CAT/C/MDA/CO/3 hygienic conditions, including: sufficient natural and artificial light; adequate sewage systems and sanitary installations, including toilets and showers; heated cells; sufficient ventilation; an adequate quality and quantity of food, bedding, blankets and items for personal hygiene; health care; outdoor activities; and family visits; (d) Take steps to address the collusion of custodial staff with criminal gangs in the prison system; (e) Provide continuous training to custodial staff and persons in the administration of detention facilities on the provisions of the Convention and the absolute prohibition of torture; (f) Implement the recommendations of the Subcommittee on Prevention of Torture arising from its visit to the country in 2012. Provision of health care in the penitentiary system 19. The Committee is concerned about reports that health care in penitentiary facilities is insufficient, that unqualified staff provide medical services to inmates, that inmates are not permitted to obtain private medical assistance or referred to outside specialists when necessary, that the needs of inmates with disabilities and those who require mental health and psychosocial services cannot be adequately accommodated, and that the health care and hygiene needs of women in the penitentiary system are not adequately addressed. The Committee is also concerned at reports concerning particularly poor material conditions, the inadequate quality of medical services, and disciplinary sanctions against patients at the penitentiary hospital (Penitentiary No. 16), and at the fact that medical staff in the penitentiary system are not independent of the prison management (arts. 2, 10 and 11). 20. The State party should: (a) Intensify its efforts to improve health care in penitentiary facilities, including by hiring adequate numbers of qualified medical staff and providing them with training on the Istanbul Protocol; (b) Establish and ensure the implementation of rules to facilitate requests from inmates for private medical assistance and referrals to outside specialist services and to accommodate the needs of inmates with disabilities in the penitentiary environment; (c) Transfer responsibility for penitentiary medical units from the Department of Penitentiary Institutions to the Ministry of Health, Labour and Social Protection; ensure that the penitentiary hospital is affiliated with the Ministry of Health; take measures to reduce overcrowding; improve material conditions, including by renovating and equipping patients’ rooms; provide adequate food and medicines; and ensure individualized treatment plans and medicines for psychoneurological patients, including anti-psychotic drugs; (d) Separate healthy prisoners from those suffering from active tuberculosis in all detention facilities, provide specialized medical care to prisoners suffering from active and multidrug-resistant tuberculosis and equip them with proper ventilation, and put in place appropriate measures to effectively prevent and control the further spread of HIV in penitentiary facilities; (e) Adopt a gender-sensitive approach and provide for the medical and personal hygiene needs of women in the penitentiary system, in keeping with international standards. Deaths in custody and violence in detention facilities 21. The Committee is seriously concerned at the 74 per cent rise in deaths in custody over the period from 2012 to 2016 and the growing number of cases in which the penitentiary authorities have not issued reports on the causes of deaths in custody; at reports of the excessive and disproportionate use of physical force and special measures against persons in custody; and at reports that penitentiary staff acquiesce to the commission of inter-prisoner violence by criminal gangs in detention facilities (arts. 2, 11–14 and 16). 7