Africa: the impossible confinement

Frédéric Le Marcis. For once, the rich are not pointing the fingers at the poor but the reverse. That is new, COVID-19 offers the possibility of a direct and global questioning of what confinement is as well as its limits, that strikes me! Let me explain – in general, since what Michel Foucault called the ‘Great Confinement’, we thought that prison, confinement and all the things that interest Prison Insider and which I work on in Africa – were reserved for the so-called others, that is to say, for the other sick one, the other delinquent, the other refugee, the other foreigner. These are the ones we put in prison. Consequently, we could no longer criticise confinement in public spaces, because it had always been reserved for the others.

With COVID-19 came a paradigm shift, those who usually lock others up, became locked down, imposing lockdown as a form of risk management.

One thing must be underlined – in Europe, we locked down based on our ability to do so. We have the means to confine ourselves and the means to continue to feed ourselves. In countries where structures and capacities are weaker, like in some African countries, this was simply impossible. Essentially, this generally imposed confinement makes everyone partake in this issue. We are at a crossroads.

It means deciding whether lockdown should become an acceptable modality, or, if we have come to realise what imprisonment really means now that everyone has experienced it?

In Africa, the menace came from the North. However, this statement no longer really holds today because even if the epidemic had lesser impact there than in the North, for reasons which must still be clearly explained (a younger population which is therefore less sensitive to the virus, the absence of retirement homes where the virus can wreak havoc and the relatively lower urban density are three sociological explanations which must be backed up by biological explanations), we have nevertheless reached the ‘communal’ stage of the epidemic. Now, everyone is concerned. The era of blaming the ‘other’ as the source of the virus is past; instead, we are now looking at the intentions of those who want to come and vaccinate the population. This is a postcolonial reality in public health procedures.

FLM. The international press often highlights the Ebola heritage, which should have positively conditioned the response to the epidemic in African. Actually, this heritage is ambiguous. First of all, Ebola mainly concerns the Democratic Republic of the Congo, Guinea, Sierra Leone and Liberia and not the whole continent. Today in these countries, the mechanisms put in place against Ebola are being applied and this could also be harmful. Although insufficient, diagnostic laboratories exist. Also, reapplying policies directly from the fight against Ebola may be negative, the Ebola virus kills easily but infects less while the SARS-CoV-2 virus spreads easily but kills less.

Also, associating Ebola and COVID-19 by applying the same policies and vocabulary contributes to creating confusion and mistrust among the population. It revives the traumatic memories of Ebola and all that is associated with it – violence, rumours, anxieties.

Regarding prisons, despite numerous alerts and release of prisoners to decongest facilities and avoid contamination in several African countries¹, the results are rather mixed and the epidemic was not prevented from spreading in prisons.

While on a prison mission in Burkina Faso, I observed the importance of micro-local actors – the local healer, the imam or the priest from the nearest town. They have always played an important role in prisons, in terms of food, for example. In Guinea, the Belgian development agency ‘Enabel’ funded Fraternité Médical Guinée while the French Development Agency (AFD) funded Terres des Hommes to carry out prevention work in prisons. This took place in the Maison Centrale in Conakry and in nine other major prisons in the country. Fraternité Médical Guinée has long been involved in HIV prevention for vulnerable populations. They therefore know the prison environment well and have focused on the prevention of COVID-19 (providing masks, hygiene kits). These NGOs complement the work carried out by the National Health Security Agency (ANSS) which has set up air-conditioned tents as epidemic treatment centre within the prison to receive and care for inmates who test positive.

It is good to see response to COVID-19 in prisons taking place; however, it still lacks proper organisation, there is more to be done (all prisoners have not yet been tested), structural issues which make it possible to manage its rapid spread within the prison population (such as overcrowding and the term of remand prisoners) are yet to be addressed.

Practises also differ from one country to the other. In Cameroon, 1,300 prisoners were released. The Ministry of Health stated on its website that the prisoners were screened before release and that 70% of them were positive. This information lasted for about two or three hours on the website before being removed without a trace. However, we sense that Cameroon has taken some steps, notably by releasing prisoners. There is a difference between what the State does and what it chooses to communicate.
We observe that some countries in Africa released prisoners to ease overcrowding. However, the practice is not unique to epidemics. In Africa, presidential pardons are one of the common practices for managing overcrowding in prisons.

FLM. I was consulted for an intervention at the prison in Conakry. I proposed using the available funds to build a Tuberculosis Centre, similar to the one at MACA prison in Abidjan. In Conakry, it is just a cell at the end of a corridor with a rope barrier and preventing people from crossing – we could conclude that there is basically no isolation. This is not the case. Air-conditioned tents were installed, therefore, the conditions for ‘COVID-19’ prisoners are better than that of those without the disease. Infected prisoners not only have air-conditioned tents, but also have better food. As with HIV patients supported by specific programmes, it is believed, with good reason, that treatment can only be effective if the patient eats well.

Being sick with HIV in prison guarantees protection as long as there is a dedicated programme for the disease. Conversely, healthy prisoners risk contracting beriberi if they don’t have external food support.

The disinfection of the premises is more of a symbolic gesture than an effective one. If only one sick person walks pass the virus will be redeposited. Lockdown in prisons is an illusion and is completely harmful. It is an illusion because prisons areas are for circulation. For example, guards are not locked up with prisoners, they come in and go out every day and are a significant vector for virus circulation.

This is harmful, because visits and delivery of food are suspended and access to prisoners is more complicated. When you add locks to a prison, you also add possible forms of racketeering.

Hygiene kits are available. They are in front of the cells and consist of a hand-washing station. It is better than nothing but the ideal would be if each prisoner had a personal hygiene kit, sanitisers and masks. In the prison in Conakry, 2,000 cloth masks were delivered for 1,400 prisoners and 700 warders. This is insufficient, inmates are supposed to change masks regularly and wash them with soap and hot water, which is not possible. An unwashed mask is a potential virus vector.

In Africa, prison healthcare remains the poor relative of the prison system. This observation rings true on a global scale, even in the most advanced countries. The SARS-CoV-2 epidemic is an opportunity to remind people of this again in a particularly salient way. Overcrowding, the weakness of preventive measures and the extent of comorbidities in prisons create fertile ground for the development of the epidemic. Once detected, its spread is enabled by half-hearted security measures (cancelling visits, postponing of group activities within facilities) done in disregard to prisoners’ rights and their health in a general sense or more simply disrespect for their basic needs. We are setting up a Guinea – Burkina – Cameroon programme with Marie Morelle called ‘Viral and Bacterial Circulation in Prison’. It focuses on the treatment of tuberculosis, HIV and hepatitis in these three countries. It is currently under review by the Global Fund. We intend to analyse the reasons behind the circulation of the virus in prison in relation to the social origin of the prisoners and their conditions of imprisonment. This project is very timely. Perhaps it will help change the way authorities view health in prisons.