Healthcare provisions All those in detention are entitled to the highest attainable standard of health, and the healthcare they receive in detention should be of the same standard as that in the outside 329 community. The UN Nelson Mandela Rules state explicitly that all medical ethics are applicable in prison healthcare provision. The Rules also reiterate the absolute prohibition of torture or other ill-treatment by healthcare staff and their obligation to document 330 and report cases they become aware of. There are concerns that (suspected) violent extremist prisoners are not always afforded the same quality of medical care as others, on discriminatory grounds or because of the (presumed) security risks posed. Due to their specific health-care needs, such policies may affect women disproportionately. The same 331 may affect others who have specific (and in many cases greater) medical needs. The UN Nelson Mandela Rules provide for full confidentiality of medical examinations, 332 files and medical information, unless this would result in a real and imminent threat 333 to the patient or to others. Failure to observe this rule may undermine trust between 334 healthcare professionals and prisoners. Reported practices regarding (suspected) violent extremist prisoners or high-security prisoners have included the presence of prison staff (including of the opposite sex) in the 335 room where medical examinations took place or the visual monitoring (without hearing) of 329 UN Nelson Mandela Rules, op. cit., note 13, Rules 24-25, 27; General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12), Twenty-second Session of the Committee on Economic, Social and Cultural Rights, 11 August 2000, E/C.12/2000/4; UN General Assembly, Resolution 37/194, “Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,” 18 December 1982, Principle 1. 330 For detailed information on healthcare in prisons, advisory duties of healthcare personnel, documenting and reporting signs of torture, ethical and professional standards and medical files, see ODIHR & PRI, Guidance Document on the Nelson Mandela Rules, op. cit., note 10, Chapter 6. 331 One example was given by the French NPM, who reported that a woman in a temporary detention facility at Fleury-Mérogis, admitted on terrorist offences, gave birth in an extremely strained atmosphere, including between the medical and prison teams, particularly because of the security conditions that were deemed necessary to apply around her: « Le Contrôleur general des lieux de privation de liberté: Annual report 2017 », p. 89. 332 UN Nelson Mandela Rules, op. cit., note 13, Rules 31 and 26. 333 Ibid., Rule 32.1.c. The principle of medical confidentiality is a fundamental tenet of medical practice and must be applied with the same care in prisons as in the general community. This is particularly important given the high risk of abuse, stigmatization and discrimination that prisoners may face if their medical or mental health condition is known to others. Detailed and accurate medical files are essential for ensuring continuity of treatment, including in cases where prisoners are transferred and released, see ODIHR & PRI, Guidance Document on the Nelson Mandela Rules, op. cit., note 10, Chapter 6, paras. 123-125. 334 See also 2.3 on the misuse of rehabilitation and reintegration programmes for intelligence gathering. 335 Report to the Italian Government on the visit to Italy Carried Out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 12 to 22 March 2019, para. 56 and: “75. Once again, the CPT’s delegation found that there was a total lack of confidentiality of medical consultations of prisoners in all the establishments visited. As mentioned in paragraph 14, several inmates who had been victims of alleged ill-treatment told the delegation that the presence of prison officers during their medical examinations discouraged them from recounting what had actually happened. At the same time, several prison officers told the delegation that they believed that it was an integral part of their work to protect health-care staff from potential aggression by inmates.” 69