fishing constitutes the principal source of work in the area, “especially for Miskito men, who start this kind of activity when they are about 14 years old.”11 35. According to PAHO, the illnesses that can appear from deep diving, as in the case of the Miskito divers, are as follows: i) drowning; ii) arterial gas embolism (AGE); iii) lung overpressure; iv) the bends (decompression sickness) (DCS); v) hypothermia; vi) barotrauma; v) carbon monoxide poisoning, among others.12 36. Several of these problems occur because of high underwater pressure, in particular decompression; the appropriate treatment is to put the diver in a hyperbaric chamber.13 Inside the hyperbaric chamber the atmospheric pressure is changed in order to simulate diving conditions so that when the diver is inside he can breathe in oxygen and exhale carbon dioxide. The length of the time of treatment depends a great deal on each patient and each injury.14 Although access to treatment in hyperbaric chambers is indispensable in cases of very deep diving, the role of the rehabilitation services that are carried out afterwards is essential for the adequate recovery of the divers.15 The impacts of decompression include the destruction of bony tissue, mainly in the arms or legs, which can lead to irreversible paralysis.16 In certain cases, the injury is so severe that it cannot be remedied, even with appropriate treatment.17 37. According to PAHO, most accidents are preventable by ensuring sound bodily fitness and suitable training. For preventive purposes, the divers must: i) refrain from drinking alcohol, smoking, or using illicit drugs; ii) always dive with someone else; iii) speed of ascent must be slower than 60 feet per minute; iv) no ascending above sea level; v) no more than three dives per day; and vi) keep contact between the vessel and the shore. In addition, the vessels must carry oxygen tanks on board and the equipment must be reviewed periodically.18 38. The National Human Rights Commissioner (Comisionado Nacional de los Derechos Humanos, hereinafter CONADEH) and the Honduran Miskito Association for Injured Divers (Asociación Miskitos Hondureños de Buzos Lisiados, hereinafter la AMHBLI) indicated that, since 2001, when the Miskitos began to be recruited to be divers they have not received any training on diving techniques or safety measures to be adopted, especially when they engage in very deep diving; in addition, in the area, there is no school or training center for safe diving. CONADEH, in its 2001 report, pointed out that the Miskito divers did not receive any medical assistance from their employers and that, in the event of an accident during their diving activities, their right to rehabilitation treatment is not recognized. It also indicated that a high percentage of persons impacted did not receive any compensation for the injuries sustained.19 According to the Honduran Miskito Association for Injured Divers, most Miskitos with a disability earn their livelihood by begging.20 39. According to the Office of the Special Prosecutor for Ethnic Groups and Cultural Heritage (Fiscalía Especial de Etnias y Patrimonio Cultural), in its 2001 report, the Miskitos receive 45 lempiras per IACHR. Report on the Situation of Human Rights in Honduras. OEA/Ser.L/V/II. Doc. 42/15. December 31, 2015. Para. 428. Pan American Health Organization. Human Rights and Disability among Indigenous Peoples. Integral Healthcare Services for the Miskito Divers in Honduras. 2004. Available at: http://cidbimena.desastres.hn/filemgmt/files/MISKITO_Derechos.pdf 13 Merck Manual of Medical Information—Home Edition. Accidents and injuries. Diving injuries. Annex to the communication from the petitioners received on November 5, 2004. 14 Interview with Rafael Díaz, physician at the Cornerstone Hyperbaric Chamber and Medical Clinic, on January 25, 2008. Annex to the communication from the petitioners of April 2, 2010. 15 Pan American Health Organization. Human Rights and Disability among Indigenous Peoples. Integral Healthcare Services for the Miskito Divers in Honduras. 2004. Available at: http://cidbimena.desastres.hn/filemgmt/files/MISKITO_Derechos.pdf 16 Merck Manual of Medical Information—Home Edition. Accidents and injuries. Diving injuries. Annex to the communication from the petitioners received on November 5, 2004. 17 Merck Manual of Medical Information—Home Edition. Accidents and injuries. Diving injuries. Annex to the communication from the petitioners received on November 5, 2004. 18 Pan American Health Organization. Human Rights and Disability among Indigenous Peoples. Integral Healthcare Services for the Miskito Divers in Honduras. 2004. Available at: http://cidbimena.desastres.hn/filemgmt/files/MISKITO_Derechos.pdf 19 National Human Rights Commissioner of Honduras (CONADEH). Final Report. Organizational Capacity Building of Ethnic Groups and Divers of the Department of Gracias a Dios, Honduras. 2001. Annex to the communication from the petitioners received on November 5, 2004. 20 AMHBLI Project to Clarify the Legal Situation of Multiple Labor Complaint Cases Filed by Divers with the Ministry of Labor, September 24, 2003. Annex to the communication from the petitioners received on November 5, 2004. 11 12 6