PRISONERS HEALTH AND SAFETY IN INDIA

There are more than 11.5 million prisoners in the globe according to the latest World Prison Population List, published in December 2021. Prisons serve as places of imprisonment and detention for those who commit heinous crimes. Most people believed that criminals were sent to prison as punishment rather than for punishment. People generally have the perception that, by virtue of being imprisoned and required to live in a cramped, enclosed space, a prisoner has forfeited his or her rights to liberty. India had 5,54,034 prisoners as of 31.12.2021, according to the most recent data on National Crime Records Bureau (which World Prison Brief has confirmed) (including pre-trial detainees).

In India, the majority of convicts are uneducated, underprivileged, and members of marginalised social groups with little knowledge of their own health and lifestyle choices. They therefore make up a unique and vulnerable health population that needs specific treatment.

The necessity to treat sickness in jails as part of a larger public health agenda and as part of primary healthcare is a concept that has yet to catch on in India, despite the fact that the lack of information about the health of prisoners is a significant human rights concern. The current situation of prison healthcare in India is examined in this article, along with the various opportunities that the “jail window” presents for interacting with those societal members who lack access to or are unable to obtain basic healthcare.

According to international agreements and treaties, prisoners have the right to non-transferability, the right to medical care, and most definitely the right not to contract a disease while in jail. Prison law acknowledges that a prisoner’s captivity cannot result in a loss of all rights. Even during imprisonment, a prisoner is entitled to some basic human rights. Within the prison facility, there is a loss of rights, nevertheless. All members of society are guaranteed good health and the greatest possible living conditions thanks to public health policy. Prisoners, however, are frequently overlooked from this formula. 

In India, cleanliness issues have gotten worse due to overcrowding. There are several prisons with poor conditions. Tehsil-class prisons do not provide even the most basic necessities. All convicts in India are subjected to a medical examination when the programme is activated, although they are not all screened for specific illnesses. National research on the prevalence of viral infections among prisoners has not been done. Inmates who are suspected of having an infectious disease must be quarantined, according to the Indian Prison Manual. They spoke with prisoners informally to discuss with medical and social organisations in some jails in order to stop the infection from spreading.

The number of prison deaths are increasing because of poor medical care for the convicts. 

Prison statistics for 2020 were issued  by the National Crime Records Bureau (NCRB), According to which 1,642 of the total fatalities were attributed to “natural causes,” while 189 were listed as “unnatural deaths.” Another 58 deaths were attributed to “unknown causes,” as several states failed to provide the necessary data.

A startling 26,426 prisoners have died while being held in judicial custody since 2000, when the NCRB began releasing data on prison mortality. Most of these deaths could be people who were waiting for justice because over 70% of the jail population is often prisoners awaiting trial.

The categories of deaths are neatly listed in the report under two columns: natural and unnatural. But a closer look at the ailments described and the causes of death under the “natural death” category shows that there is nothing natural about these deaths. The category of “unnatural deaths” also abdicates from the court and governmental obligations to ensure that persons who pass away while in judicial custody due to suicide, assaults, or other accidents receive adequate mental health care and security.

Among the natural deaths, data shows that a majority of the deaths were reported under heart-related ailments (450), lung-related ailments (235), tuberculosis (122), cancer (90), liver-related ailments (72), brain haemorrhage (59), kidney-related ailments (58) and HIV (46), among others. Prisoners’ rights activists, scholars and government hospital doctors say most of these deaths could have been avoided if proper medical care was made available on time.(The data can be vary from time to time)

Along with reducing the amount of space available for prisoners, overcrowding places an unreasonable burden on the already insufficient resources like food and medical care. The living and health situations of individuals who are imprisoned show the immediate effects of overcrowding.

Here, there is a medical centre accessible to practically every prison. However, the efficiency of these institutions depends on the staff’s availability, willingness to put in extra effort for ill inmates, and the systems in place for external supervision.

According to data from 2018, prisons are operating at less than half the authorized level of medical staff. At the end of 2018, there were actually 1,914 medical staff members working in Indian prisons, compared to a sanctioned strength of 3,220. The state with the most open positions for medical professionals is Uttar Pradesh, which has 240 of them. Bihar is next with 217 and Jharkhand has 153.

These are only the authorized posts, though. The majority of prisons in India are overcrowded, thus naturally there is a greater need for medical personnel. Rs6,068.7 crore was approved for the Indian prisons department for the fiscal year 2017–18. Only 4.3% of money was used to pay for the inmates’ medical needs.

Prisons and communicable illnesses

Due to congestion, the sanitation issue in India has gotten worse. Many prisons are in appalling circumstances. Even the most fundamental amenities are not available at tehsil level prisons. Inmates in India are not even tested for certain infectious diseases, despite the fact that all offenders receive a medical assessment when they start serving their sentences. The prevalence of STIs, HIV/AIDS, Hepatitis B, and Hepatitis C among inmates is widely documented. The detainees become more hostile because to the cramped, frequently extremely overcrowded housing circumstances.

Anger and anxiety might accumulate due to the monotonous prison environment, a lack of mental and physical stimulation, and simple boredom. In this environment, risky behavior’s like drug use and male-on-male sex are encouraged. To prevent boredom, some people partake in these activities. A study published in 2007 found that in 20 nations, the HIV prevalence rate among inmates was greater than 10%. There is some proof that HIV/STIs are very common in Indian prisons, but it is scant. A research on the incidence of HIV in Indian prisons found that 9.5% of female inmates and 1.7% of male inmates were HIV positive. This is significantly higher than the 0.32 percent for males and 0.22 percent for women HIV prevalence rate at the national level.

Rasikbhai Ramsun Rana vs. State of Gujarat

petitioners incarcerated in the Central Prison, Vadodara, who were suffering from serious illnesses, were denied sufficient and prompt medical care due to a lack of jail escorts necessary to transport them to the hospital, and that the court held negligent officers personally accountable. The Gujarat High Court granted directives to the state government in 2005 in a suo moto writ suit to guarantee that all Central and District prisons were equipped with an ICCU, pathology lab, expert physicians, sufficient staff including nurses, and the most up-to-date medical treatment devices. In Sanjay V. State (CRL.A.600 of 2000), the Delhi High Court ordered the Tihar Jail administration to offer meditational therapy and counselling to convicts.

Landmark case of Parmanand Katara Vs Union of India (1989 AIR 2039)

the Supreme Court held that the state has a duty to maintain life regardless of whether the individual is innocent or guilty of a crime, setting a strong precedent for prisoners’ rights in India, particularly the fundamental right to health guaranteed by Article 21 of the Indian Constitution.

“Our legal system, especially in severe instances, suffers from slow-motion syndrome, which is fatal to ‘fair trial’ whatever the end outcome,” Justice Krishna Iyer said while dealing with the bail petition in Babu Singh v. State of UP. He also added that speedy justice is a component of social justice since the community as a whole care about the criminal being treated with dignity and eventually punished in a fair amount of time, and the innocent being spared from the suffering of criminal or civil processes.

The Hon’ble Supreme Court expressed its concerned and said that: What faith can these lost souls have in the judicial system which denies them a bare trial for so many years and keeps them behind the bars not because they are guilty; but because they are too poor to afford bail and the courts have no time to try them. One reason why our legal and judicial system continually denies justice to the poor by keeping them for long years in pretrial detention is our highly unsatisfactory bail system. This system of bail operates very harshly against the poor and it is only the non-poor who are able to take advantage of it by getting themselves released on bail. The poor find it difficult to furnish bail even without sureties because very often the amount of bail fixed by the courts is so unrealistically excessive that in a majority of cases the poor are unable to satisfy the police or the magistrate about their solvency for the amount of the bail and where the bail is with sureties as is usually the case, it becomes an almost impossible task for the poor to find persons sufficiently solvent to stand as sureties.

Mental health and suicide

Another significant public health concern that plagues prisoners frequently is mental illness. Identification and treatment of people with mental health disorders are crucial for the sake of justice and to guarantee the protection of fundamental human rights, which are a fundamental tenet of the Indian constitution and society. According to studies conducted worldwide, the prevalence of mental diseases in jails is three times higher than it is in the general population.

Under section 27 of the Mental Health Act of 1978 (hereafter referred to as the “MHA”), a person who has been ordered to be held in or removed from a psychiatric hospital, psychiatric nursing home, prison, or any other place of secure custody is referred to as a mentally ill prisoner.

Up to 8% of suicide deaths in Indian prisons have been calculated. A 2008 study found that 11 percent of prison deaths were due to suicide. Police brutality and torture allegations regularly follow unnatural deaths in detention, especially suicides.

It can be argued that the health-related responsibility of the jail authorities does not end on the release of the prisoner; the jail needs to continue sharing the responsibility of ensuring the transitional health of prisoners as well.

(where the prisoner has formally cut ties with the prison because their sentence was completed or they were granted bail, but has not yet healthily reintegrated with mainstream society. This is called ‘transitional health’)

Prisoners require more mental healthcare than the normal population does, both while they are still inside the jail and when they leave and try to reintegrate into society. Prisoners are two to three times more likely to die by suicide than the general population. Upon being released from prison, their mental disease does not stop.

When a prisoner is incarcerated and carrying out their sentence, Indian laws pertaining to their fundamental right to health apply. In landmark cases like Sunil Batra v. Delhi Administration (II) and Ajay Singh v. State of Maharashtra as well as orders like Re – Inhuman Conditions in 1382 Prisons (2017), it was determined that while a prisoner is in custody, the state authorities are required to provide healthcare because they still have their fundamental right to health, guaranteed by Article 21 of the constitution, even though some “shrinkage” of rights does occur.

Particularly those who have done lengthy sentences feel this desire. After serving a sentence of, say, ten years, the individual can end up in an institution and struggle with mental health issues as they adjust to their “new” life outside of jail. Of the 1,44,125 total convicted prisoners, 53.54% were given life sentences, 14.4% received sentences of more than 10–13 years, and 7.77% received sentences of 7–9 years, according to Prison Statistics India 2019. Despite the lack of data on the mental health of recently released convicts, which is largely due to valid policy reasons, many prisoners are probably in poor transitional health.

The following problems are faced by people re-entering society after a long sentence in prison:

1. Adjustment and stress related disorders

2. Anxiety and mood disorders

3. Substance withdrawal related complications

4. Self-harm attempts

5. Somatoform disorders

It will be necessary for jail officials to coordinate with mental health facilities owned by the relevant governments. Under Section 18(4)(b) of the Mental Healthcare Act, these institutions may be required to establish regulations for halfway houses, sheltered housing, supported housing, and other types of housing.

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THE PRISONS ACT, 1894 

• Medical Officer

Section 13. Duties of Medical Officer.—

Subject to the control of the Superintendent, the Medical Officer shall have charge of the sanitary administration of the prison, and shall perform such duties as may be prescribed by rules made by the State Government under section [59].

Section 14. Medical Officer to report in certain cases.—

Whenever the Medical Officer has reason to believe that the mind of a prisoner is, or is likely to be, injurious affected by the discipline or treatment to which he is subjected, the Medical Officer shall report the case in writing to the Superintendent, together with such observations as he may think proper. This report, with the orders of the Superintendent thereon, shall forthwith be sent to the Inspector General for information.

Section 15. Report on death of prisoner.—

On the death of any prisoner, the Medical Officer shall forthwith record in a register the following particulars, so far as they can be ascertained, namely: (1) the day on which the deceased first complained of illness or was observed to be ill,

(2) the labour, if any, on which he was engaged on that day,

(3) the scale of his diet on that day,

(4) the day on which he was admitted to hospital,

(5) the day on which the Medical Officer was first informed of the illness,

(6) the nature of the disease,

(7) when the deceased was last seen before his death by the Medical Officer or Medical Subordinate,

(8) when the prisoner died, and

(9) (in cases where a post-mortem examination is made) an account of the appearances after death,

Together with any special remarks that appear to the Medical Officer to be required.

• HEALTH OF PRISONERS 

Section 37. Sick prisoners.—

(1) The names of prisoners desiring to see the Medical Subordinate or appearing out of health in mind or body shall, without delay, be reported by the officer in immediate charge of such prisoners to the Jailer.

(2) The Jailer shall, without delay, call the attention of the Medical Subordinate to any prisoners desiring to see him, or who is ill, or whose state of mind or body appears to require attention, and shall carry into effect all written directions given by the Medical Officer or Medical Subordinate respecting alterations of the discipline or treatment of any such prisoner.

Section 38. Record of directions of Medical Officers.—

All directions given by the Medical Officer or Medical Subordinate in relation to any prisoner, with the exception of orders for the supply of medicines or directions relating to such matters as are carried into effect by the Medical Officer himself or under his superintendence, shall be entered day by day in the prisoner’s history-ticket or in such other record as the State Government may by rule direct, and the Jailer shall make an entry in its proper place stating in respect of each direction the fact of its having been or not having been complied with, accompanied by such observations, if any, as the Jailer thinks fit to make, and the date of the entry.

Section 39. Hospital.—

In every prison an hospital or proper place for the reception of sick prisoners shall be provided. 

SECTION 55A CrPc

HEALTH AND SAFETY OF ARRESTED PERSON

“It shall be the duty of the person having the custody of an accused to take reasonable care of the health and safety of the accused”

Article 21

Article 21, which establishes “The Right to Life,” which largely covers the right to healthcare .Article 21 of the Constitution guarantees personal liberty and, as a result, forbids any inhumane, cruel, or humiliating treatment of anybody, whether a native or a foreigner. Any breach of this right is punishable under Article 14 of the Constitution, which guarantees equality and equal protection under the law. Regardless of social background, education level, financial means, or type of crime committed, every person should have access to competent medical care.

THE MENTAL HEALTH ACT, 1987

Section 28

Detention of alleged mentally ill person pending report by medical officer

(1) When any person alleged to be a mentally ill person appears or is brought before a Magistrate under section 23 or section 25, the Magistrate may, by order in writing, authorize the detention of the alleged mentally ill person under proper medical custody in an observation ward of a general hospital or general nursing Home or psychiatric hospital or psychiatric nursing home or in any other suitable place for such period not exceeding ten days as the Magistrate may consider necessary for enabling any medical officer to determine whether a medical certificate in respect of that alleged mentally ill person may properly be
given under clause (a) of sub-section (2) of section 24.
(2) The Magistrate may, from time to time, for the purpose mentioned in sub-section (1), by order in
writing, authorize such further detention of the alleged mentally ill person for periods not exceeding ten
days at a time as he may deem necessary:
Provided that no person shall be authorized to be detained under this sub-section for a continuous
period exceeding thirty days in the aggregate.

Section 29

Detention of mentally ill person pending his removal to psychiatric hospital or psychiatric
nursing home

Whenever any reception order is made by a Magistrate under section 22, section 24 or
section 25, he may, for reasons to be recorded in writing, direct that the mentally ill person in respect of
whom the order is made may be detained for such period not exceeding thirty days in such place as he
may deem appropriate, pending the removal of such person to a psychiatric hospital or psychiatric nursing
home.

Case laws

1. Nirmala Kumari Uppunganti vs The State Of Maharashtra And Anr

2. High Court On Its Own Motion vs The State Of Maharashtra 

3. Sunil Batra v. Delhi Administration, 2 SCR 557 (1980)

4. V. Vatheeswaran v. State of Tamil Nadu, 2 SCR 348 (1983)

5. State of Andhra Pradesh v Challa Ramkrishna Reddy & Ors, 5 SCC 7123 (2000)

CONCLUSION

Everyone is entitled to it under Article 21 of the Constitution, and neither the State nor anyone else has the authority to violate it. No matter if they are in jail or waiting for trial, they are still considered to be human. They also have access to all the rights that come with being a free person, albeit with some restrictions. Simply being incarcerated does not deprive people of their fundamental rights. While incarcerated, he still makes use of all of his basic rights. Even after being convicted of a crime and having their freedom taken away in accordance with the legal procedure, prisoners can still use their remaining fundamental rights.

As the custodian and protector of the citizens’ fundamental and basic human rights, the Court has a sacred duty to prevent violations of the rights of every person, whose importance cannot be overstated. The Supreme Court has made great strides in the struggle for their rights. However, it is still true that in order for them to truly consider prisoners’ rights, the police and prison administration need to be educated and trained.

Prisoners are seen inhumanely by society at large because they committed an uncivilized act, but even after receiving the appropriate punishment for their crime, society still views them as trash and treats them as though they are of no service to society. Since society as a whole is considered to be the law, they are the ones in charge of our life and determine how we should be treated.Everyone constantly treats criminals like they are beneath them, despite the fact that we are all human and ought to respect one another. People in the community don’t care about a prisoner’s health or safety unless that prisoner is a family member because, in their opinion, they deserve it as part of their punishment.The entire purpose of creating a structure like to a prison is to create a location to imprison the offender in order to prevent them from committing the crime again and give them time to reflect on their previous behaviour in order to improve in the future. However, because of the healthcare and safety difficulties, it feels like a punishment in and of itself to survive there. Additionally, they have a tougher time surviving once their prison term is over since society constantly views them as criminals and never offers them the second opportunity that everyone deserves. But even when their body is reduced to ashes, the stigma of being a criminal clings to them. When a prisoner’s sentence is up and they are released, society still views them as criminals, which places them in a lower position than other people.

To gather your opinion on what society really believes about a prisoner’s right, I’ve included a Google form link with this post.

https://forms.gle/A6VU8Yt8Lqy69chW7

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