A prison guard stands in front of a gate during a vaccination campaign against the coronavirus, at the El-Arjate prison near the capital Rabat, on May 26, 2021. (Photo by FADEL SENNA/AFP via Getty Images)
Explainers

The State of COVID-19 in MENA Prisons

Living in close quarters and confined to enclosed spaces, people in detention have been especially vulnerable to COVID-19 outbreaks during the pandemic. In a number of states across the Middle East and North Africa (MENA), overcrowding and medical negligence have put prisoners and detainees at risk.

From its onset, inmates in the region began feeling the effects of the pandemic. In March 2020, four Palestinian prisoners fell ill with suspected cases of COVID-19 at Israels Ramleh Prison, requiring their transfer to the prison clinic. The first known COVID-19 fatality in Algerias prisons came on April 9 at Koléa Prison, west of Algiers. In the following months, outbreaks emerged in prisons across the region.

Fifteen months after the World Health Organization (WHO) declared COVID-19 a pandemic, the Delta variant—more contagious than other strains—has reached the region. In mid-July 2021, Tunisia reported its highest COVID-19 death toll to date as the government struggled to distribute vaccines and treat patients in a strained healthcare system. Iraq, too, has seen a spike in cases, recording an all-time high in new infections in late July as outbreaks overwhelm hospitals. Libya, where new daily cases septupled in July, reports the regions highest daily infection rate. Rising case counts will put incarcerated people at risk and require prison authorities to renew health measures.

The danger of COVID-19 for prisoners and detainees will remain acute until vaccines are widely available to all incarcerated people. Until then, the threat of new outbreaks remains. Trends from the COVID-19 pandemic thus far shed light on issues to monitor. Prisoner releases in the early months of the pandemic somewhat reduced overcrowding at the time but are unlikely to suffice amid new outbreaks. Visitation restrictions and vaccination campaigns demonstrate how health measures can fall short of human rights standards. An acute transparency deficit obfuscates the state of the pandemic in detention in some countries. These trends are likely to remain important as the Delta variant (and other potential variants) spreads.

Prisoner releases

Early in the pandemic, civil society and advocacy organizations called for prisoner releases to reduce infection risks in overcrowded facilities. The WHO and Office of the High Commissioner for Human Rights (OHCHR) encouraged authorities to release people with preexisting health conditions, those who committed minor offenses and offenses not recognized under international law, and detainees with imminent release dates. A flurry of prisoner releases across the region followed. By April 2020, Moroccan authorities had released over 5,000 prisoners, and Iraq released over 16,000. Authorities implemented different types of releases, ranging from non-carceral alternatives in Jordan to amnesty in Syria.

Prisoner releases have not always unfold even-handedly—marginalized subsets of detainee populations face discrimination. In Syria, the Assad governments amnesty did not apply to political prisoners. While Israeli authorities released Israeli citizens, they kept Palestinians incarcerated, in a move that United Nations experts labeled a violation of international humanitarian law.

Even after initial prisoner releases (most of which came in spring 2020), many facilities remained overcrowded. Social distancing was often impossible. Lebanon released some pretrial detainees and prisoners in early April 2020, but Beiruts Roumieh prison still stood at nearly quadruple its intended capacity the next month. The Israeli Supreme Court ruled Palestinian prisoners have no right to social distancing protections, adopting the governments position that people in detention are analogous to roommates. Since spring 2020, new arrests have exacerbated overcrowding in different countries across the region.

Outside of routine Eid pardons, plans for new COVID-19 releases have not emerged even as arrests continue, case counts rise, and facilities remain overcrowded—even with a new wave of infections and constraints on vaccination.

Visitation restrictions

Prison authorities have turned to visitation restrictions to prevent the transmission of COVID-19 between inmates or staff and visitors. The Nelson Mandela Rules, which offer minimum standards for the treatment of prisoners, note in Rule 58 that prisoners must be allowed communication with the outside world through written correspondence and visitation. In March 2020 the WHO and OHCHR recognized the need to implement visitation restrictions in a manner that respects human rights by providing alternatives to in-person visitation. Some authorities in the region have excessively restricted visitation on ostensible public health grounds, while others have better complied with international human rights norms while maintaining health precautions.

Visitation restrictions on COVID-19 grounds have been implemented in countries throughout the region, with initial suspensions in spring 2020. Moroccos first suspension of visits came in March 2020, as did Egypts. Algerias justice ministry had suspended family visits by mid-April 2020. A Southern Transitional Council prison in southern Yemen banned visits starting on May 1, 2020. 

Inmates sometimes resisted restrictions. Soon after Jordanian authorities announced a two-week visitation ban in mid-March 2020, Irbids prison erupted in protest against the measure, and two inmates died after the protests turned violent.

As the COVID-19 pandemic wore on, the status of visitation restrictions differed from country to country and facility to facility. After pausing visits in March 2020 and resuming them in July 2020, Moroccan authorities reimposed restrictions in September 2020. Iraqi authorities lifted visitation restrictions when they reportedly finished vaccinating prisoners in late June 2021. Egyptian prisons resumed visits to normal levels in August 2020 after a five-month ban at the beginning of the pandemic. In November 2020, some Egyptian facilities halved allowed visits while others halted them again altogether. 

Some excessive visitation restrictions have violated the rights of incarcerated people. In guidance regarding COVID-19, the WHO and Office of the High Commissioner for Human Rights cautioned that the ability to meet with legal counsel must be maintained.” However, some visitation restrictions in some countries have impeded access to legal representation. Algerian authorities banned direct contact between lawyers and prisoners in April 2020. In November 2020, Egyptian prisons instituted a blanket ban on visits to political prisoners in every facility and prohibited direct communication with their attorneys.

Authorities have also violated human rights norms that require them to provide medical information to the families of detainees (Rule 68 of the Nelson Mandela Rules). Banned from visiting their relatives, the families of prisoners in the Bir Ahmed informal detention center in Yemen received no information about their loved oneshealth amid a COVID-19 outbreak in the facility in July 2020. In Egypt, too, some detainees with COVID-19 have been unable to communicate with their families about their medical status amid visitation restrictions, and prison authorities rarely release medical reports to families.

Some authorities have implemented measures that comply with international standards. In May 2020, Jordanian authorities allowed visitors to communicate through glass barriers with telephones on either side and provided supplementary mental health services to help reduce stress associated with isolation. As of May 2021, Iraqi prisons had provided “various means of communication” in prisons, especially for Eid al-Fitr, and allowed family visits under special circumstances for sick inmates.

Vaccination

Vaccine distribution in prisons and detention facilities has begun in much of the region, but significant challenges remain. Systemic healthcare challenges have impeded access in countries experiencing armed conflict, but medical negligence and discrimination raise concerns about the availability of vaccines for incarcerated people even where the broader population has access to vaccination. The latter phenomena violate the Basic Principles for the Treatment of Prisoners, which stipulate, prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.” 

The elderly and those with chronic illnesses have generally received priority access for prison vaccinations in the Middle East and North Africa. Israel began the regions first vaccination campaign with elderly inmates in December 2020. In the following months, governments launched prison vaccination campaigns in Morocco in March 2021, Tunisia and Lebanon in April, and Libya, Iraq, and Egypt in May. Jordans Minister of Health announced a plan to vaccinate all Jordanians, including prisoners, and the plan is underway, but authorities have not publicly indicated that prisoners have received vaccines. There is no indication that vaccination of prisoners and detainees has begun in Algeria, Palestine, Syria, or Yemen. These disparities, among other medical inequalities, will likely shape countriesexperiences in the months to come.

In some countries, a lack of vaccination in prisons reflects broader healthcare deficiencies. Yemen and Syria face ongoing armed conflict that has devastated healthcare infrastructure. Vaccination rates in both countries are among the lowest in the world, with enough doses administered to fully vaccinate just 1 in 200 Yemenis and 1 in 250 Syrians. There is no indication that vaccinations have begun in prisons in either country. By contrast, Morocco has the highest vaccination rate in Africa with enough doses administered to fully vaccinate nearly one in three citizens, and Moroccan authorities vaccinated 40 percent of its inmates by June 1.

Rule 24 of the Nelson Mandela Rules states that governments bear the responsibility of providing prisoners with health care that meets the same standards as those for the broader community. However, medical negligence is widespread in detention facilities in several countries in the region, raising well-founded concerns that vaccines may not reach incarcerated populations.

Discrimination against marginalized groups has marred some prison vaccination efforts. In Israel, Public Security Minister Amir Ohana ordered prisons not to vaccinate Palestinian security prisoners in December 2020. Human rights organizations challenged Ohana in the Israeli Supreme Court and successfully secured vaccine access for Palestinians in Israeli prisons. By late January 2021, more than three-quarters of Palestinian detainees in Israeli prisons had reportedly received vaccines. 

Egyptian inmates, too, have experienced vaccine discrimination. Even though Minister of Health Hala Zayed said in February 2021 that people in detention would be among the first Egyptians vaccinated, Egyptian political prisoners still do not have effective access to COVID-19 vaccines. Pretrial detainees have been unable to access vaccines, prompting legal action to secure equal vaccination.

Transparency

Securing access to reliable information about health conditions in prisons and detention facilities has emerged as an area of concern in much of the Middle East and North Africa. Lebanon has provided more information about COVID-19 cases in prisons than most MENA governments, with regular testing reports disaggregated by facility. However, most governments have been far less consistent, and some have denied incidences of COVID-19 in prisons despite evidence to the contrary. Political sensitivity of detention—especially when it involves political prisoners or cases of enforced disappearance—exacerbates access to information challenges.

Access to information about COVID-19 in detention facilities has been especially limited in conflict zones. Gleaning the status of detainees and prisoners has been difficult because of the inaccessibility of detention facilities for impartial monitors. Navigating competing governing authorities and armed groups further complicates matters—ascertaining which authorities control which detention facilities poses its own challenge, let alone determining medical conditions within those facilities.

The opacity of unofficial places of detention and secret security prisons obscures the condition of individuals detained there. By definition, victims of enforced disappearance are beyond the reach of the formal justice system and authorities do not acknowledge their detention, so information about their medical statuses is generally inaccessible. Egyptian and Syrian authorities are among the principal perpetrators of enforced disappearance in the region, and the state of the pandemic in Egyptian and Syrian secret detention facilities is unknown.

Civil society has played a significant role in bringing to light the state of COVID-19 in detention facilities. For example, the Mothers of Abductees Association has provided a window into COVID-19 outbreaks and a lack of preventive measures in Yemeni detention facilities. Other civil society organizations across the region, including those specialized in detention and those with a broader focus, have provided insight into prison conditions in their respective contexts.

Monitoring outbreaks, overcrowding, visitation restriction, and vaccinations will require information about the lived experiences of incarcerated people, which may not align with official government narratives. However, the challenges impeding transparency are significant, especially due to the sensitivity of the COVID-19 pandemic and detention for the regions governments.

Moving forward

The pandemic continues apace in the Middle East and North Africa—some countries saw their highest case counts yet in July 2021. With the Delta variant proliferating and a new wave of COVID-19 hitting the region, people in detention will remain vulnerable. 

Several areas of concern emerge when considering the last year and a half of COVID-19 in prisons. Prisoner releases, widely implemented in the early days of the pandemic, should be revisited where case counts rise and facilities remain overcrowded. Implementing preventive measures while upholding the human rights laws and norms remains critical, requiring authorities to refrain from excessive restrictions and explore ways to allow visitation and communication while mitigating risks. Vaccination presents a new opportunity to mitigate risks but also an administrative challenge and an avenue for inequitable distribution. Finally, transparency, a key issue since the pandemic began, continues to pose challenges for accountability and reporting, especially in conflict zones and places where press freedoms are threatened. Going forward, monitoring these issues will remain vital as the COVID-19 pandemic evolves.