CAT/OP/MKD/1 effectively investigated, in accordance with article 12 of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. B. Material conditions 22. The Subcommittee notes the relatively good material conditions in most police facilities visited. However, it is concerned that all the holding cells it visited are located in the basement of police buildings, resulting in some cells having little or no natural light, limited ventilation and in some cases no heating. There were also some reports of limited access to food and water. 23. The Subcommittee is seriously concerned by the two underground holding cells in Kičevo police station, which amount to a renovated dark room with no natural light (except for a couple of rays coming from holes in a metal plate), making it impossible to find the call button; no heating; toilets located two floors above and shared with staff; and limited access to food, drink and sanitary items. Cumulatively, the Subcommittee believes it would be inhuman to hold detainees in those cells for more than a very short period of time. 24. The delegation recommends that the cells in Kičevo police station be immediately taken out of use. In addition, the Subcommittee recommends that the State party speed up its efforts to ensure that material conditions in all police facilities are improved, with a particular focus on lighting, ventilation, heating and access to sanitation. IV. Penitentiary institutions A. Health care in prison 25. The Subcommittee is concerned that medical registers at all the facilities it visited showed that no routine thorough medical examinations are automatically carried out following the arrival of detainees at an institution and that requests to see a doctor are not necessarily granted. Medical examinations are only undertaken if there is an injury which is severe or obvious, or if it is requested by the detainee or the authorities. Even in such severe cases, the Subcommittee received allegations that medical treatment was not provided owing to lack of medical staff or was hindered by prison guards. The Subcommittee is also concerned about the general inadequacy of medical records, which lack full documentation of the initial and ongoing physical and mental condition of detainees. For example, in one facility, a fatality that was reflected in the central records was not reflected in the detainee’s medical chart. The absence of detailed recording may lead to a failure to detect cases of torture or ill-treatment. 26. The Subcommittee recommends that the State party ensure access to and examination by an independent doctor as soon as possible after arrest or transfer to a detention facility and establish a more coherent and complete form of recording of medical information in a register, with full respect for medical ethics and deontology. It also recommends that the State party develop a standard form for a full medical screening of all persons upon arrival and a summary of the medical history of detainees, and integrate it with records from previous facilities or central records. Such a register could be included in the medical information management system of the health-care system. It is recommended that such a record include: (a) A detainee’s medical history, including any allegations of recent violence, torture or ill-treatment; (b) The existence of any discomfort or symptoms; (c) The result of the clinical examination, including a description of any injuries observed and an account of how such injuries were sustained; (d) 6 An indication of whether the whole body was examined;