96. In addition, the continued shortcomings observed in terms of medical confidentiality in the pre-removal detention centres visited remain problematic. With the notable exception of Xanthi PRDC, where all medication was distributed exclusively by nursing staff, police officers were regularly tasked with distributing medicines, including neuroleptic drugs, in the absence of healthcare staff. At Paranesti PRDC, the distribution of medication was done in the presence of police officers, and, at Corinth PRDC, they were exclusively distributed by police officers. Further, in the latter centre, the paper copies of the medical files of all detained persons were kept in a lockable cupboard that – due to the high number of files stored – could no longer be closed, and the key to the infirmary was kept by police officers in the absence of healthcare staff. Moreover, at Corinth PRDC, the delegation was informed that the health visitor was required to transmit information protected by medical secrecy to the Hellenic Police’s Aliens and Border Protection Branch, for example if a detained person was confirmed as HIV- or HCV- (hepatitis B or C) positive. This measure was justified by the fact that detained persons were required to share their razors. The CPT is not convinced by this argument, as the risk of transmission could be amply avoided by handing out sufficient individual razors to all detained persons. The CPT, once more, reiterates its recommendation that the Greek authorities ensure that the principle of medical confidentiality is strictly respected. In this regard, the Committee wishes to receive confirmation that the above-mentioned shortcomings have been remedied. 97. Moreover, foreign nationals continue to be routinely handcuffed during all transfers for external medical appointments in public hospitals and to be examined in the presence of police officers. As indicated above, at Paranesti and Tavros (Petrou Ralli) PRDCs, the medical screening by the nurse or the entry check by the health visitor were systematically carried out in the presence of a police officer. In the former establishment, detained persons were even handcuffed during their transfer to the infirmary within the perimeter of the pre-removal detention centre and during certain medical examinations or acts. The CPT reiterates once again that the Greek authorities take the necessary steps to ensure that all medical consultations, in principle, take place out of the hearing and – unless the doctor concerned expressly requests otherwise in a given case – out of the sight of police officers. Further, detained persons should not be systematically handcuffed when transferred to, or examined in, external healthcare facilities or in a secure environment within a pre-removal detention centre. d. staffing issues 98. The pre-removal detention centres are usually staffed with redeployed police officers. While the staff presence in the six centres visited was sufficient to guarantee the security and safety of the establishments, interaction between police officers and detained persons was reduced to a minimum. Police officers rarely entered the detention wings and had a very static role with a focus on external security and patrolling. The CPT received many complaints by detained persons that police staff did not respond to their requests and that, especially at Corinth and Tavros (Petrou Ralli) PRDCs, they had to shout for long periods until a police officer reacted to their calls at night. In addition, the lack of interpretation services (or devices) was an obstacle to communication between detained persons and police staff, who could not understand the many different needs and requests of the foreign nationals. It is also important for more staff with appropriate communication skills to be employed in these centres who can act as cultural mediators, as well as sufficient social workers and psychologists, who should be regularly present in the detention areas to improve interactions with foreign nationals. 99. The importance of good communication between detained foreign nationals and custodial staff in a closed environment such as pre-removal detention centres cannot be overemphasised. To this end, the CPT has repeatedly advocated that custodial staff employed in immigration detention centres be distinct from police officers. Due to the challenging working environment, staff should be carefully selected and receive appropriate, specific training. They should also possess well-developed qualities both in the field of interpersonal communication and cultural sensitivity, as well as de-escalation skills. At least some of them should also have relevant language skills. 31