8 11. That the Commission acknowledged that the State has made efforts in order to treat the health condition of Mr. Fermín Ramírez. Notwithstanding, the Commission expressed its concern since the next-of- kin of Mr. Fermín Ramírez are the ones who are providing him with medicine, which constitutes a State's obligation. 12. That, despite the fact that the State has referred to the treatment provided to Mr. Fermín Ramírez, it is not clear whether Mr. Fermín Ramírez has been regularly provided with assistance according to his needs. The Court values the willingness of the State and urges it to make efforts in order to ensure that the necessary treatment is provided to Mr. Fermín Ramirez in an adequate, fully and effective way, according to what professionals in charge of his health prescribe. * * * 13. That as to the duty to adopt, within a reasonable time limit, the necessary measures to ensure that prison conditions conform to international standards on human rights (operative paragraph twelve of the Judgment), especially with regard to Mr. Fermín Ramírez, the State informed that he is confined in unit B- 4 of “Canada”, a High Security Facility, in the location of Escuintla, where there are bathrooms, adequate conditions and room in corridors and backyard; he works as a cook, he makes craftsmanship and he is in the second stage of a literacy program. 14. That, with regard to the representatives, they mentioned that the unit of the High Security Facility of Escuintla where Mr. Fermín Ramírez is confined, has insufficient permanent water and the number of bathrooms are not enough. Furthermore, the facility does not count with any work or professional training program or workshops. They pointed out that he is self managing the craftsmanship and educational programs and that he is not allowed to take part in outdoor activities. Besides, they added that the area of recreation is reduced, there is overpopulation in said facility and that the physician and dentist only attend the center three times per week. 15. That in the instant case, the responsibility of the State was determined based on the confinement conditions suffered by Mr. Fermín Ramírez. Upon delivery of the Judgment, the State must adopt all the measures necessary to end these conditions. B) REGARDING THE CASE OF RAXCACÓ REYES 16. That as to the obligation of the State to set aside the death penalty imposed on Mr. Raxcacó Reyes (operative paragraph eight of the Judgment), the State informed that on October 17, 2007, the Sixth Court on Criminal, Drug-trafficking and Environmental Offenses annulled the death penalty and sentenced Mr. Raxcacó Reyes to “forty years imprisonment” and that the defendant filed a special appeal against such decision. On March 11, 2008 the Second Chamber of the Appellate Court on Criminal, Drug- Trafficking and Environmental Offenses decided to disallow the special appeal filed by Mr. Raxcacó Reyes and confirmed the judgment delivered by the Sixth Court on Criminal matters. 17. That the representatives stated that the new penalty imposed on Mr. Raxcacó Reyes "is disproportionate in comparison to the seriousness of the crime committed". 18. That the Commission did not submit any observations in that regard. 19. That it spring from the file of the Tribunal that the State has replaced the death penalty imposed on Mr. Raxcacó Reyes with a sentence to serve a prison term;