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Swift legal intervention mitigates a drug-resistant tuberculosis outbreak in Malawian prisons, but the worst could still be ahead

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A recent outbreak of drug-resistant tuberculosis in Malawian prisons should be a wake up call. It shouldn’t be a surprise that six people in Malawi’s nightmarishly congested prisons contracted drug-resistant TB—the prisons provide ideal conditions for the bacteria to thrive and spread. This is true of many prisons throughout the world, especially in countries with high burdens of TB. Moreover, new evidence confirms that the TB that thrives in prisons spills over into communities. In other words, prisons act as engines to drive the epidemic.

The six people had been receiving inpatient treatment in a hospital, but were due to be returned to prison. The Centre for Human Rights Education Advice and Assistance joined the six in an urgent court application to prevent this. Represented by Ms Chikondi Chijozi, they argued that returning the people to prison would violate their rights as well as the rights of other detainees, who would be exposed to infection. They won an interim order preventing the transfer.

Extreme overcrowding in Malawian prisons is not new; indeed the State has since 2007 been under a court order to address it. The State shirked its duties and maintained the conditions that fueled the epidemic over the intervening decade and, predictably, caused this recent outbreak.

The treatment success rate for multidrug-resistant TB is just slightly over 50%. The success rate for extensively drug-resistant TB is far lower. The spread of this brutal disease in prisons was predicted. Future outbreaks are equally foreseeable. They are not, however, inevitable—the State could prevent them through compliance with its legal obligation to reduce overcrowding and provide healthcare services in the prisons.

The return of people with drug-resistant TB to prison would have precipitated an acute public health crisis. Brave and quick legal intervention prevented the worst of it. But the underlying conditions remain the same and a failure to address them condemns detainees and the public to future outbreaks. This experience should wake us up to the reality that urgent attention to inhumane conditions of detention is a public health and human rights imperative.


*For further information on the conditions in Malawian prisons, see this video from the Southern African Litigation Centre and the Centre for Human Rights Education Advice and Assistance.



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The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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