HEALTHCARE IN PRISONS Temperatures in prison Extreme temperatures in prisons can result in unacceptable and inhumane conditions that threaten the health and well-being of both staff and prisoners, some of whom will be especially vulnerable, including children, older people and those in poor health. This will become an increasingly important issue as global temperatures increase. Exposure to high heat can lead to an increase in aggression, overall poor mental health and, in serious cases, to death. In 2011, 10 people imprisoned in the US died from heat-related causes, triggering lawsuits that resulted in the state agreeing to place permanent air conditioning units in facilities.11 Equally, prisoners exposed to excessive cold may suffer hypothermia, particularly if they do not have adequate bedding and clothing. necessary measures put in place in order to prevent such diseases from spreading within the prison. The initial medical screening of a prisoner provides an important opportunity to identify prisoners at risk of suicide or self-harm. It is particularly important to detect these signs at an early stage, since the risk of suicide or self-harm is much greater during the first days of imprisonment. Additionally, early identification of such risks can help to determine what the safe and appropriate placement and supervision should be for prisoners that have been placed on suicide/ self-harm alert. It is good practice to involve a psychologist in initial medical assessments. Identifying health needs soon after admission helps prison administrations to plan relevant healthcare provision, staffing and other resource requirements, including the special dietary needs of prisoners. It also assists prison management in planning transport, staffing and other logistical arrangements for scheduled hospital visits. Identifying existing or potential A number of reports surfaced in 2018 that revealed the harms caused by extreme temperatures. In the US, hundreds of prisoners were locked in their cells during a week-long power blackout, during which prisoners were left in darkness, without heat and hot water for some of the coldest days of the winter.12 Conversely, in Arizona in the summer, prison logs showed temperatures of up to 119 degrees Fahrenheit (48 degrees Celsius).13 In the UK, prisons built in the 1800s proved inadequate during a summer heatwave and the lack of ventilation resulted in ‘oven-like’ conditions.14 In Fuchu prison in Japan, heating routinely does not function and frostbite is a common complaint.15 In Cambodia, a former prisoner described living in a crowded prison with her newborn baby: ‘It was actually a steaming room. I was using a fan made of a palm leaf to cool my baby down – that was what I could afford. There was a tiny hole in the wall, but can you imagine how much air you would absorb in such a crowded space? We made a request for an electric fan, but it never arrived.’16 The Nelson Mandela Rules state that a physician should regularly inspect the temperature of a prison and that accommodation and clothing should be appropriate for climatic conditions,17 while the European Prison Rules stipulate that all accommodation for prisoners should have adequate heating.18 The European Court of Human Rights19 has also recognised adequate temperature as a basic requirement for acceptable prison conditions. Prison systems now need to adapt to the impending challenge of climate change, by reducing prison overcrowding, closing or retrofitting inadequate facilities, and building sustainable and resilient facilities that ensure the health and well-being of prisoners. health problems as soon as possible after admission means that prison administrations can save resources by preventing illness or the deterioration of health conditions, and by preventing communicable diseases from spreading to other prisoners or staff. By being aware of the health situation of each prisoner, prison administrations can better plan for individualised rehabilitation programmes, including appropriate training and work opportunities. Prisoners with health problems may be unable to participate in established work programmes, or such programmes may need to be tailored to their particular situation. sanctions. Prisoners should have the opportunity to seek medical care and be able to access healthcare services confidentially. The involvement of ‘gatekeepers’ – such as cell leaders or prison staff – in the process for obtaining a medical appointment should be avoided. Ongoing healthcare provision Facilities should be easily accessible, including for those with physical disabilities. In facilities that hold both male and female prisoners or both adult and child prisoners, there should either be separate facilities or designated times when women and child prisoners can access healthcare services separately. The Nelson Mandela Rules make it clear that healthcare professionals should talk with and examine every prisoner, not only on admission but also as necessary afterwards. To have full access to all prisoners, medical staff should be informed about where they are located, including those undergoing disciplinary Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019 Medical care should be available at all times, including when cells are locked and staffing levels are reduced. This may be a particular concern at night, during weekends and on national holidays. The requirement for health services to be available at all times is linked to the need for adequate staffing levels of both prison officers and healthcare personnel. |5