CAT/OP/BRA/1 44. The SPT met with cases of serious neglect, including inmates with grave chronic conditions, broken limbs or other wounds that were not treated. Inmates expressed their apprehension for requesting medical assistance, based on their experience of punishment by prison guards or ill-treatment while being transported to hospital. 45. The SPT recommends that clear instructions be imparted to prison authorities that no inmate shall be punished for requesting medical assistance. The SPT recommends that security policies for transfers of persons to external healthcare facilities be reviewed. 46. Material conditions in most medical units were appalling and medical equipment and medication was lacking. 47. The SPT recommends that material conditions of prisons’ medical units be immediately improved, and that adequate equipment and necessary pharmaceuticals be provided. 48. From pregnant inmates and mothers with babies in prison, the SPT received allegations of lack of obstetrics care and delay in applying the necessary vaccines to infants, in contradiction with Brazilian laws.19 49. The SPT recommends that pregnant women be given regular advice on their health by a qualified health practitioner. The SPT recommends that children living with their mothers in prison be provided with on-going healthcare services and that their development be monitored by specialists.20 50. During its visit to institutions for children and adolescents, the SPT observed bruises and other types of untreated injuries. Injuries were allegedly dismissed and frequently covered up by medical staff as accidents. The SPT considers this to be in contradiction with ethical principles subscribed to by the medical profession. 21 Medical staff interviewed acknowledged the presence of guards in medical consultations with children or adolescents. 51. The SPT recommends that the State party impart clear instructions to physicians working in places of deprivation of liberty that no suspected acts of torture or ill-treatment shall be concealed or ignored and that they must be reported to relevant authorities. Medical examinations should be carried out in strict confidentiality. As a rule, guards should be out of sight and hearing, otherwise their presence should be entered into the medical record. Medical files shall be kept confidential. D. Impunity 52. Impunity for acts of torture was pervasive and was evidenced by a generalized failure to bring perpetrators to justice, as well as by the persistence of a culture that accepts abuses by public officials. In many of its meetings the SPT requested, but was not provided 19 20 21 Brazilian Law 7210/1984, art. 14.3; Regras Mínimas para o Tratamento do Preso no Brasil (Regras Mínimas), CNPCP resolution no. 14, of 11 November 1994, art. 16. United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the “Bangkok Rules”), adopted by General Assembly resolution 65/229, rules 48 and 51. Principles of Medical Ethics relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted by United Nations General Assembly resolution 37/194 of 18 December 1982; Declaration of Tokyo, adopted by the 29th World Medical Assembly, Tokyo, October 1975. 9