A few months ago, our team at Doctors Without Borders (MSF) received alarming reports about prisoners starving in Malawi’s Mulanje Prison, about 70 kms southeast of Blantyre.
Prisoners were seen crawling on the ground to collect scraps of food that were thrown over the wall to feed them. Skeletal people were in such a state of malnutrition they looked like ‘’victims in a concentration camp”.
Mulanje, a small medium-security correctional centre, wasn’t a prison where we normally worked and at first we believed these reports were exaggerated. But after sending in a medical team and screening 357 inmates, it was found that 14% of all inmates were severely malnourished.
To put this in context: if 14% of adults have severe, acute malnutrition in a particular community, it is defined as an acute food crisis.
Many of the prisoners in Mulanje displaying signs of malnutrition were HIV positive or had tuberculosis (TB). Having these conditions increases a person’s risk of becoming malnourished — and without adequate nutrition, the immune systems of HIV and TB patients will be weakened further.
Symptoms of people with acute malnutrition include muscle wasting, hair loss, anaemia and increased susceptibility to infections.
An MSF assessment found that 14% of inmates at Mulanje Prison were severely malnourished. (Luca Sola, MSF)
For the last month, an MSF nurse has been running a therapeutic feeding programme and providing primary health care at Mulanje. Out of 78 inmates who were malnourished, 34 remain in the feeding programme. A number of prisoners affected by HIV and TB have started life-saving treatment.
MSF has been working since mid-2014 to support the Malawi Prison Service in Maula and Chichiri, two of the largest prisons in the country. We have become increasingly concerned by the inadequate food and medical care prisoners are receiving. Although the Mulanje case cannot be generalised to all of the country’s 28 prisons, it is clear that the prison service is unable to meet even the minimum nutritional requirements for the 14 000 inmates under its care.
Malawi has declared a state of national disaster over food shortages caused by erratic climate conditions — drought and floods.
The prison service did not get adequate funding to feed its inmates even when food was more plentiful and maize prices were stable. Now that a food crisis is unfolding in the country, the prisons do not have the money to purchase the food required for a prisoner’s daily, staple meal - a nutritionally inadequate plate of nsima (maize flour) and beans.
Malawian prison services were chronically underfunded before, but this has only worsened as crops have failed and maize prices have risen. (Luca Sola, MSF)
In Chichiri and Maula prisons, where MSF helps with the provision of HIV, TB and other medical services, we have often seen prisoners go for up to two days with no food. Sometimes a prison relies on donations from relatives or church organisations, who may provide one sack of maize for a prison population of 1 900 that requires 28 sacks a day. When this happens, only prisoners living with HIV and TB are fed.
Malnutrition rates in Chichiri and Maula have increased in recent months. All the prisoners suffer from constant hunger and many are anaemic. We respond by providing ready-to-use therapeutic food to the severely malnourished inmates, but we’re acutely aware that it’s a Band-Aid solution that fails to address the bigger problem of inadequate prison food supplies.
In June, a group of civil society organisations sought Malawian President Peter Mutharika’s urgent intervention in the critical food shortages facing the prisons. Not only was the denial of nutritious food to prisoners inhumane, it was also unlawful, they argued. The group proposed pardoning prisoners convicted of minor offences and releasing migrants detained on immigration-related charges as immediate solutions.
Over-congestion in the country’s prisons is a chronic problem. Typically, prisons have three times as many inmates as their intended capacities. The prisons have insufficient water and poor sanitation (one tap for 900 people). Overcrowding exacerbates the risk that communicable diseases such as TB, scabies, cholera and diarrhoea will spread.
Overcrowding and food shortages recently led Malawian President Peter Mutharika to issue calls for the release of all inmates being held for petty or immigration-related crimes. (Luca Sola, MSF)
A few weeks ago, Mutharika approved measures to “protect prisoners in Malawi’s jails by reducing the prison population from its current 14 200 to manageable figures”. The minister of justice has been told to start pardoning prisoners who have been locked up for petty or immigration offences, and the treasury has been directed to prioritise the prisons in funding plans.
This development is very welcome. We are cautiously optimistic that serious de-congestion will start to occur while civil society continues to push for more humane and dignified conditions for inmates.
Increasing funding to ensure prisons have the food, dedicated health staff, drug supplies and water and sanitation services they need will be a bigger challenge. In a country facing a massive budget deficit and critical funding gaps across all government sectors, the risk – as always – will be that the prison service and its inmates will fall to the bottom of the priority list.
Donors and multilateral organisations must ensure they step in to address gaps in funding. The ministries of health and agriculture and the department of disaster management affairs in particular need to ensure national plans to improve the health and overall food status of Malawi’s citizens, including those living behind bars.
Nicolette Jackson is a deputy head of mission with MSF in Malawi
Have something to say? Tweet us on @Bhekisisa_MG or Facebook us on @Bhekisisa.Health
Detained for a dream: Inhumane treatment in Malawi's prisons
Pollsmoor Remand: "They treated us like animals"
A sickening state of affairs at Pollsmoor prison
We could be just months away from knowing whether Depo-Provera use is linked to a higher risk of HIV infection in women.
Interested in health and social justice reporting and willing to put in the hours to do it? This internship might be for you.
Bhekisisa's latest policy dialogue takes a deep dive into one of the biggest challenges facing SA's HIV response at the 9th Aids conference.
Bhekisisa means "to scrutinise" in isiZulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.