A/HRC/42/20 treatment.101 A lack of adequate access also results from organizational and structural lacuna, for example a lack of means of transportation or personnel to transfer inmates from detention facilities to hospitals102 or an absence of personalized medical records.103 Decisions on health care services are also often taken by penal-oriented administrators instead of independent public-health actors. Access to health-care services is often dependent on negotiations with staff tasked with security, sometimes resulting in a denial of access to appropriate medical services and preventable deaths. 104 Persons deprived of their liberty can often only access a limited range of treatments compared with those available in the community and, in some cases, external heath facilities refuse to admit and treat persons deprived of their liberty.105 32. Lack of health care or inadequate treatment in detention for persons who use drugs can also contravene the right to health106 and contribute to deaths in detention. Detainees’ access to medical treatment, including access to opioid substitution therapy, is often severely restricted even if it has been demonstrated that such therapy is the most effective intervention available for the treatment of opioid dependency and that it contributes to reducing mortality.107 Persons who use drugs may also face multiple forms of violence under the guise of treatment when placed in mandatory administrative detention.108 33. Deaths in custody also result from lack of medical treatment for injuries and illnesses stemming from torture and inadequate conditions of detention. Lack of basic medical attention and denial of access to medicine make otherwise treatable conditions, such as infected wounds, asthma and diabetes, fatal.109 34. Detainees should enjoy at least the same level of access to health care as that available in the community, which takes into account the additional risks linked to incarceration.110 The Nelson Mandela Rules offer extensive guidance to States on how to implement access to health care in detention in a manner that will contribute to reducing deaths in custody. In addition, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has formulated numerous recommendations in this regard in a recent report on the right to health in the context of confinement and deprivation of liberty. 111 III. Measures to address violence and prevent deaths and serious injury in situations of deprivation of liberty A. Accountability 35. By depriving persons of their liberty, States assume responsibility to care for their lives and bodily integrity. Due to this heightened duty of care, States must take all necessary measures to protect the lives of individuals deprived of their liberty. 112 The adoption of such measures requires the identification of the causes of violence, death and serious injury in custody. This can be done in a comprehensive manner by initiating and conducting investigations into these incidents and collecting and analysing detailed data on them. Adequate investigations pave the way for holding to account individuals responsible for incidents of violence, death and serious injury, while the collection of data contributes 101 102 103 104 105 106 107 108 109 110 111 112 10 See CAT/OP/MNG/1; CAT/OP/UKR/3. Submission of the Defensor del Pueblo de la Nación (Argentina). See CAT/OP/BEN/3. See A/HRC/38/36. Submission of the Defensor del Pueblo de la Nación (Argentina). See A/65/255; CAT/C/CPV/CO/1; CAT/C/CHN/CO/4. See A/HRC/10/44 and A/HRC/10/44/Corr.1. Submission of Harm Reduction International. See A/HRC/31/CRP.1 See ICRC, “Guidelines for Investigating Deaths in Custody”. See A/HRC/38/36. Human Rights Committee, general comment No. 36.