Most of India's prisoners have yet to go to trial — and many are dying in jail.

“I would see this one prison inmate being brought to the hospital every day for an entire week, and each time turned away,” recalls a young doctor at the state-run J.J. Hospital in Mumbai. The police escorting the prisoner would bring him after the outpatient department, or OPD, had closed for the day. A week later, when the patient was finally brought during OPD hours, it was too late. “The patient had developed complications. He soon died of septicemia and multiple organ failure,” says the doctor.

This patient, a prisoner awaiting trial, was one of the 1,845 incarcerated persons who died in judicial custody in 2018, the worst-ever year for inmate deaths in Indian jails, according to National Crime Records Bureau data released last week.

The mortality rate in Indian prisons has shown a steady rise in the past two decades. In 2018, the figure crossed the 1,800 mark for the first time.

As many as 1,639 persons died of “natural causes,” while 149 were categorized as “unnatural deaths.” Another 57 deaths were for “unknown reasons,” as some states have not furnished the required information.

Since 2000, when the NCRB first published prison deaths data, 26,426 incarcerated persons have lost their lives in judicial custody. Since more than 70 percent of the total prison population are still awaiting trial, a majority of these deaths could be of those who haven’t even been convicted.

Among “natural deaths,” data shows that a majority were reported under heart-related ailments (411), lung-related ailments (231), tuberculosis (103), cancer (80), liver-related ailments (72), brain hemorrhage (59), kidney-related ailments (58) and HIV (46). Prisoners’ rights activists, scholars and government hospital doctors say most of these deaths could have been avoided with proper and timely medical care.

At the end of 2018, India’s 1,339 jails held 466,084 prisoners, whereas total prison capacity is 396,223. Overcrowding, along with shrinking available space, also causes an unjustified strain on already inadequate resources like food and medical facilities. Maharashtra, where prisons are overcrowded by almost 50 percent, has been among the top four states in terms of custodial deaths.

Most prisons have an attached medical facility. But at the end of 2018, only 1,914 medical staff members were posted in Indian jails against the sanctioned figure of 3,220. Uttar Pradesh, India’s most populous state, reported the highest number of vacant medical staff posts at 240, followed by Bihar with 217 vacant posts and Jharkhand at 153.

And these are just the sanctioned posts. Most prisons in India are overcrowded, and so automatically need more medical staff. But in 2017-18, only 4.3 percent of the national budget for prisons was spent on the medical needs of those incarcerated.

Vijay Raghavan, project director at a Tata Institute of Social Sciences initiative called Prayas that works in prisons, points to the shortage of medical care facilities for prisoners, both inside prisons and in the government’s facilities outside. “Prisoners’ movement is highly dependent on the availability of police escorts,” says Raghavan, noting that prisoners often can’t be moved to hospitals owing to a shortage of escorts.

The directorate of health services has stipulated a prison ward in every Maharashtra government hospital. But very few of them are functional, so prisoners are often referred to hospitals that are dozens of miles away. They’ll need a police escort team available to take them, and they must get there before the OPD closes at 1:30 pm. And hospitals that do have a prison ward, such as J.J. Hospital, often don’t have facilities for accompanying police escorts to stay at. The police therefore try to avoid letting the prisoner be hospitalized, and instead make every effort to take them back to the prison, says a social activist at a Mumbai prison.

A Maharashtra government-led panel of experts under retired judge S Radhakrishnan had in 2017 recommended that a team consisting of a gynecologist, general physician, skin specialist, psychiatrist [or a social worker with psychological training] and pediatrician visit jails for two hours once every week. “When prisoners can’t be taken to the hospital, the hospital was to be made available for them at their doorstep,” says Raghavan, who was part of the expert committee. But the recommendation is yet to be implemented for the most part, he says.

When there is judicial intervention, the prison authorities and the state government have acted more responsibly. Raghavan says soon after the Bombay High Court issued guidelines for a case in 2006, a team of doctors started visiting a women’s prison in the Mumbai neighborhood of Byculla. “The system has been effective,” Raghavan says.

The Bombay High Court has directed the government of Maharashtra to ensure a judicial magistrate’s inquiry in the event of a custodial death, a requirement also laid down under Section 176 (1A) of India’s Criminal Procedure Code. But only a handful of states — like Tamil Nadu and some districts of Karnataka — follow this rule, despite courts pulling up others for their dereliction.

The absence of adequate data scrutiny is another challenge. Few questions are raised by authorities on what actually caused deaths listed as “natural” in the NCRB data, whether it was a “headache” or “weakness.”

The National Human Rights Commission in 1993 had instructed all states to inform it “within 24 hours of occurrence of any custodial death,” and to follow that up with a postmortem and a magisterial inquest. But the NHRC mostly accepts these reports at face value. Then, in 2010, it issued a guideline saying that “an inquiry by a judicial magistrate is not mandatory” in cases where there’s no suspicion of wrongdoing. The NHRC cited the “practical difficulties” states face in ensuring such inquires. The rights of those behind bars didn’t seem to matter.







