statements from prisoners, the low number of daily consultations, the absence, at Abomey Prison, of health care staff at weekends or on public holidays, and the fact that approximately half of the detainees who had died during the last three years had died in prison, and not in hospital. In this regard, the SPT recommends that judicial procedures be established to consider, on the basis of medical reports, early release, transfer to home or hospital, of prisoners found to have a terminal illness. 216.As to material conditions, at Abomey Prison, the infirmary was dark and dingy, and the rooms had the appearance of being unused and with no evidence that patients were actually treated there. The new Akpro-Missérété Prison had a large purpose built infirmary within the inner prison compound, with four large rooms equipped with tables, chairs, sinks and beds. However, the infirmary was not being used, as the only nurse assigned to the Prison had requested to be removed from the inner compound to a much smaller office within the visitors’ block. In Cotonou Prison, the rooms were used but, as noted above, the medicine stores were largely empty of medication. 217. The SPT recommends that the authorities take action to ensure that prison health care service is fully operational in every prison, in terms of adequate staffing levels, premises, installations and equipment. There should be appropriate supervision of the pharmacy and of the distribution of medicines, in order to ensure a constant supply of medicines. (a)Training of health-care staff 218.The delegation took note of the fact that the healthcare staff at the prisons had not had specific training relating to prison healthcare, including hygiene, control of epidemics, human rights and forensic medical documentation of injuries. By way of illustration, whereas in Cotonou Prison there was a special cell for contagious diseases, in fact the room was kept open and other detainees had access to it. The delegation observed many prisoners with visible signs of medical problems in the three prisons visited, including numerous skin conditions which can be attributed to the high level of overcrowding, poor hygiene, poor access to healthcare and the absence of any preventive measures. The SPT recommends that more emphasis be placed on preventive healthcare measures, such as reducing mosquito breeding locations, routine disposal of refuse, and mass treatment of scabies infestations, in addition to stricter measures of hygiene. In this regard, the SPT recommends that the Ministry of Justice and the Ministry of Health develop a specific training programme for all health care staff prior to and during postings in prisons, in order to ensure that the quality and appropriateness of health care and health prevention programmes provided by the health care professionals. 219.The SPT notes that article 62 of Decree No. 73-293 provides that a chief doctor is responsible for the sanitary state of prisons in his area, and that he visits prisons at least every two weeks and makes recommendations. The SPT considers that this could be an important measure in ensuring that sanitary conditions in prisons are improved, which would in turn reduce the risk of some diseases. It requests copies of any such visit reports concerning the last three years and recommendations and recommends that the authorities ensure implementation of the legal provision in practice. (b)Medical registers 220.At Cotonou Prison, the initial medical examination was recorded in a book in an acceptable manner. However, there was no specific registration of injuries, nor were all transfers for hospital treatment noted in the appropriate booklet. At Akpro-Missérété Prison, the nurse maintained some basic statistics on diseases in the prison, using forms from the Ministry of Health which she obtained through the Direction départementale de Santé. The SPT recommends that the Ministry of Justice institute the practice of initial examinations and recording of statistics on diseases in all prisons in Benin, and provide appropriate forms to each health professional. This information will also enable the Ministry of Justice to identify which medicines should be supplied to prisons. In this regard, the SPT recommends that a standardised list of generic medicines be established for all prisons. Based on the required list of medication, a budget for healthcare, including preventive measures, should be established, based upon the actual prison population. (c)Mortality rates and registers 221.At Cotonou Prison, the delegation was told of the efforts of the director to reduce the mortality rate by exercising checks for signs of malnutrition; symptoms, such as swollen feet, were noted, indicating that prisoners were malnourished and/or had not been able to lie down at night. Deaths in prisons or in a hospital were registered consecutively in a notebook. The content of the notebook was in complete accordance with the list of deaths in custody which the authorities provided to the delegation. Causes of death ranged across of a broad spectrum of ordinary diseases, while two deaths resulted from violence: one case of injuries sustained during an escape attempt and one case from ill-treatment. Neither the notebook, nor the list provided by the authorities, clarify who was responsible for the illtreatment. The SPT requests further information on the death in custody caused by ill-treatment, and in particular details of any investigation, criminal or disciplinary proceedings and any penal and/or disciplinary sanctions. 222.The delegation also noted that the statistics on deaths in custody did not indicate the age of the deceased. In addition, uncertainties as to the precision of diagnosis make inferences difficult. Nonetheless, it is clear from the statistics provided that roughly half of the deaths occurred in the prison, and most resulted from ordinary diseases, including surgical conditions which should have been treated in a hospital. For example, the prisoners sentenced to death and held at Cotonou Prison reported to the delegation that a prisoner had died in the cell on 2 January 2006. They had called the nurse on the previous day as an emergency; the nurse came and left. The prisoner died in the cell the next morning. 223.No registers of death in prison was kept by the nurse at Akpro-Missérété, and the delegation was not provided with the registers of deaths at Abomey Prison. The SPT recommends that a system be put in place to investigate, notify and record each and every death in custody.