REU, Alm.del - 2012-13 - Bilag 163: Rapport til regeringen fra Europarådets Komité til Forebyggelse af Tortur og Umenneskelig eller Nedværdigende Behandling eller Straf om indsattes vilkår i Grønland

Copy of the letter transmitting the CPT’s report ........................................................................... 5I.A.B.C.D.II.A.INTRODUCTION .................................................................................................................... 7Dates of the visit and composition of the delegation ............................................................. 7Establishments visited .............................................................................................................. 7Consultations and co-operation............................................................................................... 8Action requested ....................................................................................................................... 8FACTS FOUND DURING THE VISIT AND ACTION PROPOSED.............................. 11Police custody.......................................................................................................................... 111.2.3.4.B.Preliminary remarks ........................................................................................................ 11Ill-treatment..................................................................................................................... 11Safeguards against ill-treatment of persons detained by the police ................................ 12Conditions of detention ................................................................................................... 14

Nuuk Prison ............................................................................................................................ 151.2.3.4.5.Preliminary remarks ........................................................................................................ 15Ill-treatment..................................................................................................................... 15Conditions of detention ................................................................................................... 16Health care ...................................................................................................................... 19Other issues ..................................................................................................................... 20

Copy of the letter transmitting the CPT’s reportMr Martin BangHead of SectionHuman Rights UnitMinistry for Foreign AffairsAsiatisk Plads 21448 Copenhagen KDenmarkStrasbourg, 6 December 2012Dear Mr Bang,In pursuance of Article 10, paragraph 1, of the European Convention for the Prevention ofTorture and Inhuman or Degrading Treatment or Punishment, I enclose herewith the report to theDanish Government drawn up by the European Committee for the Prevention of Torture andInhuman or Degrading Treatment or Punishment (CPT) following its visit to Greenland from 25 to27 September 2012. The report was adopted by the CPT at its 79thmeeting, held from 5 to 9November 2012.The recommendations, comments and requests for information formulated by the CPT areset out in Appendix I. As regards more particularly the CPT’s recommendations, having regard toArticle 10 of the Convention, the Committee requests the Danish authorities to providewithin sixmonthsa response giving a full account of action taken to implement them. The Committee truststhat it will also be possible for the Danish authorities to provide, in their response, reactions to thecomments formulated in this report as well as replies to requests for information made.The CPT would ask, in the event of the response being forwarded in Danish, that it beaccompanied by an English or French translation.I am at your entire disposal if you have any questions concerning either the CPT’s report orthe future procedure.Yours sincerely,

4.In Greenland, the CPT’s delegation held consultations with the High Commissioner,Ms Mikaela ENGELL, the Chief of Police, Mr Bjørn TEGNER BAY, the Director of the Prison andProbation Service, Mr Thomas NICOLAISEN, and the Deputy Minister of Health of the GreenlandGovernment, Ms Ann BIRKEKJǼR KJELDSEN.Further, shortly after the visit to Greenland, on 28 September 2012, the delegation presentedits preliminary observations to senior officials in Copenhagen, including Mr Jens-ChristianBÜLOW, Deputy Permanent Secretary at the Ministry of Justice.The delegation also met, while in Nuuk, representatives of the Inuit Circumpolar Council(ICC) in Greenland.5.The delegation received excellent co-operation from both management and staff in theestablishments it visited in Nuuk. This included rapid access to the places visited and the possibilityto speak in private with persons deprived of their liberty, in compliance with the provisions of theConvention. Further, the delegation was provided with all the necessary documentation, andadditional requests for information made during the visit were promptly met.The CPT also wishes to put on record the very efficient assistance from Ms Mikaela Engell,who helped the delegation organise the meetings with the relevant authorities in Nuuk.

6.In the course of the above-mentioned meeting in Copenhagen on 28 September 2012, theCPT’s delegation made three requests in relation to certain urgent matters.The first request concerned the small, oppressive and nearly completely flooded yard, inwhich inmates from the remand and security sections of Nuuk Prison were expected to take theirdaily exercise. The delegation asked the Danish authorities to confirm, within one month, that theabove-mentioned yard had been taken out of service and that all prisoners were offered thepossibility of genuine physical exertion in adequate conditions (e.g. using the larger yard).The second request referred to the situation of two inmates interviewed by the CPT’sdelegation at Nuuk Prison. One of them, a female remand prisoner, was accommodated togetherwith the men in the remand section (see paragraph 28). The other inmate was a 17-year old boy(a remand prisoner) who had been accommodated for some time in one of the security cells, inconditions resembling solitary confinement (see paragraph 30). The delegation requested the Danishauthorities to inform the CPT, within one month, of steps taken to remedy the situation of these twoinmates.

-9-The third request was related with the fact that inmates at Nuuk Prison had hardly anyaccess to psychological and psychiatric assistance. In particular, the delegation interviewed a femaleprisoner (accommodated in the security section of the prison) whose mental condition clearlyrequired an urgent transfer to the psychiatric ward of Queen Ingrid Hospital in Nuuk (seeparagraphs 48 to 51). The delegation requested the Danish authorities to inform the CPT, within onemonth, of the steps taken in this context.7.The above-mentioned requests were subsequently confirmed in a letter of 4 October 2012from the Executive Secretary of the CPT.By letter of 31 October 2012, the Danish authorities informed the CPT of the measures takenin response to the delegation’s requests. The Committee will consider those measures later in thisreport.

8.At the outset of the visit, the delegation was informed by the Chief of Police that the policein Greenland remain directly under the control of the Danish authorities (the Chief of Police isadministratively subordinated to the National Police Commissioner in Copenhagen and – to theextent that the police in Greenland perform prosecution functions – to the Danish Chief Prosecutor).The legislation applicable to police custody is almost identical with that applicable in the mainlandKingdom of Denmark. Reference is thus made to the report on the 2008 visit to Denmark3.In particular, detained criminal suspects must be brought before a judge within 24 hours andthe judge may extend police custody for a further 72 hours. However, in practice, police custodytends to be very short (usually no longer than 24 hours). Further, in those very rare cases4whenforeign nationals are detained by the police in Greenland under the provisions of the Aliens Act,they can be held in custody under the sole authority of the police for a maximum of 72 hours (afterwhich they are returned to their country of origin, always through Copenhagen).In addition, pursuant to the Police Act, the police may administratively detain for amaximum of 6 hours a person who endangers public order, peace and security. If it is necessary todetain a person who is unable to look after him/herself due to intoxication, illness or other handicap,the deprivation of liberty should be “as brief and considerate as possible”.

10.The legal safeguards against ill-treatment of persons detained by the police in Greenland areessentially identical with those in force in the mainland Kingdom of Denmark; reference is thusmade to the relevant paragraphs of the report on the 2008 visit5.11.The delegation was informed that there is no express legal right for persons detained by thepolice in Greenland to notify their next-of-kin of their custody, although such a notification isusually rapidly performed by the police in practice. That said, a few prisoners interviewed by thedelegation at Nuuk Prison complained about delayed notification, and one of the inmates said thathe was not sure whether notification had actually been performed at all.The CPT recommends that steps be taken to ensure that all persons detained by thepolice in Greenland have a formally recognised right to inform a relative, or another thirdparty of their choice, of their situation, as from the very outset of their deprivation of liberty.Any possibility exceptionally to delay the exercise of this right in order to protect the interestsof justice should be clearly circumscribed in law and made subject to appropriate safeguards(i.e. any delay to be recorded in writing with the reasons therefor, and to require the approvalof a senior police officer unconnected with the case at hand or a prosecutor).Further,detained persons should be provided with feedback on whether it has beenpossible to notify a close relative or other person of the fact of their deprivation of liberty.12.Concerning the right of access to a lawyer, some of the inmates interviewed at Nuuk Prisonindicated that they had not been expressly informed of this right. Further, a few of them stated thatthe first time they had met a lawyer was in court, when the application of the measure of remandcustody was being decided.The CPT recommends that steps be taken to ensure that the rightof all persons detained by the police in Greenland to have access to a lawyer is fully effectiveas from the very outset of deprivation of liberty.A specific Greenlandic problem is the lack of easy access to professional legal assistance6;in practice, the task of defending persons detained by the police is performed by lay persons whohave followed a two-year course in law.The CPT invites the Danish authorities to improve thelegal assistance available in Greenland to persons in police custody.In this context,particularattention should be paid to the quality and the independence of the legal assistance offered.13.According to the information provided to the delegation during the official meeting in Nuukon 25 September 2012, there are no provisions expressly guaranteeing a detained persons’ right ofaccess to a doctor. That said, the delegation received assurances that persons in police custody inGreenland would face no problems with access to medical assistance. In particular, following anumber of deaths of intoxicated persons in police custody a few years ago, instructions were issuedrequiring the police to always call a doctor whenever an intoxicated person was apprehended by thepolice. The delegation saw in the custody register at Nuuk Police Station that these instructionswere duly followed.56

- 13 -That said,the CPT recommends that legal provisions be introduced, ensuring that allpersons in police custody in Greenland have an effective right to be examined by a doctor(including a doctor of their own choice, it being understood that an examination by such adoctor may be carried out at the detained person’s own expense).14.As for information on rights, the delegation was pleased to note the presence of informationsheets (“Guidelines for persons under arrest”), in Danish and Greenlandic, at Nuuk Police Station.However, a few of the prisoners interviewed by the delegation who had recently been in policecustody indicated that they had not been clearly informed of their rights and, more particularly, hadnot been given a copy of the guidelines.Consequently,the CPT recommends that a specific record be kept of the fact thatdetained persons have been provided with information on their rights; detained personsshould be asked to certify with their signature that such information has been provided and, ifnecessary, the absence of a signature in a given case should be explained.Further,it would beadvisable to draw up the above-mentioned information sheets in a range of other languages(e.g. English, Russian, etc).15.The custody records seen at Nuuk Police Station were detailed and well kept, both in theelectronic form and on paper.16.The CPT’s delegation was informed that the police complaints procedure in Greenland wasvery similar to the “old” Danish procedure, described in detail in paragraph 44 of the report on the1996 visit to Denmark7. The investigation of complaints about the behaviour of police officers onduty is the responsibility of senior police lawyers at the Headquarters level in Nuuk. Theirpreliminary findings and conclusions are sent for consultation to the Greenland Police ComplaintsBoard (composed of a private lawyer and two lay persons unconnected with the police). The policeare not bound by the Board’s opinion; however, if the decision on the complaint is contrary to theopinion of the Police Complaints Board, the complainant, his/her lawyer and the Board may appealagainst the decision to the Chief Prosecutor in Copenhagen8.Given the recent adoption of new rules on the handling of police complaints (as far as themainland Kingdom of Denmark is concerned),the CPT would like to be informed whether thereare any plans to adopt similar rules in respect of Greenland.17.At the outset of the visit, the Chief of Police provided the delegation with information on thenumber of complaints about misconduct of the police in Greenland received in 2010 and 2011 andthe outcome of these complaints (including the disciplinary and criminal sanctions imposed)9.However, in order to obtain an updated picture of the situation,the Committee would liketo receive analogous information in respect of 2012.789

- 14 -18.Systems for the monitoring of police detention facilities by an independent authority arecapable of making an important contribution towards the prevention of ill-treatment and, moregenerally, of ensuring satisfactory conditions of detention.Both the Danish and the Greenlandic Parliamentary Ombudspersons are empowered toinspect places of deprivation of liberty in Greenland. However, the delegation was informed that thelast such visit to Nuuk Police Station dated back to 200910. In this context, the CPT wishes to stressthat, in order for such monitoring to be effective, it must take place frequently.The CPT wouldwelcome the observations of the Danish authorities on this issue.

19.The conditions of detention at Nuuk Police Station were generally adequate for the period ofpolice custody (i.e., in practice, a maximum of 24 hours). The four single cells were clean, of agood size (from just under 7 m� to 9 m�), adequately lit and ventilated, and equipped with a sleepingplatform, a mattress and a call bell. Bedsheets, pillows and blankets were provided for the night,and there were arrangements for the provision of food at normal meal times. Further, persons inpolice custody had access to adequate communal toilets and washing facilities.20.The delegation was informed that persons remanded in custody could exceptionally be heldat Nuuk Police Station, for up to a few days, if there was no suitable accommodation available atNuuk Prison11. According to the Chief of Police, such prisoners would be granted access, during theday, to the part of the detention area corridor fitted with a sofa, two armchairs and a TV set; further,their cell doors would remain open during the day. Although the police station has no dedicatedoutdoor exercise yard, the police would normally take remand prisoners (under escort) for a dailywalk in the establishment’s car park.The CPT wishes to stress that, as a matter of principle, remand prisoners should not be heldin police establishments; this is also enshrined in Rule 10.2 of the European Prison Rules12. In thisconnection,the Committee would like to receive precise information, in respect of the year2012, on the number of remand prisoners who were held at Nuuk Police Station and, in eachcase, for how long.21.The delegation was informed of plans to thoroughly refurbish Nuuk Police Station.TheCPT would like to receive further details of these plans, including the timeline for theirimplementation.

The CPT’s delegation requested – prior to its visit – to meet the Greenlandic Ombudsperson (who alsoperforms the function of National Preventive Mechanism, pursuant to OPCAT, in Greenland); however, such ameeting was not possible because the Ombudsperson was not in Greenland at the time of the visit.No such person was held at Nuuk Police Station at the time of the visit.See Recommendation Rec(2006)2 of the Committee of Ministers of the Council of Europe. Rule 10.2 states asfollows: “In principle, persons who have been remanded in custody by a judicial authority and persons who aredeprived of their liberty following conviction should only be detained in prisons, that is, in institutionsreserved for detainees of these two categories. ”

22.During the initial meeting in Nuuk, the CPT’s delegation discussed general problems facingthe Greenlandic prison system with the Director of the Danish Prisons and Probation Service inGreenland (the prison system in Greenland remains within the exclusive competence of the Danishauthorities). The main issue raised by the delegation was the planned construction of a new closed-type prison in Nuuk. The opening of such an establishment wouldinter aliamake it possible torepatriate Greenlandic inmates currently accommodated at Herstedvester Institution (in themainland Kingdom of Denmark), where they are facing problems related with being far away fromtheir homes, relatives and culture13.The delegation was informed that the new prison, with a planned capacity of 72 places(including 40 in closed regime), would most likely be completed by 2017/18. The concept for thisnew establishment14foresaw that there would be facilities for association, work, education andsports; further, some 60 staff posts were planned in order to make the provision of activitiespossible.In the light of what the delegation observed at the current Nuuk Prison (see paragraphs 25 to30),the CPT recommends that the construction of the new closed-type prison in Nuuk betreated as a matter of priority. The Committee would like to be kept informed of the progressmade in this area (and be provided with more details of the new establishment, especially asregards the material conditions and the facilities for activities, association and visits).

23.From the outset, it should be emphasised that the delegation received no allegations – norany other indications – of deliberate physical ill-treatment by staff at Nuuk Prison15. On thecontrary, the atmosphere seemed to be relaxed, and several prisoners stated that their relations withstaff were good. That said, a few allegations were received of the staff using disrespectful languagevis-a-vis the inmates.Staff at Nuuk Prison should be reminded that they must always treatprisoners in their custody with respect.Likewise, no allegations were heard of inter-prisoner violence. However, the examination ofrecords of disciplinary sanctions indicated that inter-prisoner violence was a problem at theestablishment16.The management and staff of Nuuk Prison should be encouraged to exercisecontinuing vigilance in this context.131415

The issue has been described by the CPT in the reports on its previous visits to Denmark, most recently inparagraphs 79 and 80 of CPT/Inf (2008) 26.The actual architectural design was not yet prepared – a tender was about to be issued in the near future.It is noteworthy in this context that the records of use of special means (batons and handcuffs) indicated thatsuch means were rarely employed at Nuuk Prison. For example, there had been no case of use of a baton in thecourse of 2011, and handcuffs had only been applied eight times during that same year (exclusively in thecontext of the transfers of inmates to the observation/security cells, see paragraphs 40 and 41).For example, in seven cases, prisoners had been punished disciplinarily for assaulting a fellow inmate in theperiod from 1 January to 25 September 2012.

24.On the first day of the delegation’s visit, Nuuk Prison was operating at its full capacity of64. This included 19 remand prisoners and eight women17. The establishment had: two “open”sections (North and South, with 10 and 14 places respectively) for sentenced prisoners who wereallowed to work outside the prison during the day; a “semi-open” block with two sections (SectionA with 12 single cells and Section B with 14 single cells); and two closed sections: the remandsection (“Arrest”) with a capacity of six places in single cells (but holding nine inmates at the timeof the visit) and the security section (“Sikret”), which was operating at its full capacity of eightinmates in single cells18.The delegation focused its attention on the “semi-open” and “closed” sections19.25.As regards the material conditions of detention, cells in the A and B Sections were rathersmall (6 m�), though this was largely offset by the open door regime during the day (6 a.m. to10 p.m.). The cells were well lit and ventilated, and suitably furnished (bed, wardrobe, table, chairs,shelves, washbasin, call bell). No complaints were heard about access to the communal toilets andbathroom, including at night. Further, during the day, inmates could stay in communal areasequipped with a kitchenette, sofas, tables, TV sets, etc.Conditions were also generally adequate in the “Sikret” section, where the 6 m� single cellswere well lit and ventilated, and properly equipped (similar to the cells in A and B Sections).However, given that the inmates spent a large part of the day locked in their cells (except for thedaily outdoor exercise totalling one hour; a period each day when they were allowed to meet oneother inmate of their choice within the section; and occasional access to the gym), the size of thecells is barely acceptable. Further, the communal toilets and the shower were quite dilapidated.The single cells in the “Arrest” section measured approximately 7.5 m� each. However,several of them were being used for double occupancy, thereby leading to cramped conditions forthe prisoners concerned. That said, cell doors were opened during the day and inmates couldassociate in a small common room with a kitchenette, seating space, a table and a large TV set. Thewhole section was damp and poorly ventilated, and the communal toilet and showers were in a poorstate of repair. In fact, both closed sections were in need of refurbishment.The CPT recommends that immediate steps be taken to improve ventilation in the“Arrest” section of Nuuk Prison. Further, both closed sections of the establishment should berefurbished, starting with the toilets and showers. It would also be highly preferable for thecells in the “Arrest” section to be used only for single occupancy.

- 17 -26.The delegation was particularly concerned by the small (measuring some 25 m�), oppressive(surrounded with a high fence topped with barbed wire) and nearly completely flooded yard, inwhich inmates from the closed sections were supposed to take their daily outdoor exercise. Thisstate of affairs was all the more unacceptable given the presence of a much larger (approximately200 m�) secure yard, fitted with some sports equipment and a shelter against inclement weather.As already mentioned in paragraph 6, following the visit the CPT requested the Danishauthorities to confirm, within one month, that the above-mentioned small yard has been taken out ofservice and that all prisoners are offered the possibility of genuine physical exertion in adequateconditions (e.g. using the larger yard). In their letter of 31 October 2012, the Danish authoritiesinformed the Committee that the above-mentioned small yard had been taken out of service, andthat inmates from the "Arrest" and "Sikret" sections were now allowed to take their daily outdoorexercise in the large yard of Nuuk Prison. The Committee welcomes this decision.27.Throughout most of the common accommodation areas of Nuuk Prison, the general rule wasmixed-sex accommodation (though there were no mixed-sex cells). Having said that, the delegationnoted ongoing work to set up a small sub-section (with the capacity of four places) for females inSection A20.The Committee is of the view that, in principle, women deprived of their liberty should beaccommodated separately from men. Therefore,the CPT recommends that the Danishauthorities ensure that all the prisoners currently accommodated in the mixed-sex sections ofNuuk Prison unequivocally agree to this arrangement and are adequately supervised.28.As already mentioned (see paragraph 6), the delegation was concerned by the situation of afemale remand prisoner, who was accommodated together with the men in the “Arrest” section. Shefelt very uncomfortable in this mixed-sex environment and told the delegation that she had notdared to use a shower since her arrival some four days before. Her situation was aggravated by thefact that she had not been provided with any hygiene items (including sanitary napkins). Followingthe visit, the delegation requested the Danish authorities to inform the CPT, within one month, ofsteps taken to remedy the situation.In their letter of 31 October 2012, the Danish authorities informed the Committee that thefemale prisoner concerned had been provided with hygiene items and that a female guard wouldalways escort her to the shower and remain in front of the shower cabin while the inmate concernedwas inside. The CPT welcomes this positive reaction to its concerns.

- 18 -29.Regarding activities, efforts were being made to offer a varied programme to the inmates21.That said, work was not available to the prisoners in the “closed” sections and, additionally, thoseaccommodated in the “Sikret” section were not allowed access to the school and arts workshops(which were available to prisoners in the “Arrest” section). As already indicated, prisoners in the“Sikret” section spent most of their time inside their cells, with little else to do than reading,watching TV and playing computer games22.Clearly, it is not easy to provide an appropriate regime for all inmates in a smallestablishment intended to accommodate different categories of prisoners, usually for short periodsof time. However, in the CPT's view, the aim should be to ensure that all inmates are able to spend areasonable part of the day outside their cells, engaged in purposeful activities of various kinds:work, study, sport and leisure activities.The CPT recommends that steps be taken to developthe programme of activities available to all inmates at Nuuk Prison, including those placed inthe “Sikret” section for other than disciplinary reasons.30.In one of the cells of the “Sikret” section, the delegation interviewed a juvenile remandprisoner (a 17-year old boy) who had been accommodated in conditions resembling solitaryconfinement since his arrival to the establishment five days earlier23. Following the visit toGreenland, the delegation requested the Danish authorities to inform the CPT, within one month, ofsteps taken to remedy his situation.In their letter of 31 October 2012, the Danish authorities informed the Committee that thejuvenile inmate in question had been offered individual tuition (as from 1 October 2012) and thatthe establishment's social workers and pedagogical assistant (see paragraph 36) were visiting himdaily in order to engage him in recreational activities (e.g. reading and games). Further, the CPTwas informed that the inmate concerned had turned 18 years old on 23 October 2012 and that, as ofthen, he was allowed to have daily association with one chosen fellow inmate from the section. Hewas also allowed access to the classroom and to the gym (where he could associate with otherprisoners). In addition, the prison's management had taken a decision to grant him an extra hour ofdaily outdoor exercise.

31.The delegation was concerned to note that Nuuk Prison had no in-house health-care service.In case of need, recourse was had to the general medical services in Nuuk.One consequence of this situation was that there was no medical screening of newly-arrivedinmates. This is unacceptable; such screening is essential, particularly to prevent both the spread oftransmissible diseases24and suicides, and for recording injuries in good time. Save for exceptionalcircumstances, the medical screening of prisoners should be carried out on the day of admission,especially as regards those entering the prison system.The CPT calls upon the Danish authoritiesto take necessary measures to ensure that all prisoners are examined by a doctor, or by aqualified nurse reporting to a doctor, within 24 hours of their admission to Nuuk Prison.32.The Committee is also concerned by the fact that inmates at Nuuk Prison had hardly anyaccess to psychological and psychiatric assistance. It was time-consuming to arrange a consultationwith an outside psychiatrist (which required each time a referral by a GP from the local health-carecentre), and the prison did not employ a psychologist. In this context, the delegation interviewed afemale prisoner (accommodated in the “Sikret” section) whose mental condition clearly required anurgent transfer to the psychiatric ward25. After the visit, the delegation requested the Danishauthorities to inform the CPT, within one month, of the steps taken in this context. In their letter of31 October 2012, the Danish authorities confirmed that the female prisoner concerned had beenadmitted to the psychiatric ward of Queen Ingrid Hospital in Nuuk26on 9 October 2012.While welcoming this transfer,the Committee recommends that steps be taken to ensureaccess to psychological and psychiatric assistance for the inmates at Nuuk Prison.33.During the meeting with representatives of the Greenlandic Ministry of Health, thedelegation was informed that many prisoners in Greenland were addicted to drugs and/or alcohol;however, at Nuuk Prison the delegation gained the impression that the management’s approach tothis phenomenon was mainly repression-oriented27. In this context, the CPT wishes to stress that theapproach to prisoners with alcohol and drug-related problems should include a prevention policycombined with programmes for medical detoxification, psychological support, rehabilitation andsubstitution.The Committee recommends that a comprehensive strategy for the provision ofassistance to prisoners with alcohol and drug-related problems be developed in Greenland, inthe light of these remarks.34.The delegation noted the presence of medical documents (results of examinations,certificates, etc.) in the prisoners’ administrative records, which were accessible to non-medicalmembers of the staff. This is a clear violation of the confidentiality of medical data.

- 20 -The Committee recommends that no medical document be placed in prisoners’administrative records, and that measures be taken to guarantee full respect at Nuuk Prisonof the confidentiality of medical data.35.It is clear that Nuuk Prison would benefit from daily visits by a qualified nurse, who couldrespond to the prisoners’ needs for basic care and, where necessary, refer cases to a doctor.Furthermore, the nurse in question could receive prisoners’ requests for consultations, administerprescribed medicines and look after prisoners’ medical documentation, all tasks currently performedby medically untrained prison officers.The CPT recommends that a daily visit by a nurse to Nuuk Prison be ensured.Preferably, a doctor should be specifically appointed to be in charge of the health-care aspectsof the establishment, and visit the prison at least once a week.

- 21 -39.In the reports on its visits to Denmark31, the CPT expressed strong reservations about thepractice of police-imposed restrictions on remand prisoners’ contacts with the outside world (suchas supervised visits, withholding or monitoring of correspondence, and prohibition of telephonecalls) and made several recommendations designed to ensure that the adoption of such measures isstrictly proportionate to the needs of the criminal investigation.The delegation was concerned by the high proportion of remand prisoners at Nuuk Prison(14 out of the total of 19) who were subjected to restrictions imposed by the police, referred to as“B&B”. The restrictions could be applied throughout the remand period, including any appeal andwhile awaiting sentence confirmation, which effectively meant that they could continue for monthson end.In addition to their visits being supervised, most of the remand prisoners told the delegationthat they had no access to a telephone, except for calls to their lawyers.The CPT recommends that the following steps be taken in Greenland in respect ofpolice-imposed restrictions on remand prisoners’ contacts with the outside world:-the police to be given detailed instructions as regards recourse toprohibitions/restrictions concerning prisoners’ correspondence and visits;that there be an obligation to state the reasons in writing for any such measure;that, in the context of each periodic review by a court of the necessity tocontinue remand in custody, the question of the necessity for the police tocontinue to impose particular restrictions upon a remand prisoner’s visits andletters be considered as a separate issue;that the remand prisoners concerned be given the right to appeal to the courtagainst police-imposed prohibitions/restrictions.

Further,the CPT recommends that the practice of prohibiting access to a telephone bereviewed and made subject to the same safeguards as those referred to above in respect ofcorrespondence and visits.40.The delegation noted that disciplinary sanctions were imposed relatively frequently at Nuuk32Prison ; that said, the sanctions were generally quite mild33.The disciplinary procedure – analogous to that already described in the reports on the visitsto Denmark34– offered adequate safeguards to prisoners (in particular, the right to be heard; theright to legal assistance; the right to appeal against the sanction). Further, the records of disciplinaryhearings were scrupulously kept.3132

- 22 -Nuuk Prison did not possess dedicated disciplinary cells. Inmates subjected to such ameasure were usually placed in one of the cells of the “Sikret” section or – in exceptional cases andfor short periods – in one of the “observation” cells (see paragraph 40). In either case, prisoners indisciplinary isolation were granted access to daily outdoor exercise of one hour.41.Nuuk Prison possessed two “observation cells” and one “security cell” (where agitatedand/or aggressive inmates could be immobilised by force). The rules applicable to such placementshave already been described in the reports on the CPT’s visits to the mainland Kingdom ofDenmark35.The three cells were located in the basement of the establishment. The observation cellsmeasured approximately 9 m� each and were equipped with a bed with a mattress and a blanket, aswell as a call button (out of order at the time of the visit, but being repaired); one of the cells alsohad a table and a bench. There was no access to natural light and artificial lighting was poor, butventilation was adequate. Both cells were quite dilapidated though not dirty. The security cellmeasured some 20 m� and was likewise poorly lit and quite dilapidated. It was furnished with a bed,to the side of which were attached leather bracelets designed to immobilise the hands alongside thebody, a broad leather strap to immobilise the trunk and leather bracelets to immobilise the ankles.The CPT recommends that steps be taken to improve material conditions in theobservation and security cells at Nuuk Prison, in particular as regards access to natural light,artificial lighting and the general state of repair. The Committee would also like to receiveconfirmation that the call systems in the three cells have been repaired.42.The records maintained for placement in the above-mentioned three cells were excellent.A detailed protocol was drawn up in each case, comprising,inter alia,the reasons for theplacement, an account of the prisoner’s behaviour during the measure (with note taken of frequent –at least once an hour for the observation cells and every 10-15 minutes for the security cell – checksperformed by the custodial staff) and mention of the time of the beginning and end of the measure.The delegation also noted that placements in an observation cell were not frequent36- andwere very rare as regards the security cell37. The CPT welcomes this. That said,reference is madehere to the comments in paragraph 71 of the report on the CPT’s 2008 visit to Denmark.3835363738

See, in particular, paragraph 69 of CPT/Inf (2008) 26.There had been 13 placements in an observation cell between 1 January and 25 September 2012, usually forjust a few hours.Once per year in respect of 2009, 2010, 2011 and 2012.“The CPT understands that it is necessary on rare occasions to resort to means of restraint in a prison setting.However, in the Committee’s opinion, the approach to immobilisation in prisons should take into considerationthe following principles and minimum standards:• Regarding its appropriate use, immobilisation should only be used as a last resort to prevent the risk of harmto the individual or others and only when all other reasonable options would fail satisfactorily to contain thoserisks; it should never be used as a punishment or to compensate for shortages of trained staff; it should not beused in a non-medical setting when hospitalisation would be a more appropriate intervention.• Any resort to immobilisation should be immediately brought to the attention of a doctor in order to assess theneed for the measure, as opposed to certifying the individual’s fitness for it.• The equipment used should be properly designed to limit harmful effects, discomfort and pain duringrestraint, and staff must be trained in the use of the equipment.• The duration of fixation should be for the shortest possible time (usually minutes rather than hours). Theexceptional prolongation of restraint should warrant a further review by a doctor. Restraint for periods of daysat a time cannot have any justification and would amount to ill-treatment.

- 23 -43.Inmates in Nuuk Prison could lodge complaints with the prison's management, the Prisonand Probation Administration, and the Greenlandic and Danish Parliamentary Ombudspersons. Theprisoners met by the delegation were generally aware of the avenues of complaint available to them(all inmates were provided upon arrival with a brochure – in Danish and Greenlandic – containinginformation on the house rules and the complaints procedure).44.As regards independent inspections, the delegation was told that the prison could be visitedby the above-mentioned Ombudspersons. However, the establishment’s manager (who had workedin the prison for approximately two years) could remember only one visit from the staff of theDanish Parliamentary Ombudsman, and none from the Greenlandic Ombudsperson’s Office. Inorder to perform its preventive function effectively, a prison inspection mechanism must visit eachpenitentiary establishment on a frequent basis.The CPT would welcome the observations of theDanish authorities on this issue.

• Persons subject to immobilisation should receive full information on the reasons for the intervention.• The management of any establishment which might use immobilisation should issue formal writtenguidelines, taking account of the above criteria, to all staff who may be involved.• An individual subject to immobilisation should, at all times, have his/her mental and physical statecontinuously and directly monitored by an identified member of the health-care staff or another suitablytrained member of staff who has not been involved in the circumstances which gave rise to the application ofimmobilisation. The staff member concerned should offer immediate human contact to the immobilisedperson, reduce his/her anxiety, communicate with the individual and rapidly respond, including to theindividual’s personal needs regarding oral intake, hygiene and urination and defecation. Such individualisedstaff supervision should be performed from within the room or, if the inmate so wishes, very near the door(within hearing and so that personal contact can be established immediately). The supervising staff membershould be required to maintain a written running record.Further, the person concerned should be given the opportunity to discuss his/her experience, during and, in anyevent, as soon as possible after the end of a period of restraint. This discussion should always involve a seniormember of the health-care staff or another senior member of staff with appropriate training.”

46.It should be stressed at the outset that no allegations were heard – and no other evidence wasgathered – of ill-treatment of patients by staff at the psychiatric ward of Queen Ingrid Hospital inNuuk. Indeed, the atmosphere was positive and the staff appeared to be dedicated and attentive.47.However, the CPT is seriously concerned about the prolonged use of mechanical restraint(“fixation”) at the ward41. At the time of the visit, a male involuntary patient had been restrained tohis bed (albeit with interruptions at meal, toilet and shower times) since approximately a month42.In the report on its 2002 visit to Denmark, the CPT stressed43that applying instruments ofphysical restraint to psychiatric patients for days on end cannot have any medical justification andamounts, in the Committee’s view, to ill-treatment. As a general rule, a patient should only berestrained as a measure of last resort: an extreme action applied in order to prevent imminent injuryor to reduce violence. When, exceptionally, recourse is had to instruments of physical restraint, theyshould be removed at the earliest opportunity; they should never be applied, or their applicationprolonged, as a sanction for perceived misbehaviour or as a means to bring about a change inbehaviour. The use of immobilisation cannot and should not replace proper psychiatric treatment andcare. Furthermore, it should not be a substitute for proper staff resources.

Pursuant to the Danish Act on Greenland Self-Government, adopted in June 2009 following a November 2008referendum held in Greenland, the Greenland Self-Government has gradually assumed responsibility in anumber of fields, one of them being the sector of psychiatry.Described in paragraph paragraph 69 of the report on the 2002 visit to Denmark, CPT/Inf (2002) 18. As forforensic patients, the legal provisions applicable are basically the same as in the mainland Kingdom ofDenmark, and such patients are not placed in Greenland (instead, they are transferred to Risskov forensicpsychiatric ward near Aarhus, Denmark, which has 18 places reserved for the Greenlanders).The delegation was informed by the ward’s head doctor that the need to continue the measure was reassessedat 24-hour intervals; that said, there was no maximum duration set in law.The relevant records (of the use of means of restraint, including chemical restraint) were well kept anddemonstrated,inter alia,that “fixation” was used quite frequently at the ward: some 15% of patients had been“fixated” at some stage in the course of 2010, and approximately 14% in 2011. The average length of“fixation” was five days.See paragraph 75 of CPT/Inf (2002) 18.

- 25 -48.The CPT recommends that the legislation applicable in Greenland as regards theimmobilising of psychiatric patients be reviewed as a matter of urgency. In doing so, theauthorities should take into consideration the following principles and minimum standards:-regarding theirappropriate use,means of restraint should only be used as a last resortto prevent the risk of harm to the individual or others and only when all otherreasonable options would fail to satisfactorily contain that risk; they should never beused as a punishment or to compensate for shortages of trained staff; further, theyshould never be used as a precautionary measure or as a substitute for adequatemedication;staffmust betrainedin the use of the equipment. Such training should not only focuson instructing staff as to how to apply means of restraint but, equally importantly,should ensure that they understand the impact the use of restraint may have on apatient and that they know how to care for a restrained patient;qualifiedstaffshould becontinuously presentwhenever patients are subjected tomechanical restraint;thedurationof the application of means of mechanical restraint should be for theshortest possible time (usually minutes to a few hours). Any prolongation of restraintbeyond six hours should be the subject of a review by two medical doctors;a restrained patient shouldnot be exposed to other patients(unless the patient explicitlyexpresses a wish to remain in the company of a certain fellow patient);once means of restraint have been removed, adebriefingof the patient should takeplace in order, in particular, to explain to the patient the rationale behind the measure.

49.The psychiatric ward of Queen Ingrid Hospital in Nuuk was opened in 1980. It has acapacity of 10, including a small unit of three places that can be locked if there is a need toaccommodate involuntary patients there44. There were two such patients present at the time of thedelegation’s visit, a male45and a female.50.Living conditions in the ward were excellent. All patients had spacious (some 15 m�)individual rooms, which were well lit and ventilated, suitably furnished and pleasantly decorated.The communal bathrooms were in a very good state of repair and cleanliness. During the day,patients had access to a large (some 350 m�) sheltered outdoor terrace.

- 26 -51.The delegation also gained a favourable impression of the treatment provided, which wasbased on an individualised approach. Each patient had a regularly reviewed individual treatmentplan, and the care team worked in a multi-disciplinary manner. It is noteworthy that somaticscreening46was systematically performed on admission, and access to somatic care posed noproblem (given the close proximity of somatic wards of the hospital). The delegation was informedthat electro-convulsive therapy (ECT) was occasionally performed in the ward, always in themodified form (i.e. with anaesthetic and muscle relaxants) and with the patient’s written consent.However, there was no dedicated register of the use of ECT;the CPT recommends that such aregister be introduced.Further,steps should be taken to ensure that ECT is always performedwith EEG monitoring47.A range of psycho-socio-therapeutic activities and distractions was offered to all patientswho were willing and able to participate in them. These included art and music therapy, relaxation,games, reading, etc.52.Staffing levels appeared fully satisfactory: in addition to four doctors (two full-timepsychiatrists and two trainee doctors)48, there were five to seven nurses and five to seven auxiliaries(nursing assistants). During the day, there were two doctors and four to six nurses and assistantspresent on the ward; at night, two to three nurses/assistants were present and a doctor was on call.The care team was completed by a psychologist49, a child psychologist, two social workers andthree full-time occupational/art therapists. It is noteworthy that at least one Greenlandic-speakingstaff member was always present50.

53.The procedure by which involuntary placement in a psychiatric establishment is decidedshould offer guarantees of independence and impartiality as well as of objective psychiatricexpertise. Further, such placement should cease as soon as it is no longer required by the patient’smental state. Consequently, the need for placement should be reviewed by an appropriate authorityat regular intervals. In addition, the patient himself/herself should be able to request at reasonableintervals that the necessity for placement be considered by a judicial authority.54.At the time of the visit, the legislation in force foresaw the initial (involuntary) admission bydecision of the duty psychiatrist of the ward. Within 48 hours from admission, the decision had tobe reviewed by the duty psychiatrist after consultation with the head doctor and notification to theChief Medical Officer (CMO) of Greenland51.

Including a CT scan, EEG, X-ray and blood and urine tests.Without EEG surveillance it can occasionally be impossible to determine whether any seizure activity has beeninduced in the patient’s brain and what its duration has been. As a consequence, it cannot be ensured, on theone hand, that an adequate seizure is induced and, on the other hand, that a potentially dangerous prolongedseizure activity will be detected.A fifth psychiatrist was available occasionally.Two more posts for psychologists were vacant.This was important given that most of the doctors (except the head doctor), nurses and other staff qualified toprovide psycho-social therapeutic activities were Danish-speaking.Placed administratively within the structure of the Ministry of Health but not subordinated to the Minister.

- 27 -Further (internal) reviews of the measure had to be performed in 14-day intervals (thedelegation was told that, after the new law enters into force, these reviews would be done weekly).Clearly, the above-mentioned procedure fails to offer the basic guarantees mentioned inparagraph 53: there is no independent psychiatric expertise involved, no decision and review by abody independent from the admitting hospital (e.g. a court), and no regular outside review of themeasure by such an independent body. Furthermore, involuntary patients (as well as their relativesand legal representatives) are not informed in writing of the placement decision and of the appealpossibilities, and have no effective access to legal assistance.The CPT recommends that steps be taken to address theselacunae,by introducingrelevant legal amendments.55.The CPT also wishes to stress that patients should, as a matter of principle, be placed in aposition to give their free and informed consent to treatment. Every patient, whether voluntary orinvoluntary, should be given the opportunity to refuse – either in person or through the guardian –treatment or any other medical intervention. Any derogation from this fundamental principle shouldhave a legal basis and only relate to clearly and strictly defined exceptional circumstances. Theadmission of a person to a psychiatric establishment on an involuntary basis should not beconstrued (as it is presently the case in Greenland) as authorising treatment without his or herconsent.The CPT recommends that these precepts be taken into account in the preparation ofthe legal amendments referred to in paragraph 54. Psychiatric patients (and if they are legallyincompetent, also their guardians) should be provided with full, clear and accurateinformation before consenting to treatment (including on the possibility to withdraw theirconsent), both at the time of hospitalisation and prior to any treatment in the course ofhospitalisation. Relevant information should also be provided to patients (and their guardians)during and following the treatment.56.Maintaining contact with the outside world is essential for psychiatric patients, not only forpreventing ill-treatment but also from a therapeutic standpoint. The delegation was pleased to notethat visits by patients’ relatives to the psychiatric ward of Queen Ingrid Hospital in Nuuk were notonly free from restrictions, but also actively encouraged by the management and staff. As a rule,patients also had access to a telephone, except in cases where this was not appropriate given thepatient’s health condition.57.Patients at the psychiatric ward of Queen Ingrid Hospital in Nuuk could lodge complaintswith a number of outside bodies, in particular the CMO and the Danish and GreenlandicOmbudspersons. That said, it was not clear whether patients were in practice able to send acomplaint directly (i.e. other than through one’s relatives or lawyer) in a confidential manner.TheCPT recommends that measures be taken to ensure that patients are effectively in a positionto send confidential complaints to outside authorities.

Safeguards against ill-treatment of persons detained by the policerecommendations-steps to be taken to ensure that all persons detained by the police in Greenland have aformally recognised right to inform a relative, or another third party of their choice, of theirsituation, as from the very outset of their deprivation of liberty. Any possibilityexceptionally to delay the exercise of this right in order to protect the interests of justiceshould be clearly circumscribed in law and made subject to appropriate safeguards (i.e. anydelay to be recorded in writing with the reasons therefor, and to require the approval of asenior police officer unconnected with the case at hand or a prosecutor) (paragraph 11);steps to be taken to ensure that the right of all persons detained by the police in Greenland tohave access to a lawyer is fully effective as from the very outset of deprivation of liberty(paragraph 12);legal provisions to be introduced, ensuring that all persons in police custody in Greenlandhave an effective right to be examined by a doctor (including a doctor of their own choice, itbeing understood that an examination by such a doctor may be carried out at the detainedperson’s own expense) (paragraph 13);a specific record to be kept of the fact that detained persons have been provided withinformation on their rights; detained persons should be asked to certify with their signaturethat such information has been provided and, if necessary, the absence of a signature in agiven case should be explained (paragraph 14).comments--detained persons should be provided with feedback on whether it has been possible to notifya close relative or other person of the fact of their deprivation of liberty (paragraph 11);the Danish authorities are invited to improve the legal assistance available in Greenland topersons in police custody. Particular attention should be paid to the quality and theindependence of the legal assistance offered (paragraph 12);it would be advisable to draw up information sheets given to persons detained by the policein a range of other languages (e.g. English, Russian, etc) (paragraph 14).

Conditions of detentionrecommendations-immediate steps to be taken to improve ventilation in the “Arrest” section of Nuuk Prison.Further, both closed sections of the establishment should be refurbished, starting with thetoilets and showers (paragraph 25);the Danish authorities to ensure that all the prisoners currently accommodated in the mixed-sex sections of Nuuk Prison unequivocally agree to this arrangement and are adequatelysupervised (paragraph 27);steps to be taken to develop the programme of activities available to all inmates at NuukPrison, including those placed in the “Sikret” section for other than disciplinary reasons(paragraph 29).comments-it would be highly preferable for the cells in the “Arrest” section to be used only for singleoccupancy (paragraph 25).

Other issuesrecommendations-the following steps to be taken in Greenland in respect of police-imposed restrictions onremand prisoners’ contacts with the outside world:the police to be given detailed instructions as regards recourseprohibitions/restrictions concerning prisoners’ correspondence and visits;that there be an obligation to state the reasons in writing for any such measure;that, in the context of each periodic review by a court of the necessity to continueremand in custody, the question of the necessity for the police to continue to imposeparticular restrictions upon a remand prisoner’s visits and letters be considered as aseparate issue;that the remand prisoners concerned be given the right to appeal to the court againstpolice-imposed prohibitions/restrictions (paragraph 39);--the practice of prohibiting access to a telephone to be reviewed and made subject to thesame safeguards as those in respect of correspondence and visits (paragraph 39);steps to be taken to improve material conditions in the observation and security cells atNuuk Prison, in particular as regards access to natural light, artificial lighting and thegeneral state of repair (paragraph 41).comments-in the context of placements in observation and security cells at Nuuk Prison, reference ismade to the comments in paragraph 71 of the report on the CPT’s 2008 visit to Denmark(paragraph 42).to

Preliminary remarksrequest for information-.Immobilisation of psychiatric patientsrecommendations-the legislation applicable in Greenland as regards the immobilising of psychiatric patients tobe reviewed as a matter of urgency. In doing so, the authorities should take intoconsideration the following principles and minimum standards:regarding their appropriate use, means of restraint should only be used as a last resort toprevent the risk of harm to the individual or others and only when all other reasonableoptions would fail to satisfactorily contain that risk; they should never be used as apunishment or to compensate for shortages of trained staff; further, they should never beused as a precautionary measure or as a substitute for adequate medication;staff must be trained in the use of the equipment. Such training should not only focus oninstructing staff as to how to apply means of restraint but, equally importantly, shouldensure that they understand the impact the use of restraint may have on a patient and thatthey know how to care for a restrained patient;qualified staff should be continuously present whenever patients are subjected to mechanicalrestraint;the duration of the application of means of mechanical restraint should be for the shortestpossible time (usually minutes to a few hours). Any prolongation of restraint beyond sixhours should be the subject of a review by two medical doctors;confirmation of the adoption of the new Mental Health Act, and a copy of that Act(paragraph 45).

Safeguardsrecommendations--steps to be taken to address thelacunaementioned in paragraph 54 of the report, byintroducing relevant legal amendments (paragraph 54);the precepts mentioned in paragraph 55 of the report to be taken into account in thepreparation of the legal amendments referred to in paragraph 54. Psychiatric patients (and ifthey are legally incompetent, also their guardians) should be provided with full, clear andaccurate information before consenting to treatment (including on the possibility towithdraw their consent), both at the time of hospitalisation and prior to any treatment in thecourse of hospitalisation. Relevant information should also be provided to patients (and theirguardians) during and following the treatment (paragraph 55);measures to be taken to ensure that patients are effectively in a position to send confidentialcomplaints to outside authorities (paragraph 57).requests for information-observations of the Danish authorities on independent outside monitoring of psychiatricestablishments in Greenland (paragraph 58).