Exactly three years ago, I came back to Russia after treatment following my poisoning. I was arrested at the airport. And for three years, I’ve been in prison. And for three years I’ve been answering the same question. Prisoners ask it simply and directly. Prison officials inquire about it cautiously, with the recorders turned off. ‘Why did you come back?’

— Alexei Navalny, January 2024

The February death of Russian opposition leader Alexei Navalny in a remote penal colony provoked emotional outpourings across his country and around the globe. There was grief over the death of a man who had a seemingly singular ability to establish a fragile sense of unity among Russia’s historically fragmented opposition movement. There was confusion over what this would mean for the country’s beleaguered dissidents. There was anger at growing brazenness of President Vladimir Putin’s drive to crush his detractors. One reaction it did not provoke was surprise.

It was unsurprising that a dissident died in Russia, particularly a dissident who had only narrowly survived a poisoning attempt in 2020. When he died, Navalny was serving a 19-year sentence—the longest of any contemporary dissident in the country— which had been cobbled together on the basis of multiple trumped-up charges, all of which boiled down to his opposition to the Putin regime.  

Opposing Putin is incredibly dangerous.

But so were Navalny’s years in a series of increasingly brutal prison camps. The location of his death — a penal colony built on the foundations of a Soviet gulag within the Arctic Circle — contributed to the lack of surprise. Russian prisons are hotbeds of illness, abuse, and torture.

What confluence of factors ultimately killed Navalny may never be known. Still, while few can predict what new lows lie ahead for Putin, and no one can control the Kremlin, Russian prison conditions could improve, improving the prospects of the hundreds of thousands of prisoners who remain behind bars in the aftermath of Navalny’s death.

The grim state of Russian prisons

Due to a lack of transparency regarding Russia’s prisons, up-to-date information on conditions is sparse. However, according to a recent report by the Council of Europe, the Russian prisoner death rate leads all other European countries. In this cohort, 10% of all deaths were from suicide. The US has an 8% rate of death by suicide in federal and state prisons, but that rate jumps to 30% in jails.

Like the US prison experience, Russian prisons provide a protective effect for certain kinds of death in specific populations. In one study, the standardized mortality ratio from all causes for inmates was slightly over one-third of that in the Russian male population.

The Russia-Ukraine war is having a dramatic impact on mortality, but the leading cause of death in Russia before the start of the Russia-Ukraine war was cardiovascular disease. Overcrowding, malnutrition, and poor hygiene have made Russian prisons highly susceptible to infectious diseases. Drug-resistant tuberculosis, HIV/AIDS, and hepatitis are common.

International comparisons

Writing this in the US, we are no strangers to death in prison. Despite a 10% decrease in the US prison population from 2019-2020, the absolute death rate among incarcerated individuals in the same period rose by roughly 30%. But it bears noting that much of this was likely COVID-related. In fact, for some groups, incarceration has a protective effect on health. Poor health before imprisonment results from profound deficiencies in the social determinants of health, some of which are improved during imprisonment

Any prison system will entail increased health risks by the confinement of hundreds or thousands of inmates in relatively close proximity. The risk of contracting HIV is 10-100 times greater while incarcerated than not. While most Hepatitis C infections occur outside of prisons, the spread of Hepatitis C within prisons is still prevalent and problematic. HIV and Hepatitis C co-infection are common. The rate of tuberculosis while incarcerated is also higher than in the non-carceral public

However, US law has mechanisms to support prisoners. The 1976 Supreme Court case Estelle v. Gamble established that prisoners have the right to adequate medical care and that deliberate indifference to their medical needs violates the 8th Amendment. In truth, prison should not make you sick when it functions lawfully. In the US, prisoners have a constitutional right to health care. The use of illness in a prison setting, intentional or through neglect, is a violation of medical ethics and a crime

Understanding Navalny’s Death

The circumstances of Navalny’s death at age 47 remain shrouded in mystery. According to Novaya Gazeta, his body was moved multiple times before arriving at a clinical morgue in Salekhard on February 16. While officials claimed he died suddenly, his body showed bruises consistent with resuscitation attempts. The Investigative Committee of the Russian Federation concluded his death resulted from natural causes — a combination of cholecystitis, pancreatitis, and an inguinal hernia

Medical expertise suggests a different story. Sudden death, as claimed in Navalny’s case, typically results from cardiac (heart) issues—either coronary artery blockages or structural heart defects. Though diseases of the gallbladder or pancreas, or complications associated with a hernia, may cause illness, it would be highly unusual for any of these conditions to cause sudden death. An impartial autopsy could easily resolve these questions, but Russian law only requires such examination when foul play is suspected, meaning it is not automatically performed in every death case.

The Shadow of Novichok

Navalny’s time in prison undoubtedly caused a decline in his health. Accurate information is unavailable. Before Navalny’s death, he had been the victim of a prior attempt on his life in 2020 with the use of Novichok, a so-called “nerve agent” developed in the former Soviet Union. Nerve agents like Novichok work by blocking a specific enzyme called acetylcholinesterase. This enzyme removes the chemical messenger known as acetylcholine, the purpose of which is to send the chemical message that causes normal muscle contraction.  

When the nerve agent blocks the enzyme, acetylcholine levels remain elevated, and all the muscles in the body contract relentlessly until they fail. Acetylcholine also slows the heart and causes massive lung fluid release. Death occurs by a combination of an inability to breathe, move, and finally drown in one’s secretions. Besides Novichok, other nerve agents have been developed, including Sarin, Soman, Tabun, and VX. Sarin was used to kill people on a Japanese subway by the domestic terrorist group Aum Shinrikyo. Bashar al-Assad, the now-deposed former president of Syria, was accused of using Sarin in the Ghouta district of Damascus, killing 1,400 people. If Navalny were again exposed to Novichok, it would be easily found on his body.

If mystery remains as to the cause of death for Navalny, that mystery could very likely be easily solved with an impartial autopsy. Modern Russia has descended into a state of severe paranoia, but it is possible that Navalny did die “naturally.” It would be in Russia’s interest to hand over the evidence for a claim of natural death. Such findings would be verifiable and even possibly exculpatory. Death in prison, be it Russian or American, might occur naturally, be the consequence of a broken carceral system, or be the consequence of a crime.

The Political Aftermath

Navalny understood the gravity of his situation. In his prison diaries, published in his memoir “Patriot,” he acknowledged that his sentence length was irrelevant—he was effectively serving life, “either for the rest of my life or until the end of the life of this regime.” His death exemplifies Putin’s increasingly aggressive stance toward opposition figures.

Vladimir Nabokov’s novel “Invitation to a Beheading” tells of Cincinnatus C, condemned for “gnostical turpitude”—impervious to the rays of others and a dark obstacle in a world of transparent souls. Like Nabokov’s protagonist, Navalny represented an immovable obstacle to Putin’s authority. His death, rather than strengthening the regime, exposes its fundamental weakness: a government so afraid of opposition that it would rather silence than engage with its critics. The mystery surrounding his death only underscores the false existence of a regime seemingly on a path to its demise.