ESSEX PAPER 3: INITIAL GUIDANCE ON THE INTERPRETATION AND IMPLEMENTATION OF THE UN NELSON MANDELA RULES Chapter 4 Healthcare Issues/rules covered: • Provision of health-care (Rules 24-27, 30 and 31) • Medical ethics (Rules 32 and 46) • Role of doctors in case of signs of torture or other ill-treatment (Rule 34) General Principles States are under an international obligation to ensure the right to the highest attainable standard of health214. The fulfilment of this obligation is particularly acute in prisons as a combination of factors can make prison environments detrimental to health and wellbeing and place prisoners in a position of vulnerability as a result. Compared to the general population, the health needs within the prison population are typically higher in relation to physical and mental health and drug dependencies.215 Prisoners fully depend on the authorities to access health-care. Any act or omission by the authorities can have a serious impact on a prisoner’s health and well-being. It is therefore critical that there are: •  qualified staff; •  continuity of care between prisons and the community; •  robust health-care services and infrastructure are provided within prison;216 UN Committee on Economic, Social and Cultural Rights, General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12). Adopted at the Twenty-second Session of the Committee on Economic, Social and Cultural Rights, on 11 August 2000 (Contained in Document E/C.12/2000/4) at para 43(a) available at: http://www. ohchr.org/Documents/Issues/Women/WRGS/Health/GC14.pdf (General Comment No. 14) 214  World Health Organization Europe, Good governance of prison health in the 21st century. A policy brief on the organization of prison health (2013) available at: http://www.euro.who.int/__data/assets/pdf_file/0017/231506/Good-governance-for-prison-health-in-the-21st-century.pdf?ua=1 (WHO, Good governance of prison health in the 21st century) 215  United Nations Office for Project Services, Technical Guidance for Prison Planning: Technical and Operational Considerations Based on the Nelson Mandela Rules (2016) at 151 – 157 (setting out the minimum elements that must be provided in prisons including that: ‘[Prison facilities must include a dedicated space for the provision of physical and mental health services, as well as dental services. Prisons that house women must include provisions for pre- and post-natal care, and other gender-specific health care services’) available at: https://www.unops.org/ SiteCollectionDocuments/Publications/TechnicalGuidance_PrisonPlanning.pdf (UNOPS, Technical Guidance for Prison Planning); Sub-Committee on the Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, Report of the Sub-Committee on the Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment to Kyrgyzstan CAT/OP/KGZ/1 (2014) at paras. 90 - 94 (identifying the needs of a healthcare system to include adequate equipment, qualified and adequately paid staff including mental health experts, adequate and free medical supplies, a high standard of diagnostic and therapeutic services, adequate sanitary conditions, adequate central heating and adequate training including in the assessment and response to human rights violations) available at: http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CAT%2fOP%2fKGZ%2f1&Lang=en (Kyrgyzstan CAT/OP/KGZ/1) 216  Penal Reform International and the Essex Human Rights Centre | 61