examinations by prison staff in a separate room. Such situations may result in prisoners feeling uncomfortable with sharing medical and private information with medical staff and stop them from doing so. It is, therefore, contrary to the principle of confidentiality and may also undermine the right of prisoners to the highest attainable standard of physical 337 and mental health. While some security measures may be necessary and justifiable, the CPT has stressed that all medical examinations should take place out of the hearing and, unless requested otherwise by the medical personnel concerned, out of sight of prison 338 staff. Certain (suspected) violent extremist prisoners may also have specific healthcare needs that may hamper their rehabilitation and should be given appropriate attention. It is important, for example, to ensure that psychologists are available with trauma-informed training for children or that prison health services are responsive to women exposed to 339 different forms of sexual and gender-based violence. 336 In some contexts, individuals with underlying medical conditions convicted of terrorism offences have been excluded from early release measures brought in due to the COVID-19 pandemic, despite the high risk they face from contracting infectious diseases 340 in overcrowded detention conditions. It has also been reported that there is a lack of adequate medical care in other contexts, in violation of international human rights 341 standards. Failing to protect those deprived of liberty from a serious disease as a result 342 of a lack of precaution or due diligence may amount to ill-treatment, or even torture. Requests and complaint mechanisms All detainees must be able to make requests and complaints. There must be an adequate complaint mechanism in place so that prisoners can make requests and complaints “confidentially and without fear of reprisals or other negative consequences. Procedures should also mitigate against the risk of complaints being tampered with or 344 ignored.” The SPT, for example, has expressed concern that requests and complaints 345 from prisoners convicted on terrorism charges must be put in unsealed envelopes. The CAT has also noted concerns about a lack of effective complaint mechanisms or, 343 336 Based on NGO and NPM reports on the Netherlands and Norway. See Amnesty International and Open Society Justice Initiative, “Inhuman and Unnecessary Human Rights Violations in Dutch High-Security Prisons in the Context of Counter Terrorism”, op. cit., note 106, p. 49; “The Parliamentary Ombudsman Norway – NPM “Visit report: Telemark Prison, Skien branch, 2-4 June 2015”, op. cit., note 226, pp. 21-22. 337 UN ICESCR, op. cit., note 120, Article 12(1). 338 CPT 3rd General Report (CPT/Inf [93] 12, para. 51). 339 UN Nelson Mandela Rules, op. cit., note 13, Rule 25.1. Report of the UN Special Rapporteur on Torture, A/HRC/28/68, 5 March 2015, para. 85(d); Report of the UN Special Rapporteur on Torture, A/HRC/31/57, 5 January 2016, para. 25. See also: ODIHR, Guidelines for Addressing the Threats and Challenges of “Foreign Terrorist Fighters” within a Human Rights Framework, op. cit., note 23, pp. 64-67 and 68-72. 340 Human Rights Watch, “Turkey: COVID-19 Puts Sick Prisoners at Grave Risk”, 3 April 2020. 341 Forum18, “TAJIKISTAN, op. cit., note 163; UN Committee against Torture, “Concluding Observations on the Third Periodic Report of Tajikistan”, CAT/C/TJK/CO/3, 18 June 2018, para. 34. 342 ODIHR and APT, Guidance on Monitoring Places of Detention through the COVID-19 Pandemic”, op. cit., note 269, p. 4. 343 UN Nelson Mandela Rules, op. cit., note 13, Rule 56 & 57. 344 ODIHR & PRI, Guidance Document on the Nelson Mandela Rules, op. cit., note 10, Chapter 1, para. 139. 345 SPT, “Visit to Spain Undertaken from 15 to 26 October 2017: Observations and Recommendations Addressed to the State Party”, op. cit., note 293, para. 33. 70