conferred on the State a special obligation of care pursuant to its obligation to guarantee rights, in view of the responsibility involved in its actions to promote health care. 193 This announcement resulted in the first medical care that Melba Suárez Peralta received, during which her apparent ailment was diagnosed, and which channeled her towards the following medical intervention. In this regard, the Court finds that the formal delegation to another health entity, by the doctor provided by the State, of the provision of a service for which the State had assumed responsibility, did not disengage the State from this responsibility, because the relationship between the delegating State and the beneficiary of the service regarding protection of the right to personal integrity remained. 144. In this regard, the Court has established that “when health care is public, it is the State that provides the service directly to the population […]. The public health care service […] is primarily offered by public hospitals; however, private initiative, in a complementary manner, and through the signature of agreement or contracts, […] also provides health care services under the aegis of the [State]. In both situations, whether the patient is interned in a public hospital, or a private hospital under an agreement or contract […], the person is in the care of the […] State.” 194 “Even though the State may delegate the provision of services, by means of the so-called outsourcing, it retains the ownership of the obligation to provide public services and to protect the respective public rights.” 195 145. Thus, the supervision and control of the medical services provided by the State in the Polyclinic that, in this case, should have been carried out by the corresponding authorities (Guayas Polyclinic and Ministry of Public Health), were not proved (supra para. 137). The Court finds that the announcement made by the State, in General Order No. 1977, in which it promoted medical services, created a situation of risk of which the State itself should have been aware. Regarding this situation, it has been proved that medical care was provided in a public health center by someone who had not accredited that he was qualified to exercise his profession (supra para. 48) and that, despite this, the State not only permitted this, but also promoted it. This situation of risk subsequently materialized in the prejudice to the health of Melba Suárez Peralta. Therefore, this Court concludes that the State failed to comply with its obligation to safeguard and to guarantee the right to personal integrity of Melba Suárez Peralta, in relation to the medical care provided in the Polyclinic of the Guayas Traffic Commission. b) The medical services carried out in the Minchala Clinic 146. The Court takes not of the contextual conditions of the operation performed in the Minchala Clinic, alleged by Melba Suárez Peralta during the hearing, in which she described the deficient conditions of hygiene in the Clinic and the lack of expertise of the acting physicians. In this regard, she indicated that “the place was dirty, devastating, because [she] only received local anesthesia, as if they were only apprentices; it appeared that they were not providing adequate attention because they were conversing, ‘you close it here,’ ‘this is how you sew it up; this is how you suture’; in other words, everything they said made it seem that they were learning.” The Court also takes into consideration the the Ministry of Public Health of the Republic of Cuba, of September 22, 1999 (file of annexes to the final arguments, folio 3162). 193 Cf. Case of Ximenes Lopes, supra, paras. 95 and 96, 138 and 139, and 141. 194 Case of Ximenes Lopes, supra, para. 95. 195 Case of Ximenes Lopes, supra, para. 96. 43