Correctional institutions 2.5.5 Health care 2.5.5.1 Tobacco consumption and protection of non-smokers Tobacco consumption in facilities of the penitentiary system and facilities for the detention of mentally ill offenders and the lack of protection for nonsmokers constitute a national problem. There is an above-average number of heavy smokers in facilities for the detention of mentally ill offenders and others. Moreover, the majority of inmate cells in correctional institutions are cells for smokers, and some are severely polluted by nicotine. The NPM also frequently found that smoking and non-smoking inmates were held together in cells for multiple inmates. Acute health risk The negative health consequences of active and passive tobacco smoking are generally acknowledged. It is common knowledge that inhaling tobacco smoke hanging in the air is referred to as “passive smoking”. Passive smokers suffer the same acute and chronic illnesses as active smokers – only such illnesses are less extensive and less frequent. Tobacco smoke that is inhaled through passive smoking contains the same poisonous and carcinogenic substances as the smoke inhaled by smokers. Therefore, passive smoking also causes numerous illnesses, some of which are serious. Around-the-clock exposure to nicotine A special health risk exists when persons who suffer from a pre-existing illness, which is worsened by smoke, are housed together with smokers. Except for an hour of outdoor exercise, inmates remain in cells polluted by nicotine for up to 23 hours per day. In some cases, the ventilation is very limited. The prison administration is responsible for the inmates’ health. The Federal Ministry assured the NPM that facility management has consistently attempted to separate smokers and non-smokers, unless the affected persons were opposed to this. At the same time, the Federal Ministry conceded that separation cannot always be guaranteed. This is explained by the high occupancy of many correctional institutions in conjunction with the shortage of space. In addition, there are the restrictions that accompany different forms of detention (such as first-time imprisonment or pre-release) and the requirement to separate accomplices in court prisons. Inmates often have other interests – such as placement based on nationality – which are taken into account, when possible. However, these interests are secondary in the case of a pre-existing medical illness. Not to be held in the same cell Although it is understandable that smoking plays a different role in detention than in free society and providing separate accommodations can pose a challenge, the protection of non-smokers may not be disregarded. Therefore, the NPM recommends that non-smokers not be held together with smokers in cells for multiple inmates. Persons who do not smoke should be protected from 118