A/HRC/38/36 I. Introduction 1. In previous reports and country missions, the Special Rapporteur has attempted to shed light on how exclusion has negatively affected the right to health of those deprived of basic liberties and freedoms. In the present report, he uses a right-to-health framework to problematize the global approach to deprivation of liberty and confinement, pointing towards transformative directions for reform. 2. Given the breadth and scale of these issues, a comprehensive assessment is not possible within the space constraints of the present report. This is an initial contribution, focused on some practices where the right to health is a key element in meaningful assessment and guidance. 3. The report is a synthesis of insights acquired during country missions, literature reviews and multiple assessments of cases brought to the attention of the Special Rapporteur through the communications mechanism of the special procedures. The report was significantly informed and enriched through extensive consultations with a wide range of stakeholders, including people who have been deprived of their liberty, civil society representatives, members of the prison abolition movement, public-health experts, the World Health Organization (WHO) and academic experts. The Special Rapporteur is grateful for their generous commitment of time, energy and meaningful contributions. 4. Deprivation of liberty is a legally grounded term, and involves severe restriction of motion within a space that is narrower than that of other forms of interference with liberty of movement. It should be based on a judicial sentence, and is imposed without free consent. It is not prohibited per se, but such detention must be lawful and not arbitrary. Deprivation of liberty takes many forms, including police custody, remand detention, imprisonment after conviction, house arrest and administrative detention, as well as both involuntary hospitalization and institutional custody of children resulting from legal proceedings. 1 5. Confinement is a term widely used in health and social welfare settings to indicate the restriction of an individual within a limited area, following medical or social-welfare advice. It may occur with or without the consent of the person and may include some generally accepted health-grounded practices, such as those applied in the context of the recovery period after a woman has given birth. 2 6. While some forms of confinement, including retention in hospitals and in psychiatric and other medical facilities, may constitute de facto deprivation of liberty, 3 virtually all forms of confinement without informed consent represent a violation of the right to health. 7. Around the world, more than 10 million adults are imprisoned in penal settings. 4 These statistics fail to capture the global scale of persons restricted in other settings. For example, it is estimated that at least one million children are being held in other settings, that half a million adults are in compulsory drug detention and that thousands of women are being held in hospitals for non-payment of bills. An inestimable number of adults and children are confined in medical and social institutions, including persons with tuberculosis who are forcibly isolated for long durations, sometimes in prison-like settings. While the places of confinement differ, the shared experience of exclusion exposes a common narrative of deep disadvantage, discrimination, violence and hopelessness. 8. Restrictions on the liberty of movement have emerged in the past two centuries as the default tool of social control to promote public safety, “morals” and public health. This has included the detention, on the grounds of behaviour socially labelled as “immoral”, of, 1 2 3 4 See Human Rights Committee, general comment No. 35 (2014) on liberty and security of person, paras. 3, 5–6 and 10–14; see also E/CN.4/2005/6, para. 54. See Committee on the Elimination of Discrimination against Women, general recommendation No. 24 (1999) on women and health, paras. 2, 8, 22, 26 and 31. See A/HRC/30/37, para. 9. Roy Walmsley, World Prison Population List, 11th ed. (World Prison Brief and Institute for Criminal Policy Research). 3