Covid-19 Outbreaks in Prisons: A Call for Judicial System Reform

The Covid-19 pandemic has drawn attention to a usually neglected topic, the one of prison health. In the past year, prisons all over the world experienced outbreaks [1] and protests against the conditions of inmates. The specific characteristics of prison health make Covid-19 particularly challenging in these settings. It is useful to analyze them to understand the role that judicial systems play in prison and public health.

First, the prison population has on average a higher burden of disease compared to the whole population, due in part to pre-existing health issues of inmates – who often have low socioeconomic status, which is related to worse health outcomes – and in part to new health problems caused by prisons’ living conditions [2] . Prisons, being places where inmates share all the facilities, are the ideal setting for the spread of communicable diseases, especially in the case of overcrowding [3]

Second, despite seeming isolated places, prisons have much more permeable borders than may appear at first: staff goes in and out every day, and there is also the turnover of inmates, who – before and after prison term – live in their communities. Therefore, communicable diseases’ outbreaks can enter prisons from outside, but also vice versa. Moreover, the level of healthcare that people receive in prison will affect their life after the release[4]

This leads to the last point: inmates’ healthcare is under complete control of the state. What is more, in many countries it is under the responsibility of the Ministry of Justice rather than the Ministry of Health[5]. These factors are of central importance in the case of Covid-19, as the response to an outbreak can be slowed by the bureaucratic procedures to access treatment and by the lack of coordination between correctional and health authorities[6]. For this reason, during the current pandemic actors like WHO Europe [7] have highlighted the benefits of having the Ministry of Health responsible for prison health. 

It is useful to look at the case of South Africa to analyze the challenges of Covid-19 and the measures taken to address the crisis. Currently, South Africa is the African country with the highest rates of Covid-19 cases and deaths [8]. As of March 22, 2021, according to the Department of Correctional Services [9], 7,195 officials and 4,058 inmates have been infected in prisons, and 171 officials and 71 inmates died. South Africa, the sixth African country by population, has the highest prison population in the continent, around 162,000 inmates, with an overcrowding rate of 37.36%, in 2019 [10] . A main cause of overcrowding is the high number of pretrial imprisonments – about 29.30% of the prison population [11]– and prison sentences for petty crimes[12] .

During the pandemic, the government announced the release on parole of 19,000 prisoners, 12% of the prison population [13] . On one side, this measure is insufficient to solve overcrowding, as highlighted by civic organizations [14]. On the other, the release of prisoners poses new challenges to the correctional system and also to public health. After release, parolees are monitored by Community Corrections [15] , a branch of the judicial system which already faces personnel shortage and may be overburdened by this measure[16] . Moreover, parolees may go back to overcrowded neighborhoods, resulting in an increase in the risk of infection among the population [17].

To deal with Covid-19 in prisons, improving healthcare and sanitation inside prisons is necessary, but not sufficient: the issue of overcrowding must be addressed by the judicial system. However, the problems connected to the release show that overcrowding cannot be solved easily in the short period. Judicial systems should be reformed to replace imprisonment with other measures – e.g., community service, probation, house arrest – especially for pretrial cases. Moreover, it has been shown how prison affects the health outcomes of people both when they are inside and when they are released. A judicial system that lowers imprisonment rates and improves the conditions of its facilities will have a positive effect on the health of the population.

Filters:Prisons, Health Policies, Health Services, COVID-19


Teresa Nicoli Aldini, Gothenburg University


[1]:Prison Insider. (2020, April 29). Map of the coronavirus in prisons. Retrieved 29 March 2021, from

[2]: Burki, T. (2020). Prisons are “in no way equipped” to deal with COVID-19. The Lancet, 395(10234), 1411–1412. 

[3]:Kinner, S. A., Young, J. T., Snow, K., Southalan, L., Lopez-Acuña, D., Ferreira-Borges, C., & O’Moore, É. (2020). Prisons and custodial settings are part of a comprehensive response to COVID-19. The Lancet Public Health, 5(4), e188–e189.

[4]:McLeod, K. E., Butler, A., Young, J. T., Southalan, L., Borschmann, R., Sturup-Toft, S., Dirkzwager, A., Dolan, K., Acheampong, L. K., Topp, S. M., Martin, R. E., & Kinner, S. A. (2020). Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence. American Journal of Public Health, 110(3), 303–308.


[6]:Kinner, S. A., Young, J. T., Snow, K., Southalan, L., Lopez-Acuña, D., Ferreira-Borges, C., & O’Moore, É. (2020). Prisons and custodial settings are part of a comprehensive response to COVID-19. The Lancet Public Health, 5(4), e188–e189.

[7]:WHO Europe. (2020). Preparedness, prevention and control of COVID-19 in prisons and other places of detention. Interim guidance. Retrieved from‌10665/336525/‌WHO-EURO-2020-1405-41155-55954-eng.pdf?sequence=1&isAllowed=y 

[8]:WHO. (2021). WHO Coronavirus (COVID-19) Dashboard. Retrieved 27 March 2021, from

[9] :Department of Correctional Services. (2021). Home. Retrieved 27 March 2021, from  

[10] :Department of Correctional Services. (2021). DCS in Numbers. Retrieved 29 March 2021, from   

[11] : Ibid.  

[12] :Muntingh, L., & Petersen, K. (2015). Punished for being Poor: Evidence and Arguments for the decriminalisation and declassification of petty offences. ACJR Research Report. Civil Society Prison Reform Initiative (CSPRI). Retrieved from

[13] :Muntingh, L. (2020). Africa, Prisons and COVID-19. Journal of Human Rights Practice, 12(2), 284–292.

[14] :ACCORD. (2020, August 5). Africa’s prisoner release programmes: Towards preventing the spread of coronavirus COVID-19. Retrieved 29 March 2021, from‌analysis/africas-prisoner-release-programmes-towards-preventing-the-spread-of-coronavirus-covid-19/

[15] :Department of Correctional Services. (2021). Community Corrections. Retrieved 27 March 2021, from 

[16] :Kras, K. R., & Fitz, L. (2020). The Social and Environmental Implications of the Novel Coronavirus on Institutional and Community Corrections in South Africa. Victims & Offenders, 15(7–8), 933–947.

[17] :Muntingh, L. (2020). Africa, Prisons and COVID-19. Journal of Human Rights Practice, 12(2), 284–292.