A/68/295 Medical and health services 50. The State must provide adequate medical care, which is a minimum and indispensable material requirement for ensuring the humane treatment of persons in its custody. The carrying out of a prompt, independent and consensual medical examination upon a person’s admission to a place of detention and after every transfer between facilities, and thereafter on a routine basis, constitutes one of the basic safeguards against ill-treatment (see Human Rights Council resolution 10/24, paras. 4 and 9, and A/52/40 (vol. I), para. 109). Among the main challenges in the provision of medical care are the lack of appropriate and sufficient medical personnel; inadequate medicine supplies and equipment; and a lack of capacity and delays in authorizing transfers to hospitals. The Special Rapporteur notes that loss of life or a deterioration in an inmate’s well-being occurs because of a lack of or unreasonable delays in the provision of urgent medical care, and that these omissions on the part of the authorities can amount to ill-treatment and even torture. 51. The revision of the Rules offers a good opportunity to insist on the obligation of authorities to ensure free, fair and transparent access to a facility’s medical services by providing a sufficient number of qualified, independent physicians in all facilities. The Rules should insist on the obligation to guarantee the availability of prompt, impartial, adequate and consensual medical and psychological examination upon the admission of each detainee. Medical examinations should also be provided when an inmate is taken out of the place of detention for any investigative activity, upon transfer or release and in response to allegations or suspicion of torture or other ill-treatment. Likewise, medical examinations must take place if a victim makes a complaint or upon his or her lawyer’s motion, subject to judicial review in the event of delay or refusal. It is essential that medical examinations be conducted in a setting that is free of any surveillance and in full confidentiality, except for when the presence of prison staff is requested by the medical personnel. Health personnel must be free from any interference, pressure, intimidation or orders from detention authorities. 52. Medical examinations are a crucial tool in corroborating or refuting allegations of physical and psychological mistreatment. They are also integral to prevention efforts. While forensic science has made progress, the impact of medical examinations is undermined by a lack of rigorous implementation, inadequate funding, insufficient training and institutional dependencies. In many cases, health care is provided by physicians who have an almost exclusively therapeutic role or by nurses or paramedics with only basic medical training, as their focus is on curing sick detainees and examining new arrivals for contagious diseases or obvious wounds. They often lack the required expertise to properly document ill-treatment. Furthermore, reporting signs of torture raises challenges regarding perceived loyalty conflicts (to the prison administration and to the prisoner) and the responsibility to assure the safety of prisoners. In turn, persons deprived of liberty are invariably caught between a legal requirement to provide evidence to support allegations of torture or other ill-treatment and the lack of practical possibilities to produce such evidence. Records of medical examinations upon arrest or transfer often do not exist and recourse to forensic expertise is at the discretion of the supervising authority, who has ample opportunity to delay authorization until the signs of torture have disappeared. 53. The revision of the Rules offers an excellent opportunity to address these deficiencies. The Rules must include a provision obliging authorities to ensure that 13-42285 13/23