A/HRC/42/20 rights mechanisms have expressed their concern with regard to the use of mechanical restraints against both prisoners26 and patients in psychiatric hospitals,27 and warned that the prolonged use of restraint can lead to muscle atrophy, life-threatening deformities and organ failure.28 11. Police and prison officials should, when resorting to force – including the use of restraints in custodial settings – comply with the relevant international norms and standards.29 The Basic Principles on the Use of Force and Firearms by Law Enforcement Officials prescribe that, when dealing with persons in custody, force should not be used except when strictly necessary for the maintenance of security and order in the institution or when personal safety is threatened, and that in any case firearms can only be used in case of immediate threat of death or serious injury. 30 The Nelson Mandela Rules contain detailed rules on the use of restraint instruments, in particular prohibiting their use for disciplinary purposes.31 3. Sentencing 12. The death penalty32 has been recognized as a source of physical and psychological violence, in particular due to the fact that death row constitutes an environment in which persons sentenced to death are particularly vulnerable to violence.33 The Special Rapporteur on torture found that death row violated the prohibition of torture, inhuman or degrading punishment, due to, inter alia, the prevailing harsh treatment and conditions of detention. 34 This may include physical violence, the almost constant use of physical restraints, such as shackling, detention in cages or small cells, and solitary confinement. 35 13. Life sentences also have a significant impact on the physical health of prisoners, with some reports of health-care neglect by prison authorities. Some human rights mechanisms have found that prisoners serving life sentences are at risk of ill-treatment and excessive use of force by prison officers. 36 The number of prisoners serving life sentences increased by 84 per cent between 2000 and 2014, with their number amounting to close to 480,000 worldwide. 37 In addition to the fact that such sentences inevitably result in the eventual death of the sentenced person in detention, life imprisonment has been described as “civil death” due to the loss of sense of self and control experienced by prisoners. 38 B. Violence among persons deprived of liberty and resulting deaths and serious injury 1. Forms of inter-prisoner violence 14. Inter-prisoner violence constitutes an important cause of death and serious injury of persons deprived of their liberty, representing in some contexts over 17 per cent of deaths 26 27 28 29 30 31 32 33 34 35 36 37 38 See CAT/OP/MNG/1. See CAT/OP/BOL/3. A/63/175, para. 55. See UNODC and OHCHR, Resource Book on the Use of Force and Firearms in Law Enforcement (New York, 2017), p. 143. Principles 15 and 16. Rules 43 and 47–49. The death penalty is a form of death in custody, however, the present report will not address this topic as it is extensively dealt with in several reports of both the High Commissioner for Human Rights and the Secretary-General. Submission of Harm Reduction International. See A/67/279. Submission of Harm Reduction International. See Council of Europe, “Report to the Azerbaijani Government on the visit to Azerbaijan carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 8 to 12 December 2008” (Strasbourg, 26 November 2009), paras. 11–12. Submission of Penal Reform International. Ibid. 5