Access to water to maintain hygiene can be limited, due to security reasons or a lack of infrastructure to provide for taps in each cell or dormitory. Soap is frequently not provided in places where people are detained. Hand sanitizer is not readily available in the majority of prisons and is typically considered contraband due to its alcohol content. People handcuffed cannot cover their mouth when coughing. Furthermore, people in prison are said to lack information about the outbreak of COVID-19 and about any plan the prison system might have. Equivalence of care for people in prison In suspected or confirmed cases of COVID-19 people in prison should be able to access urgent, specialised healthcare without undue complications. Prison administrations should develop close links with community health services and other health-care providers. Such links are also important for the purposes of ensuring equivalence of care, as provided for in the UN Nelson Mandela Rules. For older or ill people in prison, early release programmes should be put in place as a priority, given their specific risks with COVID-19. Contact with the outside world The most common measures taken by prison authorities and in other places of detention to prevent an outbreak of COVID-19 in such facilities have related to limiting contact with the outside world through limitations on visits by relatives or legal representatives of people in prisons. In Italy, the Penitentiary Administration issued internal regulations imposing several measures to prevent the general outbreak in the country affecting prisons. Initially these included halting the transfer of people from detention centres to and from those located in the so-called ‘red zone’ (which at the time constituted an area in the north of Italy). It also denied access to detention centres to anyone coming from this zone and instructed prison administrations to apply necessary limitations to visits and activities. It was suggested that individual prisons in Italy decide whether to replace in-person visits with online contacts or phone calls. In some cases, prisons decided to ban all visits, including a number that were at the time located far from the outbreak ‘red zone’ area in the north of the country. Other prisons took less drastic measures, screening visitors and limiting some visits as required. There was a lack of communication on behalf of the authorities, with people in prison and their family members uninformed as to the status of visits. The situation in Italy escalated with the number of cases rising and spreading beyond the ‘red zone’ in the north and subsequently on 8 March 2020, all prison visits were banned, and all rehabilitation activities were paused. Over 8-9 March, riots and protests erupted in 27 prisons across the country. Seven prisoners died by overdosing on methadone after breaking into the infirmary. While the authorities have managed to bring the situation under control, the Italian prisoner rights’ non-governmental organisation, Antigone, has called for a release of prisoners (including through home detention and probation). They noted that the measures to prevent COVID-19 in prisons were imposed in cramped, overcrowded facilities, bringing a tense situation to the brink. In other countries, prison visits have been banned outright or restricted in some form. In the Philippines, where there are 33 cases reported, prison visits were banned from 11 March for a one-week period and Hungary Page 5 of 13 www.penalreform.org