Prison in Sierra Leone (Source: The Guardian)
[Commentary]
As long standing weaknesses in Sierra Leone’s healthcare system become exposed during the current Ebola crisis, not much is known about the preparedness of authorities to protect the country’s prison population should an outbreak occur behind bars.
A recent Awareness Times online article, dated August 12, 2014, reports that “The Director of Prisons, Sampha Bilo Kamara has said that no Ebola case has been reported in all Prisons across the country and advocated for urgent Personal Protective Equipment and training of their medical staff in handling In-mates and new cases from daily court sittings.”
The article went on to add that Mr. Kamara assured that “their response to the outbreak was prompt, and modalities were put in place for all Prisons across the country”. However, the director reportedly reiterated that additional help is needed from the country’s Ministry of Health in order to address the Ebola preparedness needs of its 3,500 prison population.
The 2013 Sierra Leone Human Rights Report issued by the United States Department of State, Bureau of Democracy, Human Rights and Labor reported that “detention conditions remained below minimum international standards because of overcrowding, unhygienic conditions, and insufficient medical attention.”
The report added that “In some prisons, cells measuring six feet by nine feet held nine or more prisoners”. Evidence exist to suggest that the promptness and the kinds of modalities we are used to under normal circumstances consistent with claims by the director are not going to be enough when it comes to what we need to fight Ebola.
If the current challenges faced by the government and its international partners in their effort to contain Ebola among the general public is anything to go by, authorities may need to do more in preparation to respond to the risk imposed to the prison population and by extension the general public, should an Ebola outbreak occur in the country’s prison system.
Such preparedness plans should not only be practical, it must also be flawlessly executed. Crowded prison cells, extremely poor sanitary conditions, combine with lack of reliable onsite prison healthcare facilities, and the need for a rigid set of requirements for isolating Ebola infested prisoners are just a few of the foreseeable critical challenges.
Due to overcrowding in the country’s prison cells, leaving prisoners literally sleeping on top of each other, a single Ebola case is likely to spread faster to other prisoners before authorities can have time to notice such an outbreak. The system is going to require a well-designed and adequately implemented process for ensuring timely identification and effective isolation of suspected Ebola cases.
Such will require prevention of unwarranted exposure of prisoners to the general public; as well as effective testing and evaluation of new convicts before letting them into the existing prison population. For example, a 21-day waiting period could be imposed on incoming convicts before letting them into the general prison population. Because prison officers are in contact with the general public and their family members at home, the system must limit physical interactions between them and the prison population. Prisoners attending court hearings should be prevented from coming in physical contact with the general public.
All chores performed by prisoners outside prison facilities must be reduced to the most necessary and the least physically exposed. Individual prison cells should be quarantined in instances where a suspected case of Ebola is identified. Authorities could also elect to release those prisoners heled for minor crimes as a way of reducing crowding in prison cells. Such releases present no risk because evidence suggests that crimes have fallen since the outbreak of Ebola. And across the border in Liberia where an inmate in the country’s main central prison has reportedly died of Ebola, authorities have released over one hundred prisoners held for bailable minor offenses.
The state of the sanitary conditions in the country’s prison system is going to create tremendous challenges should an Ebola outbreak occur. The lack of running water and poor sewage system inside prison cells is going to leave behind breeding grounds for the Ebola virus. Authorities are going to be required to act quickly to remediate some of those long standing deplorable conditions before it is too late. Prison cells are going to need adequate water supply as well as clean and disinfected sewage system. Also, authorities must ensure that adequate supply of chlorine is available to prison bathrooms. This should be backed by a comprehensive hygiene and sanitation awareness campaigns across the system.
The weak state of the country’s healthcare system available to the general public should give anyone an indication of the kinds of healthcare limitations present behind bars. Such a deplorable system makes it difficult for authorities to detect an Ebola outbreak.
To address this risk, the system is going to need well-trained and adequately equipped medical practitioners located onsite to detect early signs of Ebola. This will lead to timely identification, isolation and testing of potential cases. Holding centers must be established inside prison facilities for suspected Ebola cases. Personal protective equipment such gloves, face shields, and gowns, as well as chlorine and other disinfectants must be in adequate supply in prison facilities. Routine testing of prisoners must be performed to detect early signs of Ebola symptoms. Prison trucks and holding areas in court rooms must be adequately disinfected. And prisoners returning from court hearings must also be disinfected before letting them back into the prison population.
In the event that a prisoner contracts the Ebola virus, authorities are not only going to need to isolate that individual, but they will also need to confine them so that they could not escape. This is going to impose additional demands on the already struggling Ebola case management cycle. At a time when ordinary citizens infested with Ebola have been tempted to escape from treatment centers; it’s more than likely that Ebola infested prisoners serving long sentences will find it more appealing to do the same. And given that certain prisoners may be violent criminals, putting them in general isolated Ebola treatment centers poses risk to other patients. As a result, special isolation processes and related controls are going to be required for Ebola infested prisoners.
So, as authorities fight to contain Ebola in the streets of the country, it’s important to ensure that adequate readiness processes are put in place to contain the outbreak should the virus enter the walls of prisons, the home of the most dangerous and more vulnerable group of its citizens. If something has to be done about this disaster waiting to happen, it has to be done now. It will be too late to act if and when Ebola goes to jail.
