Medical parole system is failing dying prisoners

Prisoners with terminal illnesses or severe incapacitation due to injury or disease may be released early under South African law, but the process is slow and expensive. Illustration: Lisa Nelson

• Last year, 15 prisoners died before their medical parole applications were finalised. Of 80 applications, 38 were approved.
• One terminally ill prisoner says he has spent over R140,000 on private medical assessments and legal fees to apply to spend his last days with his family.
• Lawyers and experts are critical of the medical parole process, which lacks uniformity across prisons, with arbitrary outcomes.

Prisoners with terminal illnesses or severe incapacitation due to injury or disease may be released early under South African law. But the process is not evenly implemented, leaving some prisoners, who had hoped to spend their last days with their loved ones, to die in prison.

GroundUp spoke to a prisoner, John (not his real name), who is terminally ill with cancer. He struggles to walk and his eyesight is deteriorating. He says he often has to rely on other inmates to help him with basic tasks.

John is serving a life sentence and has applied for medical parole in a bid to spend his final days with his wife and family. Since applying last year, he says the process has cost him over R140,000 in fees for private doctor assessments, a lawyer, and other expenses.

Louis Snyman, associate attorney at Beyers Incorporated, told us that private attorney fees for the process can run between R20,000 and R30,000. If the prisoner needs to go to the doctor, then transport and security must also be covered, and can run to R50,000.

John says he remains hopeful, though he knows that his chances are slim.

“It’s unbearable to know that my husband is in pain and I am not there to hold him, comfort him, and to take care of him in the way that I promised,” his wife told GroundUp.

Flaws in the system

In the 2024/25 financial year there were 80 medical parole applications, according to Department of Correctional Services (DCS) spokesperson Singabakho Nxumalo. Of these, 27 were rejected, 38 were accepted and 15 applicants died before their applications were finalised. In the preceding three years, there were 214 applications with 91 rejected and a total of 15 deaths.

The Correctional Services Regulations set out six pages of information needed for a medical parole application. The information required should include: doctors’ reports on the prisoner’s health, reports from correctional officers, details of the inmates crimes, and information about what support is available for the prisoner if they are released on medical parole.

The 21 medical conditions considered include infectious diseases such as severe cerebral malaria, non-infectious conditions such as certain stage four cancers, dementia, and cardiac disease with multiple organ failure. Conditions not on the list may be considered with adequate motivation.

Nxumalo says allocating a medical parole application to a Medical Parole Advisory Board is supposed to happen within one day. After the assessments, the board takes this into its monthly meeting and is supposed to inform the correctional centre within three days.

“Medical parole is supposed to be a very straightforward process,” says Snyman.

But in practice, Snyman has found that while some prisons made this process efficient and clear, others caused months of frustration to no avail.

“There’s no uniformity,” he said.

He suspects results depend on trivialities, like whether the inmate is well-liked by wardens or whether a particular staff member is on duty when the application is made.

The first medical parole application he made on behalf of a prisoner was in 2022. The prisoner was confined to either his wheelchair or his bed. Doctors estimated he had about six months to live.

“Modderbee [prison] was quite an experience for me, because everything that the law states was, in my opinion, not followed.”

When Snyman did get a response, it was a PDF with the medical parole outcomes of sixteen cases, not his alone.

“Not one medical parole application was accepted. There was no correspondence. There was no feedback. There was nothing.”

He remembers having to break the news to the family.

He says at the core of medical parole is the belief that South Africans, no matter their crimes, have the right to dignity and healthcare. “They deserve that level of dignity, not to die in a four-by-four steel cell with 20 other people,” said Snyman.

Ministerial review

A review of the overall parole system was announced by the responsible minister back in 2015, in response to “endless litigations due to inefficiencies which led to delays”, according to a recent departmental report on its progress.

The review was recommended for tabling to Cabinet in 2023, but according to the report, the department is “currently engaging internally with the executive authority prior to finalisation”.

The proposed solution is a three-tier system of parole boards, though it is not yet clear how this would affect medical parole.

According to the report, the department is also in the process of changing financial and organisational structures to improve staffing. Five positions on the medical advisory parole board were advertised in several provinces in March 2025. At least one member per province must be in place for the functioning of the board.

Poor outcomes

An official at the prison oversight body, the Judicial Inspectorate for Correctional Services (JICS), speaking anonymously, told GroundUp the prison “environment significantly contributes to deteriorating health among inmates, particularly those who enter the system with terminal or chronic illnesses, which tend to worsen during incarceration”.

“For those with legitimate needs, being denied parole can lead to frustration, hopelessness, and behavioural issues within the facility, which also affects staff morale and operations.”

The official said that in recent months, new requirements, not yet public, including a formal risk assessment for inmates, have been added, further slowing down the process.

Dr Chesné Albertus, senior lecturer at the Department of Criminal Justice and Procedure at the University of the Western Cape, said one of the flaws in the current law is that it largely relies on the written recommendations of a correctional medical practitioner, rather than a more thorough independent confirmation.

“Room for error and unfair outcomes are possible as a result.”

She said the exact powers and functions of the Medical Parole Advisory Board also need clarification.

Albertus believes that the reason for the low number of successful applications may be in part because of the shortage of medical professionals in the correctional system.

Secondly, medical practitioners on the medical parole advisory board may be overly cautious, especially because prisoners whose health happens to improve do not need to return to prison.

She said prisons in South Africa rarely do a good job of offering palliative care to dying inmates.

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