C.3. Strengthening the health system in La Mosquitia from the perspective of inclusive social development 139. In the friendly settlement agreement, the State indicated the following: In view of the fact that many of the violations of the victims’ human rights occurred as a result of the lack of specialized comprehensive medical care, and that the obstacles to obtaining this care are a reflection of structural factors that affect all Miskito divers who suffer from decompression sickness as a result of diving accidents, the State undertakes to adopt the following measures […] C.3.1. Establish a national strategy for strengthening health care in the region 140. Accordingly, the State agreed to the following: Within one year of signing this agreement, the State shall implement a strategy to strengthen the public health system in La Mosquitia, including both the Puerto Lempira Hospital and the rural health centers located in the different communities of the region, in order to ensure that they have the necessary infrastructure for their proper functioning and, in particular, the necessary electricity and water supply. Likewise, the State undertakes to provide these health centers with specialized, trained and sufficient medical personnel to provide adequate and culturally relevant health care to members of the communities in which they are located. Within the same period, the State undertakes to design and implement a permanent comprehensive medical care program for persons who, as a result of diving accidents, remain bedridden and cannot travel to health centers. Said program shall have the necessary personnel and budget for its operation, and shall guarantee that the required health care is provided in their place of residence. C.3.2. Strengthening hyperbaric medical services in La Mosquitia 141. In the friendly settlement agreement, the State agreed to the following: The State recognizes that it would be ideal to have a hyperbaric medicine “corridor” in La Mosquitia. However, given the economic conditions, it not possible to implement such a corridor. Therefore, the Ministry of Health undertakes to carry out a study on the most frequent diseases in the area derived from diving accidents, in order to give these priority, equipping the Puerto Lempira Hospital and the region’s rural health centers with the necessary medical supplies to provide appropriate care. Likewise, the State undertakes to strengthen the operation of the Puerto Lempira hyperbaric chamber and the treatment offered there. To this end, the State will ensure that divers who suffer a decompression accident receive all the necessary hyperbaric treatment sessions free of charge in the chamber. The State shall also ensure the constant and permanent maintenance of the chamber. To this end, it shall guarantee the necessary budget allocation for the operation of the chamber, together with the required electrical supply, the necessary equipment and duly trained personnel to provide this medical service to the Miskito divers who require it. This includes the provision of trained medical personnel and/or the establishment of a training program for the medical personnel who will be operating the hyperbaric chamber, to ensure that they have the appropriate training for this purpose. C.3.3. Protocol for the prevention and care of diving accident victims 49