E.A. v. Russia

The applicant was an Uzbek national who was arrested in Perm, Russia from 2003 to 2008, due to criminal proceedings. He complained before the European Court of Human Rights (the ECHR) stating that he hadn’t been provided with appropriate medical care while he was detained in violation of Article 3 of the European Convention on Human Rights (the Convention).

The applicant submitted that he had pneumonia and had no Pulmonary Tuberculosis in 1995 and 1998 while documents presented by the government showed that he had Pulmonary Tuberculosis since 1990s for which he was treated in Uzbekistan. The medical records of the applicant  showed that he had been medically examined several times. After June 2004, the applicant had been treated for tuberculosis, gonorrhoea, haemorrhoids, hepatitis C, a psychiatric condition, and in relation to acts of self-mutilation. Although he had several tests in September 2004, his schedule to be examined by an infectious disease specialist was cancelled and it was in April 2005 that he was examined by this specialist. A medical record from 2004 also indicated the applicant’s HIV stage as HIV stage 3A.

In July 2005, the applicant complained of not being provided with appropriate medical treatment in relation to his HIV infection. The prosecutor’s office, however, held that the applicant was provided with the appropriate medical care free of charge, including consultations by infectious disease specialists, and that he couldn’t be provided with out-patient treatment for HIV as funds hadn’t been allocated for the prison he was incarcerated in. The applicant’s complaints in July 2006 to the Federal Department for the Execution of Sentences, and in September 2006 to the Medical Office of the Regional Department for the Execution of Sentences had been dismissed on the ground that the applicant’s illness and the stage of his disease didn’t require antiretroviral therapy (ART).

Between October 2006 and May 2007, the applicant was kept in hospital due to an aggravation of his pulmonary tuberculosis. The government contended that the applicant failed to commit to recommendations by the AIDS center in October 2006. In 2007, it was shown that the HIV stage was stage 4Б and the applicant started the highly active antiretroviral therapy (HAART) regimen in April same year. The applicant was released from prison in September 2008; the government submitted that he was attending the AIDS center in October 2008 and January 2009. 

In his complaint to the ECHR, the applicant alleged that he hadn’t been provided with appropriate medical care for HIV and Hepatitis C between 2003 and 2006; immunological assessment hadn’t regularly been carried out until 2007 when his state of health was deteriorated; ART was started for him after stage 4 while his prior conditions indicated a need for same; and that he had complied with medical recommendations until 2009.

The government argued that the applicant had been provided with medical care and supervision after his test for HIV. ART hadn’t been started for him from 2003-2006 due to the absence of indications necessitated for ART. The Hepatitis C and the TB he had at the time didn’t  result from HIV and weren’t determinants of the need to start ART. The applicant had been under constant medical supervision, with all the necessary diagnosis and treatment. The applicant had refused care in some instances and he had been informed of the need to continue the treatment and the consequences of his refusal though he failed to continue his treatment after his release.

The ECHR noted that the complex medical issues involved in the applicant's case hadn't been investigated by authorities except for instances where public authorities reviewed and dismissed by the applicant's complaints regarding his treatment. The ECHR wasn't convinced by the government's argument regarding the time the applicant needed the ART. It also noted that the authorities failed to perform the immunological assessment for the applicant for 4 years. The ECHR found failure on the part of the state to provide the applicant with sufficient care as between 2003 and 2006 which led to "a situation in which the applicant can be said to have been subject to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention". [Para. 67] The ECHR held that the conduct of the state amounted to inhuman and degrading treatment, constituting a violation of Article 3 of the Convention.

The ECHR awarded non-pecuniary damage to the applicant.

"Where complaints are made about a failure to provide necessary medical assistance in detention, it is not indispensable for such a failure to have led to a medical emergency or have otherwise caused severe or prolonged pain in order for the Court to find that a detainee was subjected to treatment incompatible with the guarantees of Article 3 (see Ashot Harutyunyan v. Armenia, no. 34334/04, § 114, 15 June 2010). Article 3 cannot be interpreted as laying down a general obligation to release a detainee on health grounds, save for in exceptional cases (see Papon v. France (no. 1) (dec.), no. 64666/01, ECHR 2001-VI, and Priebke v. Italy (dec.), no. 48799/99, 5 April 2001), or to place him in a civil hospital to enable him to obtain a particular kind of medical treatment. However, a lack of appropriate medical treatment may raise an issue under Article 3 even if the applicant’s state of health did not require his immediate release." [Para. 46]

"The Court reiterates that an unsubstantiated allegation of no, delayed, or otherwise unsatisfactory medical care is normally not sufficient to disclose an issue under Article 3 of the Convention. A credible complaint should normally include, among other things, sufficient reference to the medical condition in question, medical prescriptions that were sought, made or refused, and some evidence – for instance, expert reports – capable of disclosing serious failings in the applicant’s medical care (see Valeriy Samoylov v. Russia, no. 57541/09, § 80, 24 January 2012)". [Para. 49]

"In its assessment of issues under Article 3 of the Convention, the Court gives thorough scrutiny to the question of the authorities’ compliance with the prescriptions issued by medical professionals, in the light of the specific allegations made by an applicant (see Vladimir Vasilyev v. Russia, no. 28370/05, § 59, 10 January 2012)." [Para. 52]