Criminal Justice Failures, Overcrowding, and Poor Care Exacerbate Spread of TB, HIV
April 27, 2010
Zambian prisoners are starved, packed into cells unfit for human habitation, and face beatings at the hands of certain guards or fellow inmates. Children, pregnant women, pre-trial detainees, and convicted criminals are condemned to brutal treatment and are at serious risk of drug-resistant TB and HIV infection.
Kenneth Roth, executive director of Human Rights Watch

(Lusaka) - Prisoners in Zambia suffer malnutrition, overcrowding, grossly inadequate medical care, and the risk of rape or torture, the Prisons Care and Counselling Association (PRISCCA), AIDS and Rights Alliance for Southern Africa (ARASA), and Human Rights Watch said in a report released today. Some prisoners are detained for years in such conditions even before they are brought to trial, the groups said.

The 135-page report, "Unjust and Unhealthy: HIV, TB, and Abuse in Zambian Prisons," documents the failure of the Zambian prison authority to provide basic nutrition, sanitation, and housing for prisoners, and of the criminal justice system to ensure speedy trials and appeals, and to make the fullest use of non-custodial alternatives. Poor conditions and minimal medical care for prisoners lead to the transmission of HIV and tuberculosis (TB) - including difficult-to-treat and potentially deadly drug-resistant strains - that threaten the lives of both inmates and the general public, the report says.

"Zambian prisoners are starved, packed into cells unfit for human habitation, and face beatings at the hands of certain guards or fellow inmates," said Kenneth Roth, executive director of Human Rights Watch. "Children, pregnant women, pre-trial detainees, and convicted criminals are condemned to brutal treatment and are at serious risk of drug-resistant TB and HIV infection."

The groups called on the Zambian government and its partners to make immediate improvements in prison conditions and medical care, and the criminal justice system, both to respect the rights of prisoners and to protect public health.

The report says that prisoners frequently spend years in prison awaiting resolution of their case. Over a third of inmates in Zambia are not serving time following a conviction but are in prison on remand, awaiting trial or other legal action. They frequently have no access to a lawyer or to bail and may wait months even for an initial appearance before a judge. Immigration detainees often linger in prison with no due process.

Partly as a result of such justice failures, overcrowding is endemic in Zambian prisons. Children and adults, remand, immigration, and convicted detainees all are held together in spaces so tight that at some prisons, they are forced to sleep seated or in shifts. Food provided by the government is so inadequate that food has become a commodity traded for sex. Water is unclean, no soap is provided, and bathing facilities are squalid. Many prisoners are not provided with uniforms and wear rags. Blankets crawl with lice.

Infectious disease - in particular TB and drug-resistant TB - is a serious prison health and public health danger as a result of these conditions. The conditions in TB isolation cells are life-threatening, yet inmates who have completed TB treatment choose to continue sleeping in the cells with prisoners with active TB because they are less crowded than general population cells. HIV prevalence rates are high, last measured at 27 percent. While testing and treatment have improved at some prisons, serious gaps remain, particularly at smaller, rural prisons. A ban on condoms makes HIV prevention impossible.

"People are dying," said Godfrey Malembeka, a former prisoner and prison rights activist who is executive director of PRISCCA. "Zambia has an obligation to ensure humane treatment for prisoners. Human beings cannot live the way the prisoners are living - it is intolerable."

Physical abuse only compounds the ill health of inmates. Some prison officers routinely beat prisoners, or force them naked into small, dark cells where they are given minimal food. Officers flood the cells with water to exacerbate the punishment. Prisoners are also frequently beaten by other inmates, especially at farm prisons. Sexual abuse is common, and children are particularly vulnerable to rape by adult inmates in their cells.

Medical care is almost non-existent. The Zambia Prisons Service employs only 14 healthcare workers to serve 15,300 inmates, and only 15 of the country's 86 prisons have clinics or sick bays. Inmates are frequently prevented from accessing health facilities outside the prison based on the sole judgment of non-medical officers and other inmates or because of a lack of transport or security fears on the part of prison officers.

The report's authors called on the Zambian government to take prompt action to improve medical care by installing a clinical officer at each of the country's 86 prisons, and to decrease overcrowding by scaling up the use of bail, parole, and non-custodial sentencing options. The report also calls on the Zambian government, in partnership with international agencies and donors, to increase medical services within prisons to include on-site HIV and TB testing and treatment, to improve access to external health facilities, and to improve general conditions, end physical abuse, and speed the progress of prisoners' cases through the justice system.

"Zambia needs to act now to improve conditions in prisons and address the health needs of prisoners," said Michaela Clayton, director of ARASA. "Addressing prisoner health is also critical for effectively addressing community health, since prisoners and staff return to towns and villages. Forsaking justice and health for prisoners jeopardizes us all."