6. HEALTH-CARE 01 Every human being has a right to the highest attainable standard of physical and mental health and, when a state deprives someone of their liberty, it takes on the duty of care to provide medical treatment and to protect and promote their physical and mental health and wellbeing. Authorities must, therefore, devote sufficient resources to ensure that prison health-care is adequate in relation to the size and needs of the prison population. Those in prison are entitled to receive the same standard of health-care as is provided in the community outside of prison. As in the community, the primary responsibility of all health-care professionals is the care and treatment of their patients, based on individual assessments of their medical needs. Their fundamental ethical obligations are to respect the autonomy and best interests of the patient, to evaluate, promote, protect and improve the physical and mental health of prisoners, and to avoid harm being done to them. The institutional set-up of health-care in prison will vary from one facility to another, but must include doctors, nurses, psychiatrists, psychologists and dentists. Depending on the prison population other specialists, such as midwives, gynaecologists and paediatricians may be required. For some medical conditions or examinations, and in emergency situations, prisoners will need to be transported to a hospital or to specialist clinics. The Mandela Rules were revised to bring the provisions related to health-care in line with modern standards, including in relation to medical ethics. The new rules provide specific guidance on how health-care services in prisons should be organized and the specific duties and responsibilities of health-care staff. In addition, the Rules provide more detail on addressing the needs of those with mental health conditions or other specific health-care needs. The Rules also reiterate the absolute prohibition of torture or other ill‑treatment by health-care staff and their obligation to document and report cases they become aware of. RELEVANT RULES: HEALTH-CARE Rule 24: 1. The provision of health-care for prisoners is a state responsibility. Prisoners should enjoy the same standards of health-care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status. 2. Health-care services should be organized in close 6 relationship to the general public health administration and in a way that ensures continuity of treatment and care, including for HIV, tuberculosis and other infectious diseases, as well as for drug dependence. 142 2. The health-care service shall consist of an interdisciplinary team with sufficient qualified personnel acting in full clinical independence and shall encompass sufficient expertise in psychology and psychiatry. The services of a qualified dentist shall be available to every prisoner. Rule 27: 1. All prisons shall ensure prompt access to medical attention in urgent cases. Prisoners who require specialized treatment or surgery shall be transferred to specialized institutions or to civil hospitals. Where a prison service has its own hospital facilities, they shall Rule 25: be adequately staffed and equipped to provide prisoners 1. Every prison shall have in place a health-care service referred to them with appropriate treatment and care. tasked with evaluating, promoting, protecting and 2. Clinical decisions may only be taken by the improving the physical and mental health of prisoners, responsible health-care professionals and may not paying particular attention to prisoners with special be overruled or ignored by non-medical prison staff. health-care needs or with health issues that hamper their rehabilitation. Guidance document on the Nelson Mandela Rules