Towards a health-informed approach to penal reform? Evidence from ten countries Many countries base their official capacity on cell accommodation that provides so little space per prisoner that anything close to 100 per cent occupancy rates in such a country would amount to serious overcrowding. It is also important to recognise that occupancy levels fluctuate over a given period, with many more people entering a country’s prison system in the course of a year than the ‘stock’ number represented by national prison statistics and shown on the World Prison Brief. Consequently, there may be far greater numbers in custody at certain points over a given year than there are on the date to which the stock figure refers. Prison stock data can also be many years behind the current year because some countries are slow to publish prison statistics. Overcrowding can also exist in some prisons of a country even when its overall occupancy rate is below 100 per cent. At that time I remember that there were so many people sent to prison. It was extremely crowded to the point that we needed to snatch or take everything from each other. It was like a competition to survive, you know? The sleeping space, the food, everything…’ ‘Inmate H’, Thailand It was very overcrowded. If an inmate went to the toilet, he could not come back to his place, so he must stay and sleep near the toilet. There were some occasions that I had to sleep sitting on the floor because I did not have any space to lay my body down…’ ‘Inmate J’, Thailand (Prisoner interview extracts drawn from Netrabukkana, 2016) The severity of prison overcrowding and its potential health impact should not be assessed purely by reference to the physical space available to each prisoner. The amount of time that prisoners are locked in their cells and whether cells are shared with others will also affect the impact of overcrowding on health. Being locked for up to 23 hours a day in a cell intended for one person but shared by two or three requires cell-mates to eat, and to use the toilet, in the same small space. Such conditions may well be worse for prisoners’ health than sleeping in a crowded communal cell at night and then spending the day outside the cell working and interacting with others. On the other hand, if night-time conditions in a dormitory cell make sleeping impossible because of noise, bright lights, or lack of personal space, the health impact of overcrowding will be worse. It follows that the mental and physical health impacts of overcrowding depend not only on the physical living space provided in the cell, but also on factors such as: time locked up in the cell; number of people sharing the cell; sleeping conditions; opportunities to exercise, work and interact with others; access to light and fresh air; standards of sanitation; access to drinking water; quality and sufficiency of diet; and availability of medical treatment and healthcare. These factors are crucial in preventing disease and limiting risks of disease transmission, but are often compromised when prisons are overcrowded and under-resourced. The health and wellbeing of prisoners and staff are at risk as soon as resources come under pressure, as they do in any prison operating above official capacity.19 19 See affidavit of expert witness Ms Arina Smit dated 7 December 2015, in the case of Sonke Gender Justice v Republic of South Africa and another, High Court of South Africa, Western Cape Division, Cape Town, Case No 24087/35 (extract quoted on p. 23 of this report). 16