care was related to several factors including the abusive and violent conditions of the labor relations, which the State failed to supervise or oversee, as already concluded in this report. 278. Even so, another fundamental component of this lack of timely medical care is associated with structural factors in the zone, in particular, as regards the component of availability of the right to health, already noted. The Commission notes that the State, at the time of the facts, had only one hospital in the entire department of Gracias a Dios, in the city of Puerto Lempira. In addition, despite having knowledge of the problem and it being a zone with a high incidence of underwater fishing the State did not provide the Miskito population in the zone the medical implements needed to be able to adequately handle possible accidents and the resulting decompression syndrome. These structural problems, as analyzed above, contributed to the deaths of some of the victims, and, in most cases, resulted in the surviving victims having permanent sequelae that have become disabilities, for which the State has not adopted measures of habilitation and rehabilitation, which has worsened their situation of vulnerability and exclusion in the context of the region. 279. For the IACHR the facts described above fit clearly within the scope of occupational health given the close relationship between the conduct of the companies in failing to provide safe working conditions, the omissive attitude of the State when it comes to overseeing the companies, and the harmful effects on the right to health of the Miskito divers. One of the basic obligations of states in this area is supervising and evaluating the efficacy of their policies on the matter; and “an examination of occupational health must include consideration of harmful exposures during work, specific varieties of working conditions, working environment, working relationships, and the social, environmental and political contexts in which work is situated.¨365 The Commission also highlights the essential duty of the State to ensure that workers participate in and have access to adequate and timely information about occupational health in the process of drawing up regulations and policies in this area.366 In summary, the Commission considers that the human rights violations that occurred in the instant case did not occur in isolation, but in the context of a situation of abandonment, discrimination, indifference, and lack of presence of the State, which has been fully aware of the problem affecting the Miskito population and the abuses committed by the companies in the region, all without adopting measures to offer the population conditions to satisfy the minimal contents of the right to work and to just, equitable, and satisfactory working conditions, the right to health, or the right to social security; or, as will be analyzed below, access to justice. Nor did it fulfill its obligations to oversee and supervise, on not requiring the companies involved in those activities to act with due diligence, to make it possible to protect those rights, nor did it sanction them once the deplorable situation of the workers was verified. 280. Accordingly, the Commission concludes that the State violated, to the detriment of the victims, the right to work and to fair, equitable, and satisfactory working conditions, the right to health, and the right to social security, established at Article 26 of the American Convention, in relation to the obligations established at articles 1(1) and 2 of the same instrument. In addition, mindful of the many factors of vulnerability of the victims related to their belonging to a historically excluded indigenous population, in a situation of extreme poverty, and many of the victims being persons with disabilities, the Commission considers that the State is also responsible for violating the principle of equality and non-discrimination, established at articles 24 and 1(1) of the Convention. D. Additional considerations on the surviving Miskito divers with disabilities 281. The Commission takes note that some of the surviving victims reportedly acquired a physical or sensorial disability as a result of the decompression syndrome they suffered and the lack of adequate medical care. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN. Doc. A/HRC/20/15, April 10, 2012. Para. 2 366 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. UN. Doc. A/HRC/20/15, April 10, 2012. Para. 25 365 50