On January 24, 2000, the Inter-American Commission on Human Rights
(hereinafter "the Inter-American Commission" or "the IACHR")
received a petition filed by Carlos Rafael Urquilla Bonilla of the
Foundation for Studies for the Application of Law, FESPAD ("the
petitioners"), alleging international liability on the part of the
Republic of El Salvador ("the State") with respect to Jorge Odir
Miranda Cortez and 26 other persons who are carriers of the Human
Immunodeficiency Virus/Acquired Immunodeficiency Virus
("HIV/AIDS") and are members of the Atlacatl Association.
The petitioners allege that the acts reported constitute a
violation of several provisions of the American Convention on Human Rights
(hereinafter "the American Convention"): the right to life
(Article 4); humane treatment
(Article 5); equal protection before the law (Article 24); judicial
protection (Article 25); and economic, social, and cultural rights
(Article 26), in accordance with the general obligation set forth in
Article 1(1) and the duty set forth in Article 2 of the aforementioned
international instrument. They
also allege violation of Article 10 of the Additional Protocol to the
American Convention on Human Rights in the area of Economic, Social, and
Cultural Rights ("Protocol of San Salvador"), as well as other
provisions consistent with the American Declaration on the Rights and
Duties of Man ("the American Declaration") and other human
rights instruments. In light
of the gravity and urgency of the situation, the petitioners requested
precautionary measures on behalf of the 27 persons mentioned above, which
were granted by the IACHR when it began processing of the case.
2. The petition
alleges that the State violated the right to life, health, and well being
of the alleged victims in this case, inasmuch as it has not provided them
with the triple therapy medication needed to prevent them from dying and
to improve their quality of life. The petitioners maintain that the situation of these persons,
which they also attribute to negligence on the part of the State,
constitutes cruel, inhumane, and degrading treatment.
They further allege that the Salvadoran Social Security Institute (ISSS)
has discriminated against Mr. Jorge Odir Miranda Cortez and the alleged
victims because they are carriers of HIV/AIDS.
In April 1999, the petitioners instituted amparo proceedings in the Constitutional Division of the Supreme
Court of El Salvador, claiming violation of the rights outlined in their
petition to the Inter-American Commission. The petitioners assert that the
delay on the part of this Salvadoran legal entity is unreasonable and
constitutes an additional violation of the right to a fair trial and
judicial protection, and provides grounds for invoking the exception to
the exhaustion of domestic remedies set forth in Article 46(2)(c) of the
3. The State
maintains that the petitioners had access to domestic remedies and that
these remedies have been adequate in order to address the situation
reported. They add that the
authorities availed themselves of conciliation proceedings at meetings
between the Director of the ISSS and Mr. Jorge Odir Miranda Cortez
regarding the provision of triple therapy for the persons who are carriers
of HIV/AIDS (seropositive). In
the view of the State, the attention provided to the persons identified in
this report within the framework of the precautionary measures
demonstrates compliance with its international commitments, and, for this
reason, it requests that the case be closed.
prejudice to the merits of the case, the IACHR concludes in this report
that the case is admissible, inasmuch as it meets the requirements set
forth in Articles 46 and 47 of the American Convention.
The Inter-American Commission therefore decides to inform the
parties of the decision and to continue analysis of the merits regarding
the alleged violation of Articles 2, 24, 25, and 26 of the American
PROCESSING BY THE COMMISSION
5. After filing
the January 24, 2000 petition, the petitioners submitted another
communication on February 28, 2000, reiterating their request for
precautionary measures and their petition.
On February 29, 2000, the Inter-American Commission assigned the
number 12.249 to the case and requested information from the Salvadoran
State regarding the pertinent parts of the petition.
On that same date, the IACHR asked the State to adopt precautionary
measures on behalf of Jorge Odir Miranda Cortez and the other persons
listed in the petition, and to provide information on this matter within a
period of 15 days.
6. On March 2,
2000, the petitioners included the Center for Justice and International
Law (CEJIL) as a co-petitioner. On
March 15, 2000, the petitioners submitted a communication in which they
provided details on the actions taken with respect to the Salvadoran
authorities regarding the petition and the precautionary measures.
They requested, among other things, that the IACHR declare
non-compliance with the precautionary measures and seek provisional
measures from the Inter-American Court of Human Rights.
On that date, the State submitted its response to the request for
information on precautionary measures, which was forwarded to the
petitioners. On March 16,
2000, the State reported the appointment of Mr. José Roberto Mejía
Trabanino of the Office of the Director General for Foreign Policy as the
liaison official for the petitioners with respect to the issues related to
7. The comments of
the petitioners were received on March 21, 2000.
On March 24, 2000, the Inter-American Commission requested from the
petitioners the names of the alleged victims involved in this case who had
died since processing of the case began, and specific information
regarding precautionary measures. On
April 3, 2000, the petitioners submitted this information and reiterated
their request that the IACHR take the matter to the Inter-American Court
in order to request provisional measures.
On April 7, 2000, they sent another communication containing the
Inter-American Commission contacted the State on April 20, 2000 in order
to transmit the comments of the petitioners and to request additional
information regarding compliance with the precautionary measures granted
in this case. In its response
of April 28, the State informed the IACHR of the actions taken by the
Salvadoran authorities to address the claims of the alleged victims
related to care. The State
submitted additional information in this regard on May 4, 2000.
9. The petitioners
submitted additional information on precautionary measures on May 16,
2000. On May 23, 2000, the
State submitted the medical summary reports on the patients with HIV/AIDS
included in this case, issued by the ISSS Department of Preventive
Medicine. On May 26, 2000,
the IACHR asked both parties to submit additional information regarding
medical care, treatment of the alleged victims, and any other information
relevant to the processing of this case.
On June 5, 2000, the petitioners submitted "a request for
activity to move the case forward [solicitud
de impulso procesal]." On
June 9, 2000, the Salvadoran State submitted the information requested by
the Inter-American Commission, which included "the list of persons
identified in the request for precautionary measures, together with
updated and detailed information on medical care, treatment, medical
recommendations, and other pertinent information."
On that same date, the Inter-American Commission once more
requested information from the State on the petition filed regarding this
case, which was first transmitted on February 29, 2000, with a 90-day
period being granted for a response.
The State responded on June 23, 2000 to the issues raised by the
petitioners in the petition. On
June 27, 2000, the petitioners submitted their comments on the information
from the State regarding precautionary measures, and repeated their
position with respect to non-compliance with these measures.
On July 12, 2000, the State submitted a communication in which it
reported that the Governing Board of the ISSS had decided to authorize the
purchase of the triple therapy medication.
On July 14, 2000, the IACHR forwarded this additional information
to the petitioners, and, at the same time, forwarded the pertinent parts
of their comments to the State.
The State submitted additional information on July 20, 2000,
consisting of a document pertaining to the treatment received by Mr. Jorge
Odir Miranda Cortez from the ISSS. The
Inter-American Court expressed its appreciation for this information and
for the action taken by the Salvadoran State within the context of the
precautionary measures granted in this case.
On July 28, 2000, the State submitted supplementary information on
the action taken to implement the precautionary measures.
The petitioners submitted their comments regarding the exhaustion
of domestic remedies and the merits of the petition on August 3, 2000.
On August 8, 2000, the State submitted correspondence from the ISSS
regarding the treatment that was allegedly provided to the patients
infected with HIV/AIDS.
On August 25, 2000, the petitioners submitted their comments
regarding the information provided by the Salvadoran State.
They reiterated, among other things, their position regarding
non-compliance with the precautionary measures by the Salvadoran State and
their request that provisional measures be sought from the Inter-American
Court. On August 28, 2000,
the petitioners requested a hearing on the case before the Inter-American
The precautionary measures expired on August 29, 2000, the date
that marked the end of the six-month period initially established by the
Inter-American Commission in the communication of February 29, 2000.
On September 8, 2000, the Salvadoran State submitted its comments
on correspondence from the
petitioners pertaining to the petition.
On September 28, 2000, the petitioners submitted the written
arguments that were to be developed at the hearing granted by the
Inter-American Commission. The
pertinent parts of this correspondence were forwarded to the Salvadoran
The Inter-American Commission held a hearing on this case on
October 10, 2000, at its 108th regular session.
October 17, 2000, the petitioners submitted their comments regarding the
correspondence submitted by the State on September 8, 2000.
The IACHR forwarded the pertinent parts of this correspondence to
the State on October 26, 2000.
On November 24, 2000, the petitioners submitted correspondence in
which they once again asked the Inter-American Commission to declare that
the Salvadoran State had failed to comply with the precautionary measures
and to seek provisional measures from the Inter-American Court.
On December 6, 2000, they submitted additional correspondence to
that effect. On that same date, the State submitted a communication
providing a summary of the activities conducted in order to comply with
the precautionary measures and containing comments on the merits of the
At its 109th special session, the IACHR decided not to
grant the request for provisional measures.
In making this decision, the Inter-American Commission considered
the information received from both parties, and evaluated the different
actions taken by the Salvadoran State to provide medical treatment not
only to the members of the Atlacatl Association but also to other persons
infected with HIV/AIDS in that country.
These actions had continued even after expiration of the deadline
for precautionary measures on August 29, 2000.
On December 12, 2000, the Inter-American Commission forwarded the
pertinent parts of the most recent communications from the petitioners
together with a request for information from the Salvadoran State
regarding the medical care and treatment provided to the 24 surviving
persons identified in this case. On January 19, 2001, the Salvadoran State requested an
extension of the deadline for its response to several cases, including
this one, because of the national emergency in that country.
A 30-day extension was granted on January 24, 2001.
The petitioners submitted communications on February 16 and 19,
2001, in which they reiterated their position, provided a summary listing
of persons receiving treatment from the Salvadoran State, and asked that
the IACHR declare the case admissible.
The Salvadoran State forwarded the information requested by the
IACHR on February 22, 2001. In
its correspondence, it indicated that "to date, anti-retroviral
medication has been provided to 11 of the 24 persons included in Case
12.249" and explained that this medication is available to the other
persons identified in the case, subject to the appropriate medical
evaluation. In addition, the
State reported that it had expanded provision of the medication to other
persons not included in this case.
POSITIONS OF THE PARTIES
The petitioners allege that the Salvadoran State is responsible for
violation of Article 4 of the American Convention, to the detriment of
Jorge Odir Miranda Cortez and the other members of the Atlacatl
Association. They maintain
that the Salvadoran State is refusing to purchase "the triple therapy
and other medications that prevent death and improve the quality of life
of persons living with HIV/AIDS," and, for this reason, it
has failed to guarantee them the quality of life that allows them to
achieve well being. In that
regard, they stated:
right to life encompasses much more than not dying as a result of action
or negligence attributable to the State, in accordance with the rules of
international law. The right
to life, in that broader sense, presupposes, inter alia, that a
person lives under conditions that are conducive to his well being.
With regard to the alleged violation of the right of the persons
listed in this report to humane treatment, the petitioners allege that
"the State, because of its negligent acts, can also place or allow a
group of persons to be placed in cruel, inhumane, or degrading
The petitioners' position is that persons who live with HIV/AIDS
are in "a vulnerable situation that exposes them to death" which
is "clearly a cruel, inhumane, or degrading situation."
The petitioners also allege that the Salvadoran State has violated
the right of the alleged victims to health set forth in Article XI of the
American Declaration and Article 10 of the Protocol of San Salvador, as
well as social rights under Article 26 of the American Convention.
They maintain that the following "immediate legal
obligation" can be inferred from these instruments:
State should conduct all acts and omissions [sic] that are necessary to
improve health, leading to the highest level of physical, mental, and
social well being through the use of modern advances and scientific
medical discoveries. The
Salvadoran State cannot therefore fail to purchase and administer
anti-retroviral treatments to persons living with HIV/AIDS for budgetary
reasons if it did not seek and implement, some time earlier, reasonable
financial adjustments to permit their purchase and administration.
The petitioners maintain that the alleged victims were
discriminated against and stigmatized because they are infected with
HIV/AIDS. They allege, among other things, that the bed linen of
seropositive patients was separated from the bed linen of other patients
and placed in a red bag, that they were given drinking glasses with
special markings, and the nursing staff shunned them and treated them
differently from the other patients.
According to the petitioners, this case also involves violation of
the right to judicial protection enshrined in the American Convention,
taking into account the time period that has elapsed since April 1999,
when the amparo proceedings were
filed in El Salvador. They
allege that amparo proceedings
are set up in Salvadoran legislation in such a way as to prevent
fulfillment of the requirements of simplicity, rapidity, and effectiveness
mentioned in Article 25 of the American Convention, and, for this reason,
they are requesting that the IACHR declare that this State has, in
addition, failed to fulfill its duty imposed under Article 2 of the
aforementioned international instrument.
The Salvadoran State maintains that the information provided to the
IACHR during the processing of precautionary measures should be construed
as the response to the allegations of the petitioners regarding the
exhaustion of domestic remedies and the merits of the matter reported. In that regard, the State maintains:
petitioners have availed themselves of domestic remedies and have, at all
times, had access to the appropriate entities in the country. We
have evidence, which has also been provided to the Commission, pertaining
to specialized medical and hospital care, the measures adopted by State
institutions, the treatment provided to each patient living with HIV/AIDS,
and the budget approved to provide them with the medication requested.
The State explains the recommendations of medical specialists in
the field regarding the criteria to be followed to ensure that patients
benefit from triple therapy treatment and application.
The use of this therapy, according to the State, will permit a 70%
reduction in patient mortality and a 50% reduction in hospitalization,
and, furthermore, "will facilitate the reintegration of persons
receiving anti-retroviral therapy into productive and family life, thereby
guaranteeing, to a large extent, enjoyment of their economic, social, and
It adds that a Technical Advisory Committee has been established in
El Salvador for the drafting of treatment plans for persons living with
HIV/AIDS and, "internally, conciliation proceedings were used in an
attempt to meet the demands of the claimants."
In a subsequent communication, the Salvadoran State disputes the
merits of the case and asserts that no violation occurred in this case.
The State further disputes the allegations of discriminatory
treatment of seropositive patients in El Salvador.
It maintains, in that regard, that hospitals follow general rules
regarding disease prevention and control, as well as the guidelines
adopted by the World Health Organization on the classification of hospital
solid waste from infectious and contagious diseases such as AIDS and
hepatitis B and C.
With regard to measures adopted to fulfill their obligations, the
Salvadoran State informed the Inter-American Commission that:
who have not begun the treatment plan will be notified by telegram to
appear at the Social Work Unit of the Oncology Hospital of the Salvadoran
Social Security Institute, ISSS. Following
this procedure, the liaison officer for Case 12.249, Mr. José Roberto Mejía
Trabanino, forwarded correspondence dated February 12, 2001 to Mr. Carlos
Rafael Urquilla, the legal representative of the petitioners.
Based on the arguments presented and the actions taken to provide
care to patients who are carriers of HIV/AIDS, the Salvadoran State
requests that the IACHR close this case.
Competence of the Inter-American Commission ratione
personae, ratione materiae, ratione temporis, and ratione
In this case, the petitioners describe the acts that purportedly
violate rights recognized and enshrined in the American Convention, which
allegedly occurred in El Salvador when the obligation to respect and
guarantee all the rights established in this instrument was in effect for
Consequently, the IACHR is competent ratione
personae, ratione materiae, ratione temporis, and ratione
loci to examine the merits of the case.
With regard to the allegations of the petitioners regarding
violation of Article 10 of the Protocol of San Salvador, the
Inter-American Commission notes that Article 19(6) of this instrument
states the following:
The IACHR is not competent ratione
materiae to determine independently, violations of Article 10 of the
Protocol of San Salvador through the system of individual petitions.
However, the Inter-American Commission can consider this Protocol
in the interpretation of other applicable provisions, in light of the
provisions of Articles 26 and 29 of the American Convention.
Other admissibility requirements of the petition
Exhaustion of domestic remedies
The Inter-American Court of Human Rights has established the
following with respect to the rule of prior exhaustion of domestic
Parties have an obligation to provide effective judicial remedies to
victims of human rights violations (Art. 25), remedies that must be
substantiated in accordance with the rules of due process of law (Art.
8(1), all in keeping with the general obligation of such States to
guarantee the free and full exercise of the rights recognized by the
Convention to all persons subject to their jurisdiction (Art. 1).
The information furnished by the two parties in this case confirms
that domestic remedies have not been exhausted in El Salvador.
In fact, the petitioners filed a petition for amparo
proceedings on April 28, 1999 with the Supreme Court of that country
seeking the provision of anti-retroviral medication for seropositive
patients. According to the
information furnished by the petitioners (which was not disputed by the
Salvadoran State), on June 15, 1999, the Constitutional Division of the
Supreme Court decided to accept the petition.
However, as of the date of this report, it had not handed down a
final ruling on the merits of the claim.
The petitioners allege that as a result of the delay on the part of
this Salvadoran legal entity, the exception provided for in Article
46(2)(c) of the American Convention is applicable.
The Salvadoran State confines itself to arguing that the
petitioners have had access to "adequate and effective domestic
remedies," without addressing the claims of the petitioners regarding
the reasonableness of the time period for making a decision related to
In the view of the IACHR, the petitioners had access to amparo
proceedings, the remedy offered by the domestic legal system in this case,
and they filed for these proceedings within the time period and in the
manner required. However, to
date, this remedy has not proven effective in responding to the claims of
alleged violation of human rights. Almost
two years have elapsed since the petition was filed and no final decision
has been handed down by the Salvadoran Supreme Court.
These matters will be analyzed during the procedural phase,
together with the other allegations pertaining to the right to a fair
trial and to effective judicial protection.
The Inter-American Commission decides to apply the exception
provided for in the second part of Article 46(2)(b) of the American
Convention to this case. The
reasons that prevented the exhaustion of domestic remedies will be
analyzed in the report to be adopted by the IACHR on the merits of the
case, in order to determine whether the American Convention was violated.
Time period for submission
The IACHR has noted that in this case, after almost two years, a
final ruling has not been handed down regarding the claim of the
petitioners in El Salvador, and has determined that an unjustified delay
has occurred in terms of domestic remedies.
The application of Article 46(2)(c) of the American Convention
obviates the need for analysis of the requirement set forth in Article
46(1)(b) of the aforementioned international instrument.
In the view of the Inter-American Commission, based on the
circumstances analyzed, the petition was submitted within a reasonable
time period of the date on which the acts were reported in El Salvador.
Duplication of proceedings and res
No objections were raised by the Salvadoran State to the exceptions
provided for in Article 46(1)(d) and Article 47(d) of the American
Convention, nor do they emerge from the information contained in the file
related to this case.
Characterization of the allegations
The petition outlines the events which, in the view of the
petitioners, violate several articles of the American Convention.
The petitioners maintain that in this case, the IACHR should
establish the international liability of the Salvadoran State for the
delay in providing the proper medication and treatment to the patients and
for the discrimination to which they were subjected.
The petition further alleges violation of the right to judicial
protection due to the failure on the part of the Supreme Court of El
Salvador to reach a decision on the petition for amparo
proceedings that they filed in that country to protect their rights.
In their allegations, the petitioners also mention the
inappropriate nature of amparo
proceedings in Salvadoran legislation for the protection of fundamental
In the view of the Inter-American Commission, these allegations
must be examined during the phase related to the merits of the case, in
order to determine whether the facts reported violated Articles 2, 24, 25,
and 26 of the American Convention. Consequently,
the IACHR concludes that the requirements set forth in Article 47(b) and
(c) of that international instrument have been met.
The Inter-American Commission considers the allegations made with
respect to Articles 4 and 5 of the American Convention to be secondary in
nature and to be contingent on the conclusion reached with respect to the
merits of the allegations mentioned in the foregoing paragraph.
Consideration of the admissibility of the allegations of the
petitioners regarding respect of the right to life and humane treatment
will therefore be deferred to the phase involving examination of the
merits of this case.
The Inter-American Commission concludes that it is competent to
examine the merits of this case and that the petition is admissible
pursuant to Articles 46 and 47 of the American Convention.
However, although it is not competent to determine violations of
Article 10 of the Protocol of San Salvador, the IACHR will take into
account the provisions related to the right to health in its analysis of
the merits of the case, pursuant to the provisions of Articles 26 and 29
of the American Convention.
The IACHR is aware of the fact that the people of El Salvador are
in the midst of a very difficult period brought on by a series of natural
disasters, which has placed enormous demands on the health authorities and
officials. In that context,
the Inter-American Commission appreciates the efforts of the Salvadoran
authorities to address the needs of persons infected with HIV/AIDS in that
country. The supply of
anti-retroviral medications has been steadily increasing in recent months,
and the State has announced that it will continue to adopt the measures
necessary in that regard.
Based on the arguments of fact and law outlined above, and without
prejudice to the merits of the case,
INTER-AMERICAN COMMISSION ON HUMAN RIGHTS
1. Declare this
case admissible with respect to alleged violation of the rights protected
under Articles 2, 24, 25, 26 of the American Convention.
2. Inform the
parties of this decision.
analysis of the merits of the case, and
4. Publish this
decision and include it in its Annual Report to the OAS General Assembly.
Done and signed at the headquarters of the Inter-American
Commission on Human Rights, Washington, D.C., March 7, 2001.
(Signed): Claudio Grossman, Chairman; Juan E. Méndez, First
Vice-Chairman; Marta Altolaguirre, Second Vice-Chair; Robert K. Goldman,
Peter Laurie, Julio Prado Vallejo, and Hélio Bicudo, Commission Members.
The petitioners have requested that the names of the other victims not
be disclosed; the Salvadoran State is informed of those names, which
are also in the IACHR file. As
of the date of adoption of this report, three of the alleged victims
The request for precautionary measures stated:
prejudice to other actions that your Government deems necessary, the
Commission holds the view that urgent measures should be adopted in
order to provide the medical care capable of safeguarding the life and
health of Jorge Odir Miranda Cortéz and the other persons listed
above. In particular, the
IACHR asks that your Government provided the anti-retroviral treatment
and medication necessary to avoid the death of the aforementioned
persons, as well as the hospital, pharmacological, and nutritional
care needed to strengthen their immune systems and to prevent the
development of diseases and infections.
from the IACHR to the Salvadoran State on February 29, 2000.
Among other things, the petitioners asserted that the two victims who
died on May 5 and 11, 2000, respectively, did not receive the
treatment from the State that would have avoided their deaths.
They reiterated the gravity and urgency of the situation, as
well as the request for provisional measures from the Inter-American
The communication from the State includes a copy of Agreement Nº
2000-0558 to the Board of Directors of the ISSS "authorizing the
purchase of medications used to provide anti-retroviral triple therapy
for persons who are insured and are carriers of HIV/AIDS" and
reported the establishment of "a fund of 13,610,516.00 million
colones during the current fiscal year," in addition to
"other measures to provide care to persons who were ill."
The measures described in the correspondence from the ISSS refer,
among other things, to "strengthening and stepping up activities
aimed at preventing the transmission of AIDS through education and the
promotion of hygiene and preventive health … among the sectors most
at risk for this disease" and "creating a fund aimed at
purchasing anti-retroviral medications for the provision of triple
therapy to HIV infected persons."
On January 13, 2001, an earthquake measuring 7.5 on the Richter Scale
occurred in the Pacific Ocean, 55 kilometers from El Salvador's
coasts. As a result,
hundreds were killed or missing and property damaged.
That day, the President of the Republic declared a state of
emergency, which was still in effect on the date of approval of this
report. This natural
disaster was followed by a series of earthquakes of varying levels of
intensity, which exacerbated the situation in the country.
Communication from the petitioners of January 24, 2000, para. 58.
Idem, para. 57.
Idem, para. 75.
Idem, paras. 78 and 79.
Idem, para. 93.
Based on their petition, the petitioners asked the IACHR to recommend
the following to the Salvadoran State, "at a minimum:"
and provide medication to all persons in need of it based on their
medical treatment plan; approve an AIDS law that gives persons living
with HIV/AIDS the right to medication; provide fair compensation to
the families of persons who have died as a result of the negligence of
the State; ensure that hospital practices are overhauled in order to
eliminate stigmatization of and discrimination against persons living
with HIV/AIDS; carry out informational campaigns on HIV/AIDS and the
prevention of infection including the promotion and use of condoms and
other barriers; amend fully the Law on Constitutional Procedures in
order to ensure that amparo
proceedings offer an effective judicial remedy; and acknowledgement of
the expenses arising from these proceedings.
from the petitioners of February 16, 2001, para.. 22.
Communication from the State of September 8, 2000, page 2.
In that regard, the State asserted:
term "victims" used by the representative of the claimants
is indeed insulting to these persons, and, in particular, is an
affront to their dignity, since the term used in these cases is
"patients or sick persons," which is consistent with the
general guidelines established for care to persons who are suffering
from HIV/AIDS. Once it is
contracted, the infected person will develop severe immunodeficiency,
and, for this reason, will be subject to opportunistic infections,
which may shorten his life. Therefore,
in this case, it cannot be concluded that the State is responsible for
the arbitrary deprivation of life, nor can it be held that the right
to health was violated because of the extent of its impact on patients
or the manner in which care was provided.
from the State dated December 6, 2000, page 2.
Communication from the State dated February 22, 2001, page 4.
The Salvadoran State deposited its instrument of ratification on June
Inter-American Court of Human Rights, Velásquez Rodríguez case,
Judgement on Preliminary Exceptions, June 26, 1989, para. 91.
In this regard, the Inter-American Court has stated:
certain exceptions to the rule of non-exhaustion of domestic remedies
are invoked, such as the ineffectiveness of such remedies or the lack
of due process of law, not only is it contended that the victim is
under no obligation to pursue such remedies, but, indirectly, the
State in question is also charged with a new violation of the
obligations assumed under the Convention. Thus, the question of
domestic remedies is closely tied to the merits of the case.
Court, Velásquez Rodríguez judgment supra,