Health Experts and the Deadly Risks of Pretrial Detention

Dr. John May will never forget the kid. The kid was just 18 years old, and was HIV positive when he was arrested and charged with theft in Haiti. He then spent the next two years in pretrial detention, awaiting a court hearing. He was held, often without food, in an overcrowded cell where he had to fight for space to lie down. Eventually, the kid contracted drug-resistant tuberculosis from a fellow inmate. At age 20, the kid died in prison. He had never been convicted. In fact, he had never seen a judge, or even been to court.

The kid has become a permanent presence for Dr. May, an internist and an expert in the provision of healthcare for people held in detention. He is also the founder of Health through Walls, a group which supports the development of proper healthcare in prisons in the developing world. It is working on projects in Africa and the Caribbean to help control and prevent the kind of tragic outcome that took the life of the kid, fighting the illness and disease that can flourish in overcrowded or poorly managed pretrial detention facilities.

Every day, all around the world, millions of people spend time in pretrial detention. While they wait, charged but not tried, for their day in court, they are exposed to health-threatening conditions—conditions which are sometimes worse than those faced by inmates serving prison sentences after receiving guilty verdicts.

With over 10 million people moving through holding facilities every year, communicable diseases present in often overcrowded cells pass easily from detainee to detainee. Then, when people are released back to their communities, diseases such as HIV/Aids and TB can be passed on to their friends and families.

To people working in prisons this isn’t news. What is new is the focus on the issue now coming from both the medical and criminal justice communities. Reducing the number of people in pretrial detention is a logical way to reduce this epidemiological effect, especially when one takes into account that pretrial detention is supposedly only allowed as an exceptional measure under international and national laws and standards.

What’s missing is political will. Government agencies are hard to convince, as people accused of crimes don’t get much sympathy from the authorities—even if they are supposedly innocent until proven guilty—and human right arguments seldom hold sway. Nor will anecdotal evidence suffice. Hard data is needed to document the extent of the problem and to develop solutions that could prompt governments to act.

A new publication, Pretrial Detention and Health: Unintended Consequences, Deadly Results, takes a first step. Dr. Joanne Csete, of the Mailman School of Public Health at Columbia University, reviews the scant existing literature on the link between excessive and unnecessary pretrial detention and negative consequences for public health. She makes a number of recommendations for health professionals that suit both developing and developed countries, such as pursuing research on the issues, providing technical support to prison authorities, and pushing for more donor funding.

The impetus to bring about policy changes will also be boosted by the kind of broad alliance this report represents, an alliance between health professionals and those who are trying to improve the mechanisms of national justice systems.

Medical staff who care for the health of prisoners and detainees may traditionally not have much interest in how the justice system itself works. But a functioning bail system, or early access to a lawyer, can reduce overcrowding in prisons and lock-ups. Fewer people held in detention means fewer people exposed to life-threatening diseases such as HIV/Aids, hepatitis C or tuberculosis, and healthier communities.

The report argues: “Health professionals, including university-based experts, should be mobilized to provide leadership in this area—through their research and teaching, practice, technical assistance, membership in professional societies, and solidarity with prison health professions.”

Health professionals, it concludes, "are a crucial voice in advocacy for reduction in the use of pretrial detention as well as the realization of the health rights of the detained”.