DETENTION MONITORING TOOL FACTSHEET In April 2016, a 38-year-old inmate of Milwaukee County Jail, Wisconsin, died of dehydration because water to his cell was shut off for seven days as a punishment. Prosecutors not only charged the two officers who were said to be directly responsible, but also the former director of the facility for failing to preserve a surveillance video and lying to the police; if convicted, she could face more than four years in prison.38 • Has an independent authority undertaken an investigation into every serious injury in custody in line with international standards? Serious injuries in custody • Are measures in place to prevent avoidable injuries? International instruments do not conclusively define the types of injuries that can be regarded as constituting ‘serious injuries’. National norms on ‘serious bodily harm’ or similar provisions39 can provide guidance for decisions on which injuries fall into this category. Typically, the loss of limbs, fractures, injuries to inner organs and crushes, burns or severe cuts that require hospitalisation are regarded as being serious. Additionally, injuries sustained through rape and other sexual violence can be considered to constitute serious injuries.40 Prison staff are obliged to administer first aid and organise urgent medical care for the injured person, e.g. by calling an ambulance. At all times, including at night time and during weekends, an adequate number of staff trained in administering first aid should be present in the detention facility.41 If a serious injury is detected, similar recording and reporting obligations apply as outlined above in cases of death; any evidence must be secured and witnesses to the event identified and protected. Serious injuries could be indicative of ill-treatment or of a criminal act by another prisoner or non-State party (e.g. a service provider in prison) and must therefore trigger a prompt and independent investigation. As with deaths in prison, the occurrence of serious injuries should be scrutinised with a view to preventing them in the future. What could monitoring bodies check? • Are there guarantees that a sufficient number of staff members trained in first aid are present on the premises at all times? • Have all persons who suffered a serious injury in prison received urgent medical care? • Have all cases of serious injuries in custody been registered within individual prisons and in a centralised manner? • Is a regulation in place guiding the prison staff regarding their duties and required actions in case of a serious injury in custody? Are the prison administration and staff aware of and trained on the regulation? • Has the prison administration reported without delay all cases of serious injuries in custody to the relevant internal and external authorities? • Has the prison administration secured evidence and cooperated with the investigative authorities? • Is an internal procedure in place to identify lessons learned after every serious injury? • Have lessons learned been translated into reforms to address the shortcomings identified? • Is statistical data on serious injury in custody used to identify possible structural deficiencies leading to a higher risk of injuries in custody? Indications of torture and other ill-treatment Certain physical injuries, such as marks and bruises that do not necessarily qualify as ‘serious’ injuries, could nevertheless be indicative of torture or ill-treatment and should be documented and reported to the relevant investigative authorities, even in the absence of an official complaint. For instance, bruising to the soles of the feet or so-called ‘tram-line’ bruises (i.e. parallel linear bruises) may constitute typical signs of torture, as they may be the result of beatings with a baton or similarly shaped object (or ‘falanga’).42 Also, nonphysical symptoms, such as significant changes in the demeanour or complete withdrawal of a detainee,43 should be scrutinised with a view to establishing the cause of the behavioural changes. In order to detect possible indications of torture or ill-treatment and violence by other prisoners, it is necessary that all prison staff are sensitised and adequately trained. Similarly, prison healthcare staff, including psychologists and social workers, should be trained to detect ill-treatment in prison and in the use of the Istanbul Protocol. Prison healthcare services can also play an important role in reducing ill-treatment and torture by the police. Any person transferred to a prison or pre-trial detention facility should be seen by a qualified medical professional within the shortest possible time (i.e. within 24 hours) after admission.44 This initial medical screening should include a full visual examination of the body of the person. It is vital that these examinations take place in full compliance with medical confidentiality, without the presence of non-medical staff;45 moreover, women prisoners should be entitled to request that they be examined by women healthcare staff, and if this is not possible there must be a woman present.46 Additionally, detainees should be routinely presented to a member of the medical staff after incidents of inter-prisoner violence, including, in particular, indications of sexual abuse, or any use of force by staff.47 Such a practice is not only important for the early detection of ill-treatment, but also to provide timely Penal Reform International and Association for the Prevention of Torture | Incident management and independent investigations |5