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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 contagions—COVID-19. With physical distancing
core to the COVID-19 response—an 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 others—such as Indonesia, Brazil,
Nigeria, Iran, and Turkey—the 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
