Inmates at Quezon City Jail undergo processing by medical staff. Tuberculosis and other infectious diseases, including HIV, are a major problem in often overcrowded jails in the Philippines.James Griffiths/The Globe and Mail
Designed for 50, the cell at Quezon City Jail housed six times that number. The heat was intense, the air stagnant and humid. Prisoners slept in shifts – a lucky few on cots or pieces of cardboard, the rest on the hard tile floor, while others stood, waiting their turn to rest. Fights were common, over space, food or just out of frustration, the result of being crammed into a cage with so many other men.
Jails in the Philippines have struggled with overcrowding for decades. A shortage of facilities and a slow-moving, overworked court system can leave people detained for years awaiting trial. A brutal drug war launched by then-president Rodrigo Duterte in 2016 only exacerbated the situation, adding thousands of inmates to prisons built to hold hundreds and sending jail occupancy rates soaring past 600 per cent.
Overcrowding is not just unpleasant, it can be deadly. Infectious diseases spread rapidly, with tuberculosis among the most dangerous. TB, which can be transmitted through the air via droplets, like COVID-19, accounts for some 40,000 deaths annually in the Philippines.
Inmates at Quezon City Jail queue to be X-rayed for signs of tuberculosis infection.James Griffiths/The Globe and Mail
In an interview, an inmate who spent time in the cell at Quezon City Jail described how TB tore through the confined space last October, infecting 40 men before it was detected and quarantine measures were put in place. He spoke to The Globe and Mail at a new facility, also in Quezon City, where he had been transferred for treatment. A handful of reporters were given access on the condition they not identify any prisoners, many of whom are still awaiting trial.
The 35-year-old man, dressed in a yellow Bureau of Jail Management T-shirt with the slogan “Changing lives, building a safer nation,” said he developed a fever and cough and feared he would die. In the new facility, he was housed alongside 30 other TB patients in an isolation ward for six months, sharing a single toilet. The medication they were given often left them feeling dizzy, with dry skin. Their urine turned an alarming reddish brown.
Henrick Fabro, chief medical officer at Quezon City Jail, speaks to reporters about efforts to combat tuberculosis.James Griffiths/The Globe and Mail
The Globe visited the isolation cell, where 18 prisoners were undergoing treatment. Even here, there were not enough beds, with only the sickest having a cot to themselves. All the men said they had contracted TB in prison, despite concerted efforts by authorities to screen for the disease during the processing of new inmates.
“Prior to commitment, all PDLs undergo X-rays, and possible TB patients are immediately isolated and tested,” said the jail’s chief medical officer, Henrick Fabro, using an acronym for persons deprived of liberty, as inmates are called in the Philippines. “Because it’s airborne, it spreads quickly, and once it reaches the general population the spread is fast.”
The situation is far worse in older prisons, where overcrowding remains a major issue, Dr. Fabro said.
“Even before the drug war, it was already congested, and of course the population increased,” he said. “If there is congestion, the risk for TB will be greater. That’s why we are constructing new, modern jails.”
Heat, too, can be a major problem. The Philippines is hot and humid for most of the year, with temperatures regularly cresting 30 degrees Celsius and trending upward as a result of climate change. A recent heat wave saw the mercury hit 50 Celsius in parts of the country, straining tolerance even in modern, climate-controlled buildings, let alone old, overcrowded, poorly ventilated prisons.
A former tuberculosis patient, who agreed to an interview if his anonymity was preserved, sits at a nurse's station in Quezon City Jail.James Griffiths/The Globe and Mail
In May, after widespread reports of health problems and violence in jails, the Supreme Court of the Philippines ordered judges to visit prisons “for the sole purpose of determining how PDLs are affected by this heat wave.” The issue has renewed calls to ease overcrowding by transferring prisoners to new facilities and expediting court cases.
Even on a relatively cool (by Philippine standards), 34-degree day, the facility The Globe visited – which houses about 4,000 inmates and has a total capacity of 6,000 – was stiflingly hot. The sun beat down in the central yard, as dozens of prisoners queued for a portable X-ray truck to undergo a monthly TB test, while in the 29-person cells, rickety fans did little to move the air around, as men sat or lay down on the concrete floor, fanning themselves with whatever they had at hand.
Jail superintendent Warren Geronimo said that while overcrowding was not a problem at his facility, TB and heat both remained of major concern.
“We need to take care of the health of PDLs,” he said. “They don’t have the means to take care of themselves.”
James Griffiths travelled to the Philippines as a guest of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which supports TB programs in the country’s jails. Global Fund did not review this article.