ESSEX PAPER 3: INITIAL GUIDANCE ON THE INTERPRETATION AND IMPLEMENTATION OF THE UN NELSON MANDELA RULES care in ‘close relationship to the general public health administration’ as a means of ensuring equivalence and continuity of care. The Essex Group noted that in some states health-care in the community may be very poor. In such circumstances, as outlined by the UN Office for Project Services in its interpretation of the Nelson Mandela Rules, ‘[w]hile it is a typical expectation that health facilities should be equivalent to the standard of facilities serving the broader community, it must be recognized that the absence of local health facilities does not imply a lack of responsibility toward the healthcare of prisoners’.227 Continuity of Care Rule 24(2) of the Nelson Mandela Rules addresses continuity of care, a key aspect of which is the organisation of health-care services in close relationship to the public health administration.228 The Essex Group noted that continuity of care has two dimensions: first, continuity with care prior to and upon entering prison; and second, continuity with care in prison on release or transfer. (See Rule 26(2) concerning transfer of medical files upon transfer of prisoners). For example, on entering prison, Rule 24(2) would require prisoners to be able to bring drugs like an inhaler into prison in order to ensure continuity of care.229 Health-care staff have the duty to cooperate in the coordination of continuous care (see also Rule 30(a)).230 The Essex Group noted that continuity of care extends to drug dependence, noting the importance of ensuring that treatment allowed in the community, like methadone, is also allowed in prisons in line with harm reduction and to avoid prisoners having to go ‘cold-turkey’.231 The UN High Commissioner for Human Rights, in his study on the impact of the world drug problem on the enjoyment of human rights, emphasised the entitlement of persons in custodial settings, to the same standard of health-care found on the outside, including with regard to prevention, harm reduction and antiretroviral therapy.232 The importance of continuity of care with regard to treatment UNOPS Technical Guidance for Prison Planning at 153. 227  Commentary to Recommendation REC(2006)2. It reads: Organisation of prison health care. Rule 40. The most effective way of implementing Rule 40 is that the national health authority should also be responsible for providing health care in prison (..). (…). This will (..) allow for a continuity of treatment (..).” 228  229  Gladkiy v. Russia, Application No. 3242/03 (ECHR, 21 December 2010) at para. 47 WMA Declaration of Lisbon on the Rights of the Patient (1981/Rev. 2015), available at: (http://www.wma.net/ en/30publications/10policies/l4/) Principle 1. Right to medical care of good quality (f). “The patient has the right to continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care.” See also Commentary to Recommendation REC(2006)2. It reads (at p. 17): Organisation of prison health care. Rule 40. The most effective way of implementing Rule 40 is that the national health authority should also be responsible for providing health care in prison, as is the case in a number of European countries. (…). This will (..) allow for a continuity of treatment (..).” It also reads (at p. 19) “Rule 42.2 provides that if a prisoner is released before the completion of his treatment, it is important that the medical practitioner establishes links with medical services in the community so as to enable the prisoner to continue his treatment following release.” 230  Principle 6, UNODC/WHO, Principles of Drug Dependence Treatment Discussion Paper (March 2008), available at: https://www.unodc.org/documents/drug-treatment/UNODC-WHO-Principles-of-Drug-Dependence-TreatmentMarch08.pdf; The UN Committee on Economic, Social and Cultural Rights, the Special Rapporteur on the Right to Health and the UN High Commissioner for Human Rights have all mentioned harm reduction as part of the right to health: UN Committee on Economic, Social and Cultural Rights, Concluding Observations: Tajikistan (24 November 2006) UN Doc No E/C.12/TJK/CO/1, at para. 70; UN Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Paul Hunt, Mission to Sweden (28 February 2007) UN Doc No A/HRC/4/28/Add.2, at para. 60 and UN General Assembly, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (6 August 2010) A/65/255, at para. 60; United Nations High Commissioner for Human Rights, Study on the impact of the world drug problem on the enjoyment of human rights (4 September 2015) UN Doc A/HRC/30/65, at paras. 21-23 (OHCHR Study on the impact of the world drug problem). 231  OHCHR Study on the impact of the world drug problem, para. 21 232  Penal Reform International and the Essex Human Rights Centre | 64