Civil rights, right to health and preventing COVID-19 in prisons Right to health and hygiene Under international human rights law, every human being has the right to the highest attainable standard of physical and mental health. When a state deprives someone of their liberty, it takes on the duty of care to provide medical treatment and to protect and promote his or her physical and mental health and well-being, as laid out by the United Nations Standard Minimum Rules for the Treatment of Nelson Mandela Rules).5 This duty of care is critical, because prisoners have no alternative but to rely on the authorities to promote and protect their health. the transmission of diseases is rife in overcrowded facilities, placing the lives of both prisoners and staff at risk. Rates of disease, substance dependency and mental illness among people in prison are much higher than in the community. People in prison often come from impoverished and marginalised backgrounds where they may have been exposed to transmissible diseases and inadequate nutrition, and their access to good quality health services will have been limited. Some prisoners may have neglected their health and may never have been treated by a qualified doctor before their imprisonment, particularly if they come from rural or remote areas. Concerns with ensuring equivalence of care in places of detention amid the COVID-19 pandemic are wide ranging. The basic protective measures issued by the World Health Organization. These include two key components: washing your hands frequently and maintain distance from others. They also advise to seek medical care early in case of a fever, cough or breathing difficulties, and stay informed. Communicable diseases are a particular concern, with infection rates for tuberculosis between 10 and 100 times higher than in the community. People in prison are five times more likely to be living with HIV than adults in the general population, and they have been identified by UNAIDS as a key population that has been left behind in responses to the AIDS epidemic. As we reported in Global Prison Trends 2019, which had healthcare in prisons as a special focus,6 For more information on the Nelson Mandela Rules: https://www.penalreform.org/issues/prisonconditions/standard-minimum-rules/. 6 Global Prison Trends 2019, available at https://www.penalreform.org/resource/global-prisontrends-2019/. 5 The Nelson Mandela Rules require equivalence of healthcare – meaning health provision in prison settings should be the same standard as available in the community. In practice, however the healthcare services many people in prison receive is of an inferior standard to that available in the wider community, and some do not receive treatment at all. For most people in the community these are relatively easy actions to implement. However, for people in detention they rely on the state authorities to be able to exercise their right to health. It is reported, for instance, that the Arizona (USA) Department of Corrections has not taken appropriate preventive measures, and that its prison conditions are ‘crowded, filthy, unventilated dorms, tents, and Quonset huts housing elderly, frail men with chronic health conditions and multiple disabilities’.7 ‘Attorneys, Inmates, Correctional Officers Say Arizona Prisons Not Ready For The Coronavirus’, 14 March 2020, available at https://kjzz.org/content/1485691/attorneysinmates-correctional-officers-say-arizona-prisons-notready-coronavirus. 7 Page 4 of 13 www.penalreform.org