the possibility of significant COVID-19 outbreaks and deaths in the prison system, because of the poor infrastructure, lack of healthcare and adequate COVID-19 mitigation measures, existing co-morbidities (tuberculosis, HIV and hepatitis C), malnutrition and poor health of many prisoners. Design/methodology/approach: The authors conducted a legal-realist assessment of the Malawian prison system response to COVID-19 during state disaster measures, with a specific focus on the right to health and standards of healthcare as mandated in international, African and domestic law. Findings: The Malawi prison system was relatively successful in preventing serious COVID-19 outbreaks in its prisons, despite the lack of resources and the ad hoc reactive approach adopted. Whilst the Malawi national COVID plan was aligned to international and regional protocols, the combination of infrastructural deficits (clinical staff and medical provisions) and poor conditions of detention (congestion, lack of ventilation, hygiene and sanitation) were conducive to poor health and the spread of communicable disease. The state of disaster declared by the Malawi Government and visitation restrictions at prisons worsened prison conditions for those working and living there. Originality/value: In sub-Saharan Africa, there is limited capacity of prisons to adequately respond to COVID-19. This is the first legal-realist assessment of the Malawian prison system approach to tackling COVID-19, and it contributes to a growing evidence of human rights-based investigations into COVID-19 responses in African prisons (Ethiopia, South Africa and Zimbabwe).
Article
Purpose The purpose of the paper was to conduct a legal-realist assessment of the South African prison system response to COVID-19. Severely congested and ill-resourced prison systems in Africa face unprecedented challenges amplified by COVID-19. South Africa has recorded the highest COVID-19 positivity rate in Africa and, on March 15th 2020, declared a national state of disaster. The first prison system case was notified on April 6th 2020. Design/methodology/approach A legal-realist assessment of the South African prison system response to COVID-19 in the 12 months following initial case notification focused on the minimum State obligations to comply with human rights norms, and the extent to which human, health and occupational health rights of prisoners and staff were upheld during disaster measures. Findings A legal-realist account was developed, which revealed the indeterminate nature of application of South African COVID-19 government directives, ill-resourced COVID-19 mitigation measures, alarming occupational health and prison conditions and inadequate standards of health care in prisons when evaluated against the rule of law during State declaration of disaster. Originality/value This legal-realist assessment is original by virtue of its unique evaluation of the South African prison system approach to tackling COVID-19. It acknowledged State efforts, policymaking processes and outcomes and how these operated within the prison system itself. By moving beyond the deleterious impacts of the COVID-19 pandemic on the already precarious South African prison system, the authors argue for rights assurance for those who live and work in its prisons, improved infrastructure and greater substantive equality of all deprived of their liberty in South Africa.
Article
Background: Several Southeast Asian countries have implemented compulsory drug detention centres in which people who use or are suspected of using drugs, mainly amphetamine-type stimulants, are confined without their consent and in most cases without due process and clinical evaluation of their substance use disorder. Given these facilities' lack of access to evidence-based drug dependence treatment, and the human rights implications of peoples' arbitrary detention under the pretext of "treatment", international organizations have called for their closure. The aim of this study was to estimate recent numbers of compulsory drug treatment centres and of people in these centres in the region. Methods: We conducted an analysis of cross-sectional governmental data collected from seven countries in the region with compulsory drug detention centres, namely Cambodia, China, Lao PDR, Malaysia, the Philippines, Thailand and Viet Nam. We computed descriptive data provided by government representatives for the period between 2012 and 2014. Results: The total number of people in compulsory detention centres overall decreased by only 4% between 2012 and 2014. In 2014, over 450,000 people were detained in 948 facilities in the seven countries. While only two countries decreased the number of compulsory detention centres, most countries increased the number of people detained. Conclusions: In spite of international calls for the closure of compulsory detention centres, the number of facilities and detained people remained high in the seven countries included in the analysis. These officially reported figures are concerning regarding access to effective drug dependence treatment and given the potential for additional human rights abuses within compulsory detention centers. Further concerted policy and advocacy efforts should support transition of treatment for people with drug dependence towards human rights-based and evidence-based drug dependence treatment. Expansion of existing drug and HIV services in the community rather than compulsory treatment modalities will effectively address the region's drug and HIV burden.
Description of the Jail Distemper as it appeared amongst the Spanish Prisoners
  • James Carmichael Smyth
James Carmichael Smyth, Description of the Jail Distemper as it appeared amongst the Spanish Prisoners, at Winchester, in the year 1780, London, 1803, p. 7.
  • C Francis
  • Webb
Francis C Webb, An Historical Account of Gaol Fever, Read before the Epidemiological Society, on Monday, July 6th, 1857, p. 1.
Harm Reduction in Prisons. Human Rights, Minimum Standards and Monitoring at the European and International Levels, Harm Reduction International
  • Gen Sander
  • Hcv Hiv
Gen Sander, HIV, HCV, TB and Harm Reduction in Prisons. Human Rights, Minimum Standards and Monitoring at the European and International Levels, Harm Reduction International, 2016. Available at https://www.hri.global/files/2016/02/10/HRI_PrisonProjectReport_FINAL.pdf
World Prison Brief, 12 th edn, Institute for Criminal Policy Research
  • Roy Walmsley
Roy Walmsley, World Prison Brief, 12 th edn, Institute for Criminal Policy Research, Available at https://www.prisonstudies.org/sites/default/files/resources/downloads/wppl_12.pdf
The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic
Global Commission on Drug Policy, The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic, 2012, Available at https://www.globalcommissionondrugs.org/wpcontent/uploads/2012/03/GCDP_HIV-AIDS_2012_EN.pdf