Court Rules TB Prevention and Treatment Must Extend into Prisons

Shambhavi Singh

The Supreme Court of India has re-anchored the right to health within the constitutional framework of custodial dignity, holding that incarceration curtails liberty, not humanity. In its July 2025 decision of L. Muruganantham v. State of Tamil Nadu the court reaffirmed that article 21 of the Constitution extends fully to persons in custody, convicted, or under-trial, and the state’s duty to provide adequate medical care is absolute. Relying on the Nelson Mandela Rules and the Model Prison Manual 2016, it held that logistical or financial limitations cannot justify withdrawal of the state’s obligation to preserve health and dignity, as per its international human rights obligations.

Although the petition concerned a disabled prisoner denied accessible facilities, the Court’s reasoning extends beyond disability. By constitutionalising equivalence of healthcare in custody, Muruganantham lays the legal groundwork for confronting India’s neglected public-health crisis—the spread of tuberculosis (TB) among under-trial prisoners.

India’s prisons are chronically overcrowded and under-resourced—conditions that turn confinement into contagion. The Lancet Public Health estimates TB incidence among Indian prisoners at 1,076 per 100,000, nearly five times the Indian national rate. Most Indian prisons operate at 120–130% capacity, where malnutrition, poor ventilation, and absent infection control make disease inevitable. Of India’s 0.53 million inmates, almost three-quarters are under-trial prisoners enduring what Justice Ramana called “punishment by process.” Prisons thus become epidemiological reservoirs, incubating infection that spreads beyond their walls—a public-health crisis sustained by systemic neglect.

A 2024 Parliamentary report found that only two-thirds of prisons had ever conducted TB screening; diagnostic facilities exist in just 18%, and treatment capacity in barely half. Medical staff are scarce, isolation wards rare, and continuity of care upon release almost nonexistent. In these environments, punishment takes a biological form, manifesting as exposure, malnutrition, and neglect.

Legal and policy vacuum

The Supreme Court has consistently affirmed that the state’s duty to preserve life under article 21 extends behind prison walls. In Inhuman Conditions in 1382 Prisons (2016), the Court declared the right to health a human right and directed all states to ensure minimum standards of medical care and integrate prison healthcare with public-health systems.

Earlier, in Rama Murthy v. State of Karnataka (1997), it identified chronic deficiencies—overcrowding, lack of medical staff, and no segregation for the sick—and ordered the Union  government to draft a national prison manual. The resulting Model Prison Manual 2016 prescribed routine screening, isolation wards, vaccination, nutrition, and designated medical officers. Yet most states remain governed by the colonial Prisons Act, 1894, designed for control rather than care.

The subsequent decision in Re: Death of 177 Prisoners in Punjab and Haryana (2019) underscored the state’s enduring failure to provide basic medical infrastructure, holding that inadequate staffing and delayed hospital transfers violate article 21. Yet, the Union’s Modernisation of Prisons scheme (2022), National Human Rights Commission guidelines, and successive advisories remain non-binding and weakly enforced.

Expert panels, from the Mulla Committee (1983) to the Justice Krishna Iyer Committee (1987), gave guidelines regarding maintenance of standards in prison hospitals. They also urged routine visits from specialists in local specialty hospitals yet fewer than half the states have complied. Even the Supreme Court’s direction requiring Legal Services Authorities to furnish bail bonds for indigent detainees has barely dented overcrowding—the very condition under which TB proliferates.

International norms draw a sharper contrast. The Nelson Mandela Rules (United Nations Standard Minimum Rules for the Treatment of Prisoners) adopted in 2015, promote equivalence of care—the same healthcare standards inside prisons as outside. Rule 24 furthers this by requiring a close relationship between the prison and public health facilities. Nations like Brazil, South Africa, and Thailand have integrated prison health into national TB programs, recognising that prison health is public health.

India’s National Strategic Plan for TB Elimination (2017–2025) and the Ministry of Home Affairs’ “100-Day TB Screening Campaign” (2025) acknowledge the crisis but lack legal force. The result is a constitutional paradox: dignity recognised in doctrine, denied in practice.

From aspiration to legal obligation

Muruganantham transforms custodial health from a constitutional promise to an enforceable duty. The Supreme Court directed all states to document every prisoner’s medical and disability needs, modernise prison infrastructure with accessible facilities and specialist doctors, amend manuals in line with the Model Prison Manual 2016, and establish independent oversight and audit mechanisms.

By embedding these mandates in article 21 and aligning them with the Nelson Mandela Rules, the Court constitutionalised equivalence of care, converting healthcare in custody from a welfare measure into a binding constitutional duty. Courts may now mandate routine screening, timely referrals, adequate nutrition, and continuous treatment—core pillars of TB control—and scrutinise health budgets, staffing, and compliance with national disease-control norms.

Crucially, Muruganantham links overcrowding to public health: every expedited trial, every reduction in overcrowding, every monitored hospital referral advances not only liberty but life itself. It reframes prisons as a test of the state’s constitutional fidelity—affirming that deprivation of liberty must never mean deprivation of dignity or care.

TB among under-trial prisoners epitomises the collision of neglect and delay. To fulfil Muruganantham’s promise, India must extend its TB-elimination mission beyond its clinics and into its cells, because the Constitution’s guarantee of health is indivisible, even behind bars.

Shambhavi Singh, BA, LLB, is a lawyer practising at the Supreme Court of India