48. On August 24, 2006, Manuela went to the Cacaopera Health Unit because she was suffering from a headache, nausea, pain in the pit of her stomach and tiredness. 106 She was diagnosed with acute gastritis.107 On May 14, 2007, Manuela visited the unit again due to headaches and it was recorded that she had what “appeared to be a painful lump behind her ear”; she was diagnosed with cervical adenitis and was prescribed analgesics.108 Manuela then developed several lumps in her neck, which were visible and caused her pain; therefore, she had further appointments in June and August 2007 and was then diagnosed with right neck lymphadenopathy and referred to the San Francisco Gotera National Hospital.109 The case file does not reveal whether the presumed victim went to that hospital or whether she received treatment there. D. Manuela’s pregnancy 49. In February 2008, Manuela was pregnant; however, there is no information with regard to how many weeks pregnant she was at that time.110 50. On February 26, 2008, Manuela was washing clothes in the river with her elder son, when she fell heavily and injured her pelvic area; 111 this resulted in pelvic girdle pain which increased in intensity and duration and led to transvaginal bleeding.112 51. According to Manuela’s mother, on February 27, 2008, her daughter was lying in bed in her room because she felt ill. At around midday, she went to her daughter’s room and found her pale, bleeding from the vagina, sweating and unconscious. Manuela’s father took his daughter to the San Francisco Gotera Hospital.113 E. The medical treatment of the obstetric emergency 52. On February 27, 2008, at 3:25 p.m., Manuela was admitted to the emergency department of the San Francisco Gotera National Hospital, where she was seen at 4 p.m.114 Cf. Identification document from the medical record of August 24, 2006 (evidence file, folios 1812 to 1814 and 5176), and Medical appraisal in the case of Manuela. Review of clinical and hospital treatment in the Cacaopera Health Unit and the San Francisco National Hospital” (evidence file, folio 186). 106 Cf. Medical appraisal in the case of Manuela. Review of clinical and hospital treatment in the Cacaopera Health Unit and the San Francisco National Hospital” (evidence file, folio 186). 107 Cf. Medical appraisal in the case of Manuela. Review of clinical and hospital treatment in the Cacaopera Health Unit and the San Francisco National Hospital” (evidence file, folio 186), and Medical record of Manuela from March to June 2007 (evidence file, folios 5179 to 5181). 108 Cf. Medical appraisal in the case of Manuela. Review of clinical and hospital treatment in the Cacaopera Health Unit and the San Francisco National Hospital” (evidence file, folios 186 and 187); Manuela’s medical record of June 6, 2007 (evidence file, folios 5180 and 5181); Sworn statement of Manuela’s mother on September 3, 2017 (evidence file, folio 2281), and Sworn statement of Manuela’s father on September 3, 2017 (evidence file, folio 2288). 109 110 Cf. Record of interview of Manuela’s mother on February 28, 2008 (evidence file, folios 1822 and 1823). Cf. Emergency record of February 27, 2008 (evidence file, folio 16); Sworn statement of Manuela’s father on September 3, 2017 (evidence file, folio 2288), and Sworn statement of Manuela’s mother on September 3, 2017 (evidence file, folio 2281). 111 112 Cf. Emergency record of February 27, 2008 (evidence file, folio 16). Sworn statement of Manuela’s mother on September 3, 2017 (evidence file, folio 2281); Sworn statement of Manuela’s father on September 3, 2017 (evidence file, folio 2288), and Record of interview of Manuela’s mother on February 28, 2008 (evidence file, folio 1822). Similarly, Record of the interview of Manuela’s sister of February 28, 2008 (evidence file, folios 1803 and 1804). 113 114 Cf. Record of the interview of the treating physician on February 28, 2008 (evidence file, folio 24). 21