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Addressing COVID-19 and Its Impact on the Future of Prison Healthcare

As the second wave of COVID-19 hammers communities around the world, governments and health organizations are working to diminish risk in our most vulnerable populations. Prisons pose particular challenges for staff, policymakers, and designers alike. Much like long-term care facilities that are experiencing devastating breakouts, prisons by nature are enclosed spaces that render social distancing difficult—especially when respiratory infections like COVID can spread readily.

COVID-19 is a threat to the people who live and who work within prisons. Staff members also risk inadvertently spreading the virus to their families and communities. Tackling the unique issues that prisons face can improve the well-being of those living and working in prisons and communities—today and into the future.

An international perspective on healthcare in prisons

In 2009, Parkin Architects Director and Corrections lead, Robert Boraks, responded to a request by the International Corrections and Prisons Association (ICPA) and the United Nations Department of Peacekeeping Operations (UNDPKO), to help create a design that would improve conditions within the existing Pénitencier Nacional in Port-au-Prince, Haiti. The international consortium that Boraks volunteered with developed a project that was recognized by the United Nations as a cutting-edge design that could contribute to a healthy, humane corrections institution.

The devastating earthquake in Haiti unfortunately paused the project, but the challenge of COVID-19 has resurrected the design principles developed by the voluntary consortium. Earlier this year, Health through Walls (HtW) asked the consortium to shift its focus to a rapidly deployable prison (RDP) to help alleviate the COVID-19 threat in countries like Haiti, where prison systems are often overwhelmed and healthcare and disease containments are difficult to administer. HtW is a Florida-based non-profit organization committed to helping developing countries improve healthcare services in their prisons. Its focus is on contagious and infectious diseases, particularly HIV, AIDS, and tuberculosis. The organization is uniquely poised to address the problems of infection spread in carceral institutions in developing countries.

The consortium’s RPD agile solution meets the immediate needs of correctional facilities faced with the COVID-19 emergency; it can then be reconfigured for future use. The overall solution is to provide quick-build mobile facilities that enable physical distancing and provide hygienic spaces for treatment and healing, along with segregated spaces where healthcare providers and staff can work while maintaining physical distancing.

Emergency solutions can address long-term needs

Significant issues for prisons are overcrowding and the inability to physically distance. Decarceration of low-risk prisoners is one strategy that has helped to address the problem in Canada and elsewhere. Facilities are also limiting visits from family and friends to mitigate the spread of the virus. However, isolation exacerbates mental health problems for many, so the ability to connect with family and friends virtually is a crucial element that can help to support prisoners’ mental health. Updated technologies that enable virtual connections will be an important element for mental health support in corrections facilities.

For those who cannot be released early, paramount measures include improved hygiene protocols, masking, and the ability to isolate anyone who tests positive for an easily communicable disease like COVID. In the case of the Pénitencier Nacional RPD solution, the UN has committed to donating a number of modular healthcare units that would provide treatment wards, along with secure housing, a separate washroom/ shower facility, an exam space, and a separate office unit. The modules could also house treatment and quarantine wards, or individual secure rooms. They can be fitted with supply and exhaust fans to circulate fresh air, which can help mitigate the transmission of COVID-19 through aerosols.

These temporary 8’ x 20’ modules can be configured for multiple purposes to meet the immediate needs of the prison population and can be easily relocated for future uses.

Social convergence

Drawing on evidence-based design principles, Boraks believes correctional facilities need to be seen as healing environments. His contribution to the Pénitencier Nacional RDP solution is informed by the designs for institutions like Nunavut’s Rankin Inlet Healing Facility, which was developed to promote healing and well-being for the people who live and work there. Soaring ceiling heights, natural materials, and colour were used to destigmatize the facility and to normalize the environment.

The aim of Parkin’s correctional facility designs is to minimize tension and alienation within the spaces that incarcerated people inhabit. Residents enjoy privacy and some room to roam within secured spaces, depending on their security classifications.

Designing for the future

Correctional environmental design will change by recognizing that detention centres are part of a justice continuum. Rather than large dormitories where disease can easily spread, smaller housing units with a maximum of 32 beds will help to contain outbreaks. Importantly, for both mental health and disease containment, private rooms with ensuite bathrooms can provide a sense of dignity for incarcerated people and promote physical distancing. These spaces can also provide some autonomy for prisoners where they can control temperatures and lighting in their rooms.

A connection to nature and biophilic design will work to create a normalized environment in contrast to hard, cold spaces built with concrete and steel. Environments that depend on artificial lighting will be replaced with spaces that incorporate as much natural light as possible, in order to reduce stress and anxiety levels, and to promote healing.

The pandemic has shone a light on the shortcomings of traditional design. By addressing the challenges posed by COVID-19, however, future corrections facilities can become more humane, person-centred spaces for rehabilitation that do not inadvertently expose the people who live and work there to further harm.


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