Thought Leadership

The health of our prisoners – who cares?

Have you ever wondered…with the state of health care facilities in Nigeria, what the health services available to prisoners would be like?

While in medical school at the University of Nigeria Teaching Hospital, Enugu…it was a regular feature of our days to see a prisoner being brought to the hospital in a wheel barrow.

I remember one particular young man. He was brought to our unit with “crusted scabies”, a severe form of scabies that would usually only occur in imunocompromised patients. Despite the usual challenges of raising the funds to pay…he was slowly managed to better health. We spoke a lot during his time at the hospital. Together with other medical students on our team, we bought him the odd bottle of coca cola and groundnuts. Despite his illness he was happy for the 1-week in hospital. He tried to explain the situations under which prisoners live in Nigeria. For us young medical students, about to dedicate the rest of our professional lives to the concept of “saving lives” …it was difficult to come to terms with. Probably why I cannot forget this guy….

It is easy to forget that prisoners have just as much a right to health as the rest of us. I have not yet head of a prison sentence that includes the removal of the right to health.

It is also easy to forget that most prisoners currently in prison are going to come out soon and return to society, our society, so that the diseases/conditions they potentially acquire in prison…will soon become part of our society’s burden, and potentially transmitted to the rest of us…the “good ones” (who might ourselves be ending up in prison soon!). This is to illustrate that “prisoners” are not a separate breed…they are us!

In preparing this blog, I was happy to find that the Nigerian Prison Service does have a website!…and has a Directorate of Health and Social Welfare charged with the physical, psychological and developmental well-being of the inmates and staff. They, for the most part try to provide for the health care of prisoners themselves by directly employing doctors and other health care professionals. How well this is done….you tell me!

….then I looked up Pubmed to search for any articles on the health of prisoners in Nigeria. I barely found a handful, a few on HIV/AIDS…a few on psychiatric consequences.

….then I searched the web for an NGO that worked for the health of prisoners in Nigeria….and I found one (Prison Rehabilitation Mission International (PREMI) (if you know of any other, pls holla)

….then I looked out for politicians speeches talking about the health of prisoners…and you can guess what I found.

There is a general ignorance about prisons and prisoners, there are no votes in them, so politicians ignore them. The rest of us feel embarrassed to be associated with “them” so we pretended they do not exist.

I contend that we do need to know what goes on in prisons, and what happens to the health of prisoners. Even if it is for selfish reasons as “they” will return to our communities. “Their” physical and mental health when they return does matter….it should matter to us!

…do you know that:

  • Most of the total prison population have not been convicted!
  • Many are locked up 24 hours a day because there are not enough warders to prevent escapes.

  • Cells are dirty, hot and hold scores of people.

Read more on the BBC

Over 150 inmates have broken out of an overcrowded prison in Nigeria’s south-east during a midnight escape bid.

Andrew Walker visits a prison in the south-eastern city of Enugu where some people who have not committed any crime are locked up for years on end.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

By Chikwe Ihekweazu

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

4 replies on “The health of our prisoners – who cares?”

Having done some work among prison inmates in 3 regions of the country, I must confess that what is seen in the prison paints a picture of utter neglect, is dehumanising and could be considered beyond the prescription of justice. Truely, prison inmates are part of us, and majority are there who have never been convicted, nobody really knows whether they stole the N1000 they where locked up for or not. Public health personnel need to rise to the challenge of not just providing information of what prison inmates face, but also advocating for their potential to receive right to life and health.

I’ve had the opportunity to do some work with KUJE prisons in Abuja and I must say that though the living conditions of the prisoiners made me vow to forever avoid crime, they had quite good medical facilities and dedicated staff. The major issue to me was the prison quarter itself, which i think gave suitable conditions for the evolution of new bacteria and viruses and consequently, major health problems. In my opinion, tackling the challenge of overcrowding and proper feeding would greatly improve the health of the prisoners.

The Health and Fate of Prisoners in Nigeria

The populations in Nigerian prisons consist of the Convicted and the “Awaiting Trial.” The latter form the majority. Prison authorities feel they have full responsibility for the convicted, but not quite for the “Awaiting Trial.” They therefore have problems with feeding, accommodation and health services.

Inadequate resources and bureaucracy among the police is often responsible for the long imprisonment of those Awaiting Trial. They have to collect sufficient evidence before taking the accused to court, but they are not provided with the wherewithal to do the job, such as the funds needed for investigation. Unwilling to release people they arrested for committing a crime, and unable to collect sufficient evidence to take them to court, these people are often forgotten, resulting in their spending several years awaiting trial for offences whose maximum sentence would be no longer than six months. Their relatives may be too poor to do the things necessary to get them off the hook, and in many cases, unaware of the arrest. The unfortunate people Awaiting Trial may therefore suffer many years of malnutrition, starvation, unhygienic conditions, deficiency diseases and may die of preventable causes, and nobody feels responsible for their fate.

In these days of payment of fees even in government health institutions, who would provide the funds for the care of prison inmates? Ask any prison officer how much is provided for the health care of prisoners, you would be astounded.

The prison authorities are usually very sympathetic but unable to help them. They have no power to release them, and their budget is totally inadequate to cater for the population under their care. You will hear many stories of how poorly paid prison warders did their best to keep these people alive.

On the surface, it is easy to blame the police and prison warders when you see the pathetic condition of these people, but this is not quite fair. The condition is caused by the failure of the entire Nigerian society to look after the vulnerable. While there are indeed bad examples among the services, the proportion is no more than exists in other professions.

There are a number of philanthropic groups that try to relieve the suffering in our prisons by visits and taking gifts of clothes, food and other relief materials to them. Some legal practitioners try to get them out by insisting on their trial and defending them free. Judges who have the power to release long detainees do so, but they are careful to avoid being accused of releasing dangerous people.

Every concerned Nigerian who knows about our prisons is frustrated about the fate of these people. In the minds of many, prisons are punishment centres, and the more uncomfortable they are, the more the convicted would do their best to go straight after release, so that they are not taken back there anymore. This is based on the old un-enlightened view, for the correct and modern practice is that prisons are for rehabilitation of those who have gone astray.

First, we need increased interest of everyone. The most privileged in our society do not go to prison no matter what they do, and the next class to them are usually detained under very comfortable conditions and have no idea what the conditions really are inside the prison. Only the poor and vulnerable suffer the full indignity of prison.

We need increased funding of the police and prison services. We need laws that obligate the authorities to prosecute all arrested persons within a stated number of days or weeks. We need legislators who passionate about the welfare of prisoners to push through the correct legislation to effectively reform our prison services. These changes will come only after the Nigerian society evolves to become humane enough to look after its vulnerable citizens. We may have to wait long.

Shima K Gyoh.

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