18. Regarding the State's obligation to provide medical, psychological and psychiatric treatment, as appropriate, to De Belén Areco, Pedro Vargas, and Juan, María Elisa, Patricio, Daniel, Doralicia, Mario, María Magdalena, Sebastián and Jorge Ramón, all of whom have the surname Vargas Areco, if they so require, and for as long as necessary (operative paragraph eleven of the Judgment), the State reported on the signing of a cooperation agreement between the Ministry of National Defense and AFAVISEM (Association of Relatives of Victims of Compulsory Military Service) on July 30, 2008, which allows medical care to be given to soldiers injured and affected by Compulsory Military Service, as well as the families of deceased soldiers, through the Hospital Central de las Fuerzas Armadas de la Nación [Central Hospital of the Armed Forces of the Nation]. Furthermore, it indicated that the Human Rights Unit of the Ministry of Public Health and Social Welfare was created, which "channels the requirements that arise in the health area," and "it already has the background facts of the case, in order to offer appropriate treatment in any eventuality." In the private hearing, the State manifested that Mr. Vargas had attended the Military Hospital, who has given cards to the parents of Vargas Areco so as to expedite any medical treatment, and the Regional Director has taken charge of their cause so as to compile a report. Finally, it stated that the Director of the XIII Región Sanitaria Amambay [XIII Health Region, Amambay], is familiar with the case of Ms. De Belén Areco de Vargas and will be responsible for monitoring the visits necessary to safeguard her health, manage the diagnosis and provide medications as needed. The counseling will be conducted through the Department of Mental Health, once you have obtained the approval of family members. 19. The representatives noted that "[t]he information provided by the State does not account for effective compliance," as "an agreement for the exclusive benefit of 'parents, spouses and minors of military personnel with disabilities and killed in duty' and limited only to certain medical benefits [...], does not satisfy the State obligation." They further pointed out that the hospital is based in Asunción, thus it "can hardly be useful for purposes of providing effective care to victims of the case living in Bel[l]a Vista Norte some 570 km from Asuncion."They stated that at a meeting in February 2009, the Statecommitted to oversee the health care in the public hospital in the city of Pedro Juan Caballero, considering that the victim's parents expressed difficulties in receiving specialist care. Regarding the recent appointment of the Director of the XIII Región Sanitaria Amambay [XIII Health Region, Amambay], next-of-kin said they will contact the Director as soon as possible for the health care. Finally, they confirmed that the families have a card and access to psychological care. 20. The Commission noted that the State must take important actions to give close and appropriate attention to all the victims named in this case, and noted "with concern that more than three years after the issuance of the Judgment, the State had not complied with these important reparation measures." Also at the hearing, it said the visit to the family constitutes a first step but is does not represent effective compliance with the orders of the Judgment. 21. The Court takes note of the various initiatives undertaken by the State related to the provision of "[the] medical services to people who [were left] with injuries and were affected as a result of the Compulsory Military Service," as well as to the next-of-kin "of military personnel left disabled or killed on active service." Notwithstanding the foregoing, it is necessary that the State, in addition to the measures taken in the framework of this cooperation agreement between the Ministry of National Defence and AFAVISEM (supra Having Seen 18), to grant preferential treatment to victims17. In this regard, the Court has 17 Cf. Case of 19 Tradesmen v. Colombia.Monitoring compliance with Judgment.Order of the Inter-American Court of Human Rights of July 8, 2009, Considering Clause thirty four; Case of Heliodoro Portugal, supra note 16,