A/HRC/43/61 surgery should be transferred to specialized institutions or to civil hospitals and, where a prison service has its own hospital facilities, they should be adequately staffed and equipped to provide prisoners referred to them with appropriate treatment and care (rule 27 (1)). Prisoners who require specialist treatment must be transferred to specialized institutions or outside hospitals when such treatment is unavailable in prison. In line with the Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment (principle 24) and the Nelson Mandela Rules (rule 24 (1)), health care provided to individuals in custody must be free of charge. The failure to provide adequate health care to prisoners may violate the absolute prohibition of torture and other cruel, inhuman or degrading treatment or punishment, including under article 7 of the International Covenant on Civil and Political Rights. 64. The Prison Regulations provide a comprehensive framework for the provision of health care to prisoners and, if fully complied with, would largely be in compliance with international standards regarding prison conditions. In practice however, there are consistent, significant breaches of these Regulations. 65. Iranian prisons can provide only basic medical facilities. Therefore, prisoners with serious medical conditions either need to be seen by a specialist physician within the prison or to be transferred to outside hospitals. The Special Rapporteur was informed that prison infirmaries have poor, outdated and insufficient stocks of medicine and the relevant prison staff are usually untrained or are unhelpful to prisoners, particularly political prisoners. Specialist physicians visit prisons irregularly, which results in many prisoners waiting for considerable periods for examinations, even when their condition is serious and requires urgent attention. The Special Rapporteur was informed by several prisoners that specialist physicians were under time pressure. He also received reports of failures to see seriously ill patients, inordinate delays and of trivializing or dismissive attitudes towards prisoners’ health conditions. On occasions, specialists have reportedly refused to order diagnostic tests or provide essential medication and instead prescribed ordinary tranquillizers. 66. The Special Rapporteur received alarming reports that detainees with previous and known medical conditions are not provided with any medical attention. While it is acknowledged that prisoners with serious medical conditions need to be transferred to hospitals outside of the prison where they are detained, such transfers must be approved by the prison clinic and then by the head of the prison and the associate prosecutor of the prison.107 It has been reported that sometimes prison officials inform the prisoners that the prosecuting authorities or intelligence officials have refused medical leave or hospitalization, in contravention of international human rights norms. There have also been reports of medication provided by the family being withheld from the prisoner as a form of punishment. The Special Rapporteur has also received disturbing information regarding the failure of the prison authorities to provide prisoners with regular check-ups. 67. Contrary to the Prison Regulations, the Special Rapporteur has received disturbing evidence of prisoners in hospital or undergoing medical care being forced to interrupt their treatment and return to prison against medical advice. An emblematic case is the continuous denial by the authorities of Raja’i Shahr Prison of medical treatment to Mr. Sadeghi, who did not receive a medical examination until May 2018 despite having complained of severe pain to his elbow and shoulder for 18 months. 108 Even after his examinations, he reportedly only discovered that he had a tumour after briefly being allowed to look at his medical file. Mr. Sadeghi was allowed surgery for cancer in September 2018 but the prison authorities reportedly delayed the operation despite medical specialists finding that he needed an operation urgently. Furthermore, the prison authorities returned him to prison three days after surgery against medical advice that he remain in hospital for 25 days to assess the need for further treatment. The prison authorities reportedly blocked a follow-up examination with his specialist on 22 September 2018, resulting in Mr. Sadeghi only seeing a general practitioner. He was diagnosed with a 107 108 18 Ibid., art. 103. www.amnesty.org/en/documents/mde13/8687/2018/en/; www.ohchr.org/en/NewsEvents/Pages/ DisplayNews.aspx?NewsID=24813&LangID=E.