187.
The WHO has established that the treatment of diabetes “consists of the reduction
of glycaemia and other known risk factors that damage the blood vessels. […].” Among the
interventions that “are feasible and economical in developing countries” the WHO mentions
the following: i) moderate control of glycaemia; ii) blood pressure control; iii) foot care; iv)
screening for retinopathy (cause of blindness); v) blood lipid control (to regulate cholesterol
levels); and, screening for early signs of diabetes-related kidney disease.287 Specific
recommendations for the treatment of this disease include physical activity and an appropriate
diet.288
188.
The Court considers that the need to protect health, as part of the State’s
obligation to ensure the rights to personal integrity and to life, increases in respect of a person
who suffers serious or chronic illnesses, where their health can deteriorate progressively.
Under the principle of non-discrimination (Article 1(1) of the Convention), this obligation
acquires particular importance in relation to persons deprived of liberty. This obligation may
also be conditioned, accentuated or specified, according to the type of disease, particularly if
it is of a terminal nature or, even if it is not terminal per se, if it can be complicated or
aggravated either by the individual’s own circumstances, by the conditions of incarceration or
by the capacity of the prison establishment or of the prison authorities to provide health care.
This obligation rests with the prison authorities and, ultimately and indirectly, with the judicial
authorities who, ex officio or at request of the interested party, must exercise judicial control
over the guarantees due to persons deprived of liberty.
189.
The authorities must ensure that detainees receive regular and systematic
monitoring of their medical condition, as required, and that treatment is aimed at curing their
diseases or preventing their aggravation, rather than merely treating them on a symptomatic
basis.289 The European Court has incorporated the principle of equivalence of health care
established by the European Committee for the Prevention of Torture and Inhuman or
Degrading Treatment, according to which health care services in prisons must be able to
provide medical treatment and nursing care, as well as appropriate diets, physiotherapy,
rehabilitation and any other necessary special facilities, in conditions comparable to those
enjoyed by patients in the outside community. 290 A lack and/or deficiency in the provision of
medical attention, or negligent or deficient medical treatment, is not consistent with the
obligation to protect the right to life of persons deprived of liberty. 291
World Health Organization, Diabetes. Fact Sheet No. 312. January 2015. Available at:
http://www.who.int/mediacentre/factsheets/fs312/es/index.html.
287
The WHO recommendations for people who suffer from diabetes include: i) practicing an endurance activity
at a moderate or higher level of intensity (e.g. brisk walking) at least one hour daily most days of the week; ii)
ensuring that saturated fat intake does not exceed 10% of total energy and for high risk groups, fat intake should be
less than 7% of total energy; iii) achieving adequate intake of NSP–non-starch polysaccharides through regular
consumption of wholegrain cereals, legumes, fruits and vegetables. World Health Organization, Diet, nutrition and
the prevention of chronic diseases. Report of the joint WHO/FAO expert consultation. WHO, Technical Report Series
No.
916.
Geneva
2003,
page
77.
Available
at:
http://www.who.int/nutrition/publications/obesity/WHO_TRS_916_spa.pdf
288
The European Court ruled on the medical treatment that a person with diabetes should receive, finding that
“the mere fact that a detainee was seen by a doctor and prescribed a certain form of treatment cannot automatically
lead to the conclusion that the medical assistance was adequate”. ECHR, Barilo v. Ukraine, No. 9607/06, Judgment
of May 16, 2013, para. 68.
289
The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment, Third General
Report of Activities for the period January 1-December, 1992. Ref.: CPT/Inf (93) 12 [EN], published on June 4, 1993,
para. 38. Available at: http://www.cpt.coe.int/en/annual/rep-03.htm#III cited in: ECHR, Kudhobin v. Russia, No.
59696/00, Judgment of October 26, 2006, para. 56.
290
ECHR, Tarariyeva v. Russia, No. 4353/03, Judgment of December 14, 2006, para. 87. In its analysis of these
types of violations the European Court has held that: “ill-treatment must attain a minimum level of severity if it is to
fall within the scope of Article 3. The assessment of this minimum level is, in the nature of things, relative; it depends
291
59