Sick of at Christmas

Busy on steroids

Right now I'm on my way home from the Boxing Day duty doctor shift in one of the London prisons. It's always busy at this prison, but today could be best described as ‘busy suped up on steroids’.

There have been many new arrivals from police stations via court - as crime doesn't stop for Christmas - with many of them withdrawing from both drugs and alcohol. On the wings there were lots of chronically sick men: their complex mental health conditions inter-play with long neglected physical ailments. There was the usual blob of inter-prisoner violence. And then there were several acutely unwell men, and it was one of these who caused me the most concern…

Properly sick

At home…

Think back to the last time you were ‘properly sick’ with something like influenza or pneumonia? No doubt you had a fever. What helped with this? Maybe you decided to take a nice cool shower or have a steamy bath. How many pillows did you prop yourself up with in your bed next to a wide open window? Perhaps a nice caring family member popped out to the pharmacy to get medicines for you.

And did you need urgent medical attention? If so, maybe you called a cab or even an ambulance to get you to the help you needed. an ambulance to take you to hospital. Or did the paramedic or doctor come to you? There are so many ways to get treatment within a high-income country like the UK. You are an autonomous being with many options for exercising your right to health.

… and ‘away’

What about being sick behind bars though? Can you think what it must be like to be really sick and yet be trapped in a prison cell? Imagine that you're in prison and developa severe dose of flu with a high fever, shortness of breath, blinding headache, and pains all over, and most likely vomiting and diarrhea. The heating is likely on full blast and non-adjustable, the window doesn't open, and you can't just go and take a cooling shower. Most likely you're sharing your cell and its integral toilet with a complete stranger: you've got a 50% chance of being on the top bunk and likely a 100% chance of it being paired with a saggy mattress. And most critically, the door is locked and your only recourse to help is your cell's call bell.

Even in the prison cells of high-income countries like the UK, where the healthcare is commissioned to the same standard as that provided to free citizens, you are still entirely at the mercy of whoever responds to you pressing your cell's call bell. Yet the prison is always busy, sometimes more than others, and it can take ages for someone to answer the bell. Then they have to radio for a nurse, who is also busy. Then the nurse will have to ask a doctor - like me today - to come and see you or, at the very least (if the nurse isn't too worried about you) to prescribe for you. And then finally the tablets have to be sourced and administered. This process can take many hours. And of course, receiving that first tablet doesn't mean that you're instantly better! You may (or may not) start to improve. You may get an awful lot worse. And each time you decide to ask for a review, once again you're at the mercy of the call bell.

You 0 Prison 1

Dependence

These stark differences boil down to a drastically reduced degree of autonomy. When a judge deprives you of your liberty, that in itself is a serious blow. Most of us free citizens live our lives with high degree of independence and autonomy. Sometimes we only learn to value something when it’s taken away. And the way most of us like to access medical help is underpinned by a high degree of autonomy. During a health crisis in prison, you are almost totally dependent on the goodwill and professionalism of others.

Non-delivery

Yet in global terms, my London patients and indeed detainees in most other high-income countries are very lucky indeed - because they are detained in countries that have commissioned offender healthcare in all their places of detention.

What about all the sick detainees in countries that don’t have adequate or any commissioned offender healthcare? I’ve seen many of these poor souls in my capacity as the chief medical officer of Integritas Healthcare, which does humanitarian offender healthcare in places including the Philippines where the state does not oblige. It’s truly pitiful to see the state that some of them end up in. And the numbers we can help are paltry in the grand scheme of things.

Priorities

It’s time for all the countries of the world to recognise that healthcare is a fundamental human right to which detainees are equally entitled as they don’t leave their human rights at the prison gates.

First published in 202X, the original version of this article was written by one of our fellows. In X 2025, Dr Rachael Pickering gave it a refresh - updating statistics & other time-sensitive information, and inserting additional commentary and opinion.

Is anyone happy? Let them sing…
James 5:13