234. The Court also recalls that a medical examination of persons deprived of liberty should
be carried out as often as necessary. The authorities should ensure that, when required by
the nature of a medical condition, this should be subject to systematic periodical supervision
in order to cure the detainee’s ailments or to prevent them from deteriorating, rather than
merely treating the symptoms.381
235. In the case of Manuela, bearing in mind the lumps in her neck and that, between
November 2008 and February 2009 she lost more than 13 kilograms in weight, and suffered
from a high fever and jaundice,382 it was reasonable to consider that a medical examination
was required. However, there is no record in the case file that any medical examination of
Manuela was carried out between her detention in March 2008 and February 2009. The Court
considers that the State was obliged to ensure that the presumed victim be examined by a
physician to verify her health following the obstetric emergency, as well as the cause of the
lumps in her neck, and to provide medical treatment as necessary.
B.4.b The medical treatment that Manuela received
236. The Court has indicated that prison health services should have the same level of quality
as the services for people who are not deprived of liberty. Health should be understood as a
fundamental and essential guarantee for the exercise of the rights to life and to personal
integrity that entails the obligation for States to adopt domestic legal provisions, including
adequate practices, to ensure equal access to health care for persons deprived of liberty, as
well as the availability, accessibility, acceptability and quality of such services. 383 Therefore,
the accessibility of the right to health for persons deprived of liberty means that, when
necessary, health services must be provided in specialized health centers.
237. In the instant case, Manuela was diagnosed with nodular sclerosis Hodgkin’s lymphoma
on February 12, 2009.384 The Court has indicated that persons deprived of liberty who suffer
from serious chronic or terminal diseases should not remain in prisons unless States are able
to ensure that they have adequate medical units to provide them with appropriate specialized
care and treatment, and this includes facilities, equipment and qualified medical and nursing
staff. In any case, and especially if someone is evidently ill, States have the obligation to
ensure that a record or file is kept of the health and treatment of anyone who enters a
detention center, either in the center itself or in the hospitals or clinics where treatment is
received.385
238. In this case, following the diagnosis of Hodgkin’s lymphoma, Manuela was prescribed
chemotherapy. According to the medical record, the treatment she received was irregular. In
particular, it can be seen that: (i) she was not taken to her April 2, 2009, appointment to
receive chemotherapy until April 22, and during this time her tumor increased in size; 386 (ii)
in January 2010, the treatment was postponed for a month,387 and (iii) after receiving
381
Cf. Case of Chinchilla Sandoval et al. v. Guatemala, supra, para. 189.
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 190).
382
383
Cf. Case of Chinchilla Sandoval et al. v. Guatemala, supra, para. 177.
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 191).
384
385
Cf. Case of Chinchilla Sandoval et al. v. Guatemala, supra, para. 184.
386
Cf. Manuela’s medical record in the Rosales National Hospital. Entry for April 22, 2009 (evidence file, folio
2640).
387
2743).
Cf. Manuela’s medical record in the Rosales National Hospital. Entry for January 6, 2010 (evidence file, folio
67