(b)Medical record keeping 157.In Malé Custodial there were no individual medical records whereas in Dhoonidhoo personal medical files were opened only for those detainees who requested medical assistance either upon arrival or at a later stage. Furthermore, at Dhonidhoo some of the records did not contain all necessary information. 158.The SPT emphasizes that good record keeping is an essential part of the doctor’s work; this applies not only to the routine examination upon arrival, but to any aspect of each encounter with patients. Furthermore, documentation of torture and other forms of ill-treatment is the first step in the medical contribution to preventing torture and other forms of ill-treatment and combating impunity. The doctor must also have clear guidelines on how, when and to whom alleged and medically documented cases of ill-treatment should be reported. If the detainee does not want his/her name to be included in the report, the doctor should do it in a way that safeguards the anonymity of the detainee. The SPT recommends that individual files should be opened for every detainee upon arrival at police detention centres and be updated systematically and comprehensively after every medical examination or intervention and that clear instructions are established for the doctors on how to document and to report possible cases of torture or ill-treatment. 159.The delegation was concerned about the fact that medical confidentiality as to record keeping appeared to be virtually absent in medical clinics, where such existed. The members of the delegation observed that police officers had access to medical files. The SPT considers that confidentiality between patient and doctor is an essential part of their relationship, including in police custody and prison settings and a potentially important factor in preventing ill-treatment and combating impunity. The SPT recommends that immediate measures are taken to establish and maintain confidentiality in the keeping of medical documents and records. (c)Detainees with psychiatric conditions 160.Delegates heard allegations that detainees with psychiatric conditions were treated in a harsh manner to control odd behaviour. 161.The SPT is aware of the scarcity of psychiatrists in the country; however, the sparse availability of specialist resources underlines the need for some basic training of officers in the identification of serious mental conditions and clear guidelines for referring such detainees to a medical facility. 17. Allegations of ill-treatment and corroborative findings 162.The delegation received numerous credible allegations from detained persons that they had been physically ill-treated while in the custody of police officers, both at the time of their apprehension or arrest, and in the police detention facilities to which they were transferred. 163.There was a consistent pattern of the allegations: whilst handcuffed, detainees said that they had been pushed and kicked by police officers. In addition, on many occasions and from a variety of locations in various atolls the SPT heard about the abusive use of handcuffs by police officers to restrain people being questioned or held at the police detention facilities in painful squatting positions for prolonged periods of time. For example at Malé Custodial the delegation heard allegations that detainees in that establishment were often held handcuffed for weeks. Furthermore, almost all the detainees accommodated in the yard were held handcuffed, some to the chairs. The delegation also heard numerous allegations of beating of detainees in the yard by the police officers, and allegations that detainees’ hands had been burned with cigarette buts. On two occasions the delegation heard allegations of suspension from handcuffed wrists. The clinical findings and injuries documented by the medical members of the delegation were in complete agreement with these allegations of ill-treatment. 164.In discussions with the SPT, the members of the Public Complaints Bureau were sceptical about the fact that torture is practised in the Maldives because police investigations now take place in the presence of lawyers and are videotaped. Furthermore, they emphasized that the Bureau had not so far found any substantiated cases of torture. In the note verbale of 22 June 2008, the authorities noted that whereas isolated incidents may occur, they did not agree with the conclusion that ill-treatment is a wide-spread practice in the Maldives. In the note a reference was also made to the fact that custodial department staff are continuously monitored with the CCTV system, and it was noted that the authorities believe that these allegations are part of an ongoing collusion by certain prisoners to discredit the Maldives Police Service and the Government of Maldives. 165.The SPT acknowledges that a CCTV system can be an important means to prevent ill treatment but stresses that the existence of such a system does not exclude the occurrence of torture and ill-treatment. Furthermore, the SPT notes that the alleged illtreatment had taken place in locations outside the range of the CCTV system. On the basis of the allegations of ill treatment heard from the detainees coupled with the findings of the medical members of the delegation, the SPT concluded that ill-treatment of persons deprived of their liberty still occurs in the Maldives. 166.From a preventive perspective, it is important to acknowledge the risk of torture and other forms of ill-treatment during apprehension, police investigation and in police custody.Furthermore, if adequate safeguards were in place, and police officers knew that they would be held accountable for their actions, physical ill-treatment of this kind would be much less likely to happen. The SPT recommends that the authorities take steps to ensure that there are adequate safeguards in place to prevent torture and ill-treatment. Furthermore the SPT recommends that all allegations of illtreatment be fully investigated through competent, independent and impartial authorities. B. In prisons 1. Preliminary remarks