​​Prisons in lockdown: The public health case for abolition

Incarceration is a public health crisis.

Art by Bonnie Huang

This article mentions the names of Aboriginal people who have died.

As the prison population experiences its largest outbreak since the beginning of the pandemic, the NSW government has announced a statewide prison lockdown. Currently, there are more than 300 COVID-positive inmates across NSW alone, a tripling of cases since early September. This includes 84 Aboriginal and Torres Strait Islander people, who are not only over-represented in Australia’s prisons but are the most incarcerated in the world. As authorities fail to manage outbreaks in several facilities, we get a harrowing glimpse into the public health crisis of incarceration.

The COVID-19 outbreak within prisons

Infections are spreading quickly in prisons because they are one of the most dangerous exposure sites for COVID-19, with poor ventilation and overcrowding. With the prison population reaching over 43,000, many facilities are operating at or above capacity. As a result, prisons are doubling and tripling the number of beds in single cells, making physical distance impossible. Poor sanitation and hygiene within prisons further promote the spread of the virus — hand sanitiser and masks are not provided, and very few prisoners have access to hand washing.

People in prison are especially vulnerable because they’re more likely to have existing health conditions. One in three prisoners have a chronic physical health condition, increasing the likelihood of severe complications or death from the virus. Aboriginal and Torres Strait Islander people, who experience more health issues than the general population, are at greater risk.

During the lockdown, inmates who develop cold or flu-like symptoms are put in “isolation” and monitored until their symptoms resolve. However, there is little difference between isolation for quarantine purposes and solitary confinement — a practice widely condemned as harmful and cruel. Prisoners are stuck in their cells, stripped away of what little freedoms they had. They are unable to attend education, training or rehabilitation programs, or leisure in the prison yards. They are also unable to access phones or in-cell tablets to contact loved ones. And if they develop symptoms or if their situation worsens, they can’t alert staff quickly.

Honi understands that MRRC, Bathurst Correctional Centre, and Mid North Coast Correctional Centre amongst others, have suspended all calls with solicitors. Some solicitors have been unable to contact their clients for months, which is particularly concerning given that around a third of Australia’s prison population is on remand — charged but not yet found guilty within the current legal system.

“None of [my clients] are coping during the prison lockdown,” said Jenna,* who works as a legal representative defending Aboriginal and Torres Strait Islander prisoners. “There’s a lot of anxiety from both inmates as well as their families. A lot of these inmates are subject to inhumane conditions, cut off from the rest of the world, and unable to receive the support and treatment they require in custody.”

Since March, inmates have been eligible for the jab as part of the federal government’s phase 1b vaccine rollout. Aboriginal and Torres Strait Islander prisoners would have had vaccine priority status in two categories. However, the vaccination rate for inmates is substantially below the general population. Just 21 per cent of inmates in public prisons in NSW are fully vaccinated, while 42 per cent have received one dose. In comparison, 72 per cent and 39 per cent of the NSW public have had their first and second doses, respectively.

Even though prisoners are at higher risk of transmission and death, they have been left behind in the government’s vaccine rollout. Corrective Services have confirmed that the vaccines earmarked for NSW prisoners in July were redirected to Year 12 students doing their HSC exams. This decision is ideologicial — under capitalism, where health resources aren’t distributed equitably, the health and safety of Australia’s most vulnerable populations are less important than that of the graduates who will soon enter the workforce.

Incarceration is a public health crisis

The health issues relating to the current lockdown are not isolated — prisons have long been quasi-health institutions, failing to provide proper care to people experiencing systemic disadvantage. In addition to chronic health conditions, almost half of Australia’s prison entrants reported a previous diagnosis of a mental health disorder. At the same time, 26 per cent showed high or very high levels of psychological distress.

However, prison health services fall well below acceptable standards. There have been over 474 Indigenous deaths in custody since the Royal Commission in 1991. A 2019 report found that 58 per cent of deaths were health-related, including cardiovascular diseases, strokes, heart failure and cancer; the second most common cause was death by hanging (32 per cent). While the Royal Commission made several recommendations to prevent further deaths, including screening and removal of hanging points from cells, it is deplorable that many of its recommendations are unimplemented three decades later.

What’s more, there’s a system-wide lack of proper procedures for exchanging inmates’ medical information. A 1996 report found that most prisons had no protocol for those at risk of self-harm. If there was a protocol, it was often unsatisfactory or not followed by staff. Additionally, the report noted that medical staff and prisoners were often not aware of cross-cultural health issues.

You don’t need to look further than recent coronial inquests, such as the death of Jonathon Hogan in 2018, to see how these health failings are still playing out. Hogan made multiple attempts at suicide and self-harm. While he was in custody, his son was born, and his relationship with his partner broke down. However, there is no record of any medical staff talking to Hogan about these issues. Hogan also reported experiencing auditory hallucinations since 2012, which a mental health practitioner had not reviewed for months. Despite being at risk of self-harm, Hogan was moved from a two-person to a single cell room with a hanging point, which ultimately led to his death.

Jenna also shared stories of prisoners being unable to access medication for heroin addictions and prisoners’ mental health rapidly deteriorating as days went by in lockdown. She recalled how one inmate was able to access razorblades despite previous instances of self-harm. 

Indigenous deaths in custody are not only caused by negligence or a lack of care — inmates are being killed in deliberate acts of violence. During a cell extraction, David Dungay Jr was pinned to the ground by correctional officers and died from choking. Dungay’s story tragically illustrates the relationship between health and state-sanctioned violence — despite being an insulin-dependent diabetic who had also been diagnosed with chronic paranoid schizophrenia, officers brutally restrained Dungay for the act of eating a biscuit. 

Incarceration, therefore, becomes a public health concern on two fronts. Firstly, it is a tool of upholding racist power structures, actively harming populations’ physical, mental, social, and emotional health, particularly Aboriginal and Torres Strait Islander people. Secondly, criminalisation and punitive responses to social problems reproduce the social and economic conditions that result in criminalised behaviours, undermining the overall health of communities. The violent history of settler colonialism underpins the prison system. As Karen Wyld, a Martu writer, argues: “One of the longstanding strategies of colonisation has been to criminalise, institutionalise and incarcerate Aboriginal and Torres Strait Islander people.” 

Reform is not the solution

The health crisis within NSW prisons demonstrates that incarceration systems, including policing, are ineffective responses to systemic social problems. Despite a promise of “rehabilitation,” incarceration is a violent measure that in no way transforms, restores, or heals. By locking people in jail cells, the settler-colonial state pushes them out of sight and mind, causing incalculable harm and leaving the root causes of “crime” unaddressed. 

Abolitionist Ruth Wilson Gilmore observes that governments are privatising essential public services such as healthcare, divesting from social welfare and investing in institutions of state violence in an “organised abandonment of vulnerable communities.” In this lockdown, hospitals are underfunded, understaffed and lacking equipment, while the government deploys hundreds of police officers and military officers to enforce public health orders in Western Sydney.

Aboriginal and Torres Strait Islander people are disproportionately arrested and placed in custody due to failure to comply with COVID-19 directions or to wear a mask. Jenna points out the irony of this situation — vulnerable communities are being overpoliced and incarcerated for breaching orders aimed at protecting public health while also being thrown into prisons which are high-risk settings.

Like many have said before, the carceral system isn’t “broken” — it is fulfilling its goal of subjugating an underclass of people in the interests of the state. Today, the annual cost of running Australia’s prisons is over $4.6 billion, one of the highest in the world. With more people funnelled into prisons by the day, it is impossible to justify pouring more resources into reforming or “improving” an inherently violent system.

A fundamental goal of abolitionist public health is to develop community-led solutions that tackle the social, economic and political determinants of health, thus making incarceration obsolete. Writing about abolitionist alternatives, Angela Davis asks us to forget the idea of pursuing one solution — the road ahead requires a constellation of new strategies and institutions, including secure housing, welfare support and educational access, amongst other goals. As COVID-19 exposes the fundamental failings of the prison system, we must push for a world in which sickness and death are not the status quo but where communities can flourish.

*Name has been anonymised.