A/63/175 (b) Use of restraints, and seclusion 55. Poor conditions in institutions are often coupled with severe forms of restraint and seclusion. Children and adults with disabilities may be tied to their beds, cribs or chairs for prolonged periods, including with chains and handcuffs; they may be locked in “cage” or “net beds” and may be overmedicated as a form of chemical restraint. 15 It is important to note that “prolonged use of restraint can lead to muscle atrophy, life-threatening deformities and even organ failure”, and exacerbates psychological damage. 16 The Special Rapporteur notes that there can be no therapeutic justification for the prolonged use of restraints, which may amount to torture or ill-treatment. 17 56. Within institutions, persons with disabilities are often held in seclusion or solitary confinement as a form of control or medical treatment, although this cannot be justified for therapeutic reasons, or as a form of punishment. 18 In December 2003, the Inter-American Commission on Human Rights approved precautionary measures to protect 460 individuals detained in the State-run Neuro-psychiatric Hospital in Paraguay, including two teenage boys who had been detained in solitary confinement for over four years in isolation cells, naked and in unhygienic conditions. 19 In Victor Rosario Congo v. Ecuador, the Inter-American Commission on Human Rights considered that the solitary confinement to which Mr. Congo (who had a mental disability) was subjected in a social rehabilitation centre constituted inhuman and degrading treatment in terms of article 5, paragraph 2, of the American Convention on Human Rights. 20 The Special Rapporteur notes that prolonged solitary confinement and seclusion of persons may constitute torture or illtreatment. 21 (c) Medical context 57. It is in the medical context that persons with disabilities often experience serious abuse and violations of their right to physical and mental integrity, notably in relation to experimentation or treatments directed to correct and alleviate particular impairments. __________________ 15 16 17 18 19 20 21 08-44075 See the standards set by the Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) of the Council of Europe contained in The CPT Standards: “Substantive” sections of the CPT’s General Reports (CPT/Inf/E (2002) 1-Rev.2006), p. 64. MDRI “Torment not treatment: Serbia’s segregation and abuse of children and adults with disabilities”, 2004. pp. 19, 47 and 49. See Inter-American Court of Human Rights, Ximenes Lopes v. Brasil, op. cit., paras. 133-136; see also The CPT Standards, op. cit., 62-68. See Human Rights Committee, concluding observations on the second periodic report of Slovakia (CCPR/CO/78/SVK), para. 13 and on the second periodic report of the Czech Republic (CCPR/C/CZE/CO/2), para. 13, where the Committee expressed concern about the persistent use of cage-net beds as a means to restrain psychiatric patients, recalling that this practice is considered inhuman and degrading treatment and amounts to a violation of articles 7, 9 and 10 of the International Covenant on Civil and Political Rights. See Annual Report of the Inter-American Commission on Human Rights 2003 (OEA/Ser.L/V/II.118, Doc. 5 rev. 2), chap. III.C.1, para. 60. See Inter-American Commission of Human Rights, Rosario Congo v. Ecuador, report 63/99, case 11.427 of 13 April 1999, para. 59. See also Keenan v. the United Kingdom, European Court of Human Rights, judgement of 3 April 2001, application No. 27229/95, para. 113. See section IV, below. 13