Humane and dignified conditions in detention Ø Challenges to offering child healthcare in detention facilities include the need for children’s consent if they are unaccompanied. Recurrent obstacles to adequate child healthcare include the lack of specialised doctors, access to medicines, and lack of trust if medical staff are closely affiliated with the authorities in charge of the facility, confidentiality is compromised and/or interpretation is not available. In Cyprus, criminal sanctions are possible if the detainee is deemed to have abused the right to medical examination and treatment. The sentence can be imprisonment for up to three years and/or a fine corresponding to a maximum of approximately €5,124).364 The CPT and UNCAT have criticised the provision for deterring people from effectively exercising their right to be examined routinely and free of charge by an independent doctor.365 Several Member States differentiate children’s capacity to consent to medical treatment according to age and maturity (e.g. Finland, the Netherlands, Slovenia and Spain). Where consent is required, the child’s legal guardian should normally give it. If no guardian is present, Croatia allows the police or medical staff to consent to the treatment.366 Where the guardian is also the director of the detention facility, as in Romania, this may affect the impartiality of decisions on access to outside specialised healthcare, particularly when unaccompanied migrant children have serious conditions.367 A recurrent obstacle to adequate child healthcare is the lack of specialised doctors. Medical services at detention facilities rarely include staff specialised in working with children or visiting paediatricians. Even where paediatricians visit detention facilities, such as in Poland, visits are not regular except at the detention centre in 364 Cyprus, Law on the rights of persons arrested and detained (Ο περί των Δικαιωμάτων Προσώπων που Συλλαμβάνονται και Τελούν υπό Κράτηση Νόμος) N.163(I)/2005 as amended, Article 30. 365 Council of Europe CPT (2014), Report to the Government of Cyprus on the visit to Cyprus carried out from 23 September to 1 October 2013, 9 December 2014, CPT/Inf (2014) 31, Strasbourg, para. 20; UN, United Nations Committee against Torture, Concluding observations on the fourth report of Cyprus, 21 May 2014. 366 Croatia, Ministry of Social Policy and Youth (Ministarstvo socijalne politike i mladih), 13 April 2016. 367 Romania, JRS Romania. Biała Podlaska.368 Access to psychological treatment is generally limited by restricted availability, but also by language barriers. In the majority of Member States, children are therefore referred to hospital for child-specific healthcare. In Slovenia, for example, upon request for psychotherapeutic help by a legal representative or Asylum Home, the Ministry of the Interior appoints a commission to approve of the request and define the appropriate treatment.369 Access to pharmacy services may be limited by shortage of stock. NGOs in Bulgaria collected donated medicines for persons detained at special homes until the demand dropped because numbers of detainees decreased.370 Excessive restrictions on keeping medicines may also directly affect detainees’ health. For example, at the Bělá-Jezová facility, the administration confiscates all personal medicine, including vitamins for pregnant women. Only medical staff may hand them out, and may not always be present when needed.371 A child with acute asthma did not receive proper medication because no medical staff were present, NGOs reported.372 Lack of trust is another recurrent obstacle to effective healthcare provision. This is often the case when medical staff are closely affiliated with the authorities in charge of the facility, when confidentiality is compromised and/ or when interpretation is not available. In Poland, for example, psychologists are also Border Guard officers (except in the detention centre in Biała Podlaska), 368 Poland, Bieszczadzki Border Guard Division (Bieszczadzkiego Oddziału Straży Granicznej), Reply to Helsinki Foundation for Human Rights to the request for disclosure of public records, 11 February 2016, OA/ XIV/182/16; Poland, Nadbużański Border Guard Division (Nadbużańskiego Oddziału Straży Granicznej), Reply to Helsinki Foundation for Human Rights to the request for disclosure of public records, February 2016, concerning the response to the letter No. 201/2016/FRA/JS/MJ; Poland, Warmińsko-Mazurski Border Guard Division ( Warmińsko-Mazurskiego Oddziału Straży Granicznej), Reply to Helsinki Foundation for Human Rights to the request for disclosure of public records, 12 February 2016, WM-SO/270/16; The detention center in Przemyśl. 369 Slovenia, International Protection Act (Zakon o mednarodni zaščiti), 2007, Article 84 (2); and Article 19 (3) of the Rules on rights of applicants for international protection. 370 For more information, see the website of the Bulgarian Red Cross (Български червен кръст), and the Facebook pages of the Refugee Support Group, and of the Council of Refugee Women in Bulgaria (Съвет на жените бежанки в България). 371 Czech Republic, The Public Defender of Rights (2015) ‘Facility for the Detention of Foreign Nationals in BěláJezová: Evaluation Report of Systematic Visit‘ (Zařízení pro zajištění cizincu Bělá-Jezová: Vyhodnocení systematické návštěvy), p. 25. 372 Muller, Robert (2015) Czechs under fire for harsh, lengthy migrant detentions, Reuters, 18 October 2015. 83