221. Concerning the right to physical integrity, the Inter-American Court has established that this and the right to life are also directly linked to “human health care” and that “a lack of appropriate medical care does not satisfy the minimum requirements of humane treatment due because of a person’s nature as a human being pursuant to Article 5 of the American Convention”.284 Thus, it has established the special duty of States to adopt measures to protect the physical integrity and inherent dignity of the human person, of persons under their direct custody or control – for example, persons deprived of their liberty285 or confined to specialized institutions of the public health system.286 222. In the instant case, the Commission has established the State’s responsibility for failing in its special duty of protection in relation to the right to life of Johan Alexis Ortiz, who, under the direction and supervision of State agents, was exposed to participation in a training activity as an ESGUARNAC student where live rounds were used in violation of the conditions indicated in the instructions for the activity, without the minimum safety conditions and medical care also required for the exercise. By the same token, in relation to the right to physical integrity, the lack of specialized medical personnel or an ambulance to provide medical care during his transfer to a medical facility (elements required in the instructions) are omissions directly attributable to the State. These omissions are especially serious, given the circumstances and isolated location of the exercise, factors that together reduced Mr. Ortiz’s possibility of surviving the gunshot wounds. In this scenario, the Commission considers it reasonable to infer that at these moments, the victim experienced severe pain, anguish, and suffering, which in itself constituted an assault on his physical, mental, and moral integrity. The Commission therefore concludes that the State violated the right to personal integrity established in Article 5 of the American Convention in connection with Article 1.1 of that same instrument, to the detriment of Johan Alexis Ortiz Hernández. C. Right of Johan Alexis Ortiz’s next of kin to personal integrity 223. Article 5.1 of the American Convention states that “[e]very person has the right to have his physical, mental, and moral integrity respected.” This Inter-American Court has held that the next of kin of the victims of certain human rights violations can, in turn, be victims,287 and that their mental and moral integrity can be affected as a result of the particular circumstances endured by their loved ones and the subsequent acts or omissions of the State authorities in relation to the events.288 224. Specifically, the Court has established that the absence of a complete and effective investigation “constitutes a source of additional suffering and anguish for victims and their next of kin, who have the right to know the truth of what happened,” and that this right includes a “procedural determination 284 I/A Court H.R., Case of Pedro Miguel Vera Vera v. Ecuador, Preliminary Objections, Merits, Reparations, and Costs. Judgment of May 19, 2011. Series C No. 226, Par. 44; Case of De la Cruz Flores v. Peru. Merits, Reparations, and Costs. Judgment of November 18, 2004. Series C No. 115, Par. 131; Case of García Asto and Ramírez Rojas v. Peru. Preliminary Objections, Merits, Reparations, and Costs. Judgment of November 25, 2005. Series C No. 137, Par. 226, and Case of Montero Aranguren et al. (Detention Center of Catia) v. Venezuela, supra note 37, Par. 102. 285 I/A Court H.R., Case of Montero Aranguren et al. (Detention Center of Catia). Judgment of July 5, 2006. Series C No. 150, pars. 102 and103; Case of De la Cruz Flores. Judgment of November 18, 2004. Series C No. 115, Par. 132; and Case of Tibi. Judgment of September 7, 2004. Series C No. 114, Par. 157. See also: U.N. Doc. HRI/GEN/1/Rev.7 at 176 (1992), Human Rights Committee, General Comment 21, Par. 3; European Court of Human Rights, Case of Dzieciak v. Poland, Application no. 77766/01, Judgment of December 9, 2008; European Court or Human Rights, Case of Slimani v. France, Application no. 57671/00, Judgment of July 27, 2004, Par. 28. 286 I/A Court H.R., Case of Ximenes Lopes v. Brazil, Judgment of July 4, 2006, pars. 119-122. I/A Court H.R., Case of Cantoral Huamaní and García Santa Cruz v. Peru. Preliminary Objections, Merits, Reparations, and Costs. Judgment of July 10, 2007. Series C No. 167. Par. 112; I/A Court H.R., Case of Bueno Alves. Judgment of May 11, 2007. Series C. No. 164. Par. 102. 287 288 I/A Court H.R., Case of Cantoral Huamaní and García Santa Cruz v. Peru. Preliminary Objections, Merits, Reparations, and Costs. Judgment of July 10, 2007. Series C No. 167. Par. 112; I/A Court H.R., Case of Vargas Areco v. Paraguay. Judgment of September 26, 2006. Series C No. 155. Par. 96.