of All Persons under Any Form of Detention or Prison stipulates that “[a] proper medical examination shall be offered to a detained or imprisoned person as promptly as possible after his admission to the place of detention or imprisonment, and thereafter medical care and treatment shall be provided whenever necessary. This care and treatment shall be provided free of charge.”248 Care by a doctor who does not have links to the prison or detention authorities is an important safeguard against the torture or physical or mental ill-treatment of the persons deprived of liberty.249 In this regard, the lack of adequate medical treatment for a persons who is deprived of liberty and in the State’s custody may be considered a violation of Article 5(1) and 5(2) of the Convention depending on the particular circumstances of the specific person, such as their health or the type of ailments they suffer from, the time that has passed without attention, the accumulative physical and mental effects,250 and in some cases the sex and age of the person.251 138. In order to rule on the alleged violations of Article 5(1) and 5(2) of the American Convention, the Court must now refer only to the conditions regarding which the Commission made factual determination in the merits report (supra para. 34). 139. The pertinent facts were described in extenso in section F) of Chapter V, entitled “Detention conditions and deterioration of Mr. Díaz Peña’s health” (supra, paras. 91 to 108). In brief, the Court has verified that during the time Mr. Díaz Peña remained detained in the Pre-Trial Detention Center, the medical reports that were prepared showed a progressive deterioration in his health. On November 15, 2004, more than eight months after Mr. Díaz Peña entered the Pre-Trial Detention Center, it was recorded that Mr. Díaz Peña, with a history of a myringoplasty in the right ear in 1999, had otalgia and hypoacusis in the left ear with an evolution of nine months. Various medical reports indicated a decrease in his hearing and nasal allergies, a syndrome of nasal obstruction due to allergic rhinitis, meningitis, sinusitis, gingivitis, and gingivorragia; in November 2006, it was recorded that Mr. Díaz Peña had abdominal colic, flatulence and recurrent diarrhea; in 2007, the presence of recurrent perianal abscesses was recorded; an expert appraisal of November 28, 2008, indicated that Mr. Díaz Peña had a perianal fistula with an evolution of two years, and the medical report of March 12, 2010, recorded that he had suffered from a perianal abscess on four occasions, which had resulted in an anal fissure, all of which had been drained and treated by the patient himself, which explained their recurrent nature (supra, para. 107). 140. In summary, it must be considered proved that the detention conditions were extremely deficient, in particular the lack of access to light and natural ventilation, and the restricting time in the open air for more than six years, as well as being locked up at night and thus the restrictions in access to the only sanitary installations available for 10 individual cells for more than three years. In addition, it has been proved that Mr. Díaz Peña suffered a serious progressive deterioration in his health and that the medical assistance services were not provided opportunely, adequately and completely for the problems that Mr. Díaz Peña had in his left ear; in particular as regards the indication of the ear, nose and throat specialist that he required an examination and evaluation in an external center specialized in this type of ear problem that had adequate instruments to treat it, and the delay of several months in performing the computerized axial tomography (CAT scan) of the middle ear and mastoids, as well as the tonal audiometry. 248 United Nations, Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment, Adopted by the General Assembly in Resolution 43/173, 9 December 1988, Principle 24. See also, Rule 24 of the United Nations Standard Minimum Rules for the Treatment of Prisoners. 249 Cf. Case of Montero Aranguren et al. (Retén de Catia) v. Venezuela, para. 102, and Case of Vélez Loor v. Panama, para. 220. 250 Cf. Case of Montero Aranguren et al. (Retén de Catia) v. Venezuela, para. 103, and Case of Vélez Loor v. Panama, para. 220. 251 Cf. Case of the “Street Children” (Villagrán Morales et al.) v. Guatemala. Merits. Judgment of November 19, 1999. Series C No. 63, para. 74, and Case of Vera Vera et al. v. Ecuador, para. 44. 50