CASE OF PATRANIN v. RUSSIA

1. The case originated in an application (no. 12983/14) against the Russian Federation lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Russian national, Mr Artem Grigoryevich Patranin (“the applicant”), on 8 February 2014.
2. The applicant was represented by Ms E. Gilmitdinova, a lawyer practising in Kazan. The Russian Government (“the Government”) were represented by Mr G. Matyushkin, Representative of the Russian Federation at the European Court of Human Rights.
3. The applicant alleged he had not benefited from adequate medical care in detention, had not had an effective remedy for his complaint about poor medical services, and that his right of individual application to the Court had been hindered.
4. On 12 February 2014 the President of the First Section, acting upon the applicant ’ s request, decided to apply Rules 39 and 41 of the Rules of Court, indicating to the Government that the applicant should be immediately examined by medical experts independent of the penal system, with a view to determining (1) whether the treatment he was receiving in the temporary detention facility was adequate for his condition; (2) whether his state of health was compatible with the conditions of his detention; and (3) whether his condition required his placement in a hospital.
5. On 15 May 2014 the application was communicated to the Government. Among other matters the Court asked the Government whether their response to the Court ’ s decision to impose, on 12 February 2014, an interim measure under Rule 39 of the Rules of Court could entail a breach of Article 34 of the Convention.
I. THE CIRCUMSTANCES OF THE CASE
6. The applicant was born in 1976 and is detained in correctional colony no. 2 in the Tatarstan Republic.
A. The applicant ’ s state of health
7. Since 1999 the applicant has been suffering from progressive multiple sclerosis. He was designated with Category 1 disability as a result of that condition.
8. On 22 February 2012 the applicant was arrested on suspicion of active membership of an organised criminal group between 1995 and 2005 and the murder or attempted murder of several people in 1999.
9. The applicant ’ s health deteriorated significantly and rapidly in the detention facility, where his health complaints were not addressed in any way, as the facility did not have any medical specialists. In August 2012 the prison authorities recorded that the applicant ’ s movement was impaired and that he was unable to walk without a cane.
10. In September 2012 the applicant suffered an epileptic seizure which resulted in paralysis of the left side of his body. Several days later an investigator authorised a forensic medical examination of the applicant to determine whether he was fit to stay in a detention facility. A medical examination, based, inter alia, on the results of an MRI exam performed by civilian experts from the Tatarstan Republic medical institute, led to the conclusion that the applicant was suffering from “a serious condition preventing his detention”. In particular, experts diagnosed him with progressive multiple sclerosis, left-sided hemiplegia ( paralysis) in the cerebral spinal form, acute right-sided hemiparesis ( muscle weakness of the right side of the body ) with the persistent astheno-depressive syndrome, memory deterioration, partial atrophy of the visual nerves, symptomatic epilepsy with polymorphic partial motor and generalised attacks three to four times a month, arterial hypertension of the first degree, and light myopathy of both eyes. On 25 September 2012 the applicant was released from detention.
11. On 29 May 2013 the Supreme Court of the Tatarstan Republic found the applicant guilty as charged and sentenced him to ten years ’ imprisonment, to be served in a correctional facility under a strict regime. The trial court, however, decided that the applicant should not be placed in custody pending appeal proceedings. On 3 September 2013 the Supreme Court of the Russian Federation upheld the judgment on appeal.
12. On 17 September 2013 the applicant asked the Supreme Court of the Tatarstan Republic to order a medical examination for him with a view to confirming that he was not fit for detention. The request was not processed.
13. The applicant was taken into custody on 8 October 2013. He was placed in a prison hospital in correctional colony no. 2 in the Tatarstan Republic.
14. In November 2013 the applicant underwent an MRI test and was examined by several doctors, including by a neurologist, from the prison hospital in correctional colony no. 2. Their decision issued on 23 November 2013 indicated that given the negative prognosis for and the severity of the applicant ’ s condition, he should be sent for a forensic medical examination to determine whether he could be released early on health grounds. The doctors relied, inter alia, on the results of the MRI examination, which had shown that in comparison to the results of the previous MRI exam in September 2012 the applicant ’ s illness had progressed significantly and demonstrated further negative dynamic. The applicant was informed by the prison administration that they would seek his immediate release on health grounds.
15. However, a week later the applicant was notified that an additional expert examination was to be performed. Two medical experts visited the applicant, spoke with him and informed him that his condition did not warrant release. On 20 January 2014 the applicant was served with a copy of an opinion by the two medical experts who had concluded that he did not suffer from any condition listed in Government Decree no. 54 of 6 February 2004 on illnesses warranting release on health grounds, as his condition had not yet reached the crucial stage which required early release.
16. Relying on a number of medical certificates and reports issued by medical specialists from civilian medical facilities, who had either treated him following his release from detention in September 2012 or had studied his medical history in 2013, the applicant argued that he was unable to care for himself and that he required constant assistance, care and medical treatment which the Russian penal system was not able to provide. In particular, a report issued in September 2013 by a neurologist from the Tatarstan Republican hospital indicated that the applicant had no movement on the left side of his body and could only partly move the fingers of his right hand and his right leg; he could not walk or sit without assistance; and he required assistance even if placed in a wheelchair. Another report indicated that the applicant was suffering from urethral dysfunction leading to involuntary urination, an additional element calling for constant care. The civilian doctors concluded that the stage of development of the applicant ’ s illness was 9 (with death expected to occur according to that scale at stage 10).
17. Having provided copies of his complaints to various Russian authorities, the applicant submitted that his requests for an independent medical examination to determine whether he could remain in detention, as well as his complaints about the lack of proper medical assistance, had gone unanswered.
18. The applicant argued that he spent his entire day in bed. Prison doctors, who had no proper training to deal with patients in his condition, came to see him only once every few days. He had not been bathed for months. He could not eat or drink unaided, so he received food once a day. He suffered from severe pain, as he could not defecate and the medical personnel only gave him an enema once every two weeks. He did not receive any treatment, and had not been seen in detention by specialists such as a neurologist.
19. On 12 February 2014 the Court, in response to the applicant ’ s request under Rule 39 of the Rules of Court, decided to indicate to the Government that the applicant should be examined immediately by medical experts independent of the penal system, including by a neurologist and an epileptologist. The experts were to be asked whether the treatment and physical care the applicant was receiving was adequate for his condition, whether his current state of health was compatible with detention in the conditions of a correctional colony or a prison hospital, and lastly whether the applicant ’ s current condition required him to be admitted to a specialised hospital or released. The Russian Government were also asked to ensure the applicant ’ s immediate transfer to a specialised hospital if the medical experts concluded that he required to be admitted to such a hospital.
20. In response to the Court ’ s request, the Government provided the Court with a typed copy of the applicant ’ s medical history prepared by the detention authorities; certificates issued by the head of the applicant ’ s correctional colony and the head of the Service for the Execution of Sentences in the Tatarstan Republic; and a copy of the report drawn up on 25 December 2013 by a medical panel comprising the head, deputy head and senior inspector of the medical unit of the Service for the Execution of Sentences in the Tatarstan Republic and a deputy head of the prison hospital of correctional colony no. 2, where the applicant was detained. Relying on those documents, the Government argued that the applicant was receiving adequate medical assistance and that the medical panel of the Service for the Execution of Sentences in the Tatarstan Republic had concluded that “the degree of the manifestation of the applicant ’ s condition (multiple sclerosis) did not [reach the level] which could be described as bodily function impairment” warranting release in compliance with the Government ’ s decree of 6 February 2004 which laid down a list of illnesses calling for inmates ’ early release.
21. The applicant commented on the Government ’ s information, insisting that the medical assistance afforded to him was virtually non ‑ existent. He relied on his medical record, and stated that prior to the application of the interim measure under Rule 39 of the Rules of Court he had been prescribed over twenty different drugs, of which, as indicated in the record, he had only received five. At the same time the applicant argued that the medical record was a forgery, as he had in fact only received one drug. Following the application of the interim measure he had been allowed to obtain certain medication from his wife to treat the epilepsy. He further submitted that the prison hospital where he was an inmate did not have the necessary medical equipment. He had usually been taken to another hospital for examinations, or a specialist with the proper equipment had been allowed to visit him in the prison hospital. The prison hospital only employed a neurologist, a specialist who, according to her own assessment, did not have the skill to treat the applicant ’ s complex condition. Despite the fact that the applicant ’ s condition was progressing and that the prognosis for him was negative, the authorities had not taken any steps to alleviate his sufferings and safeguard his life and limb.
C. Developments following the application of Rule 39 and communication of the case to the Government
22. The applicant submitted that since March 2014 he had developed new health problems, but the medical staff of the prison hospital had failed to address the ongoing deterioration of his health. In particular, he had begun suffering from kidney pain, but no nephrologist was available in the prison hospital. On 18 March 2014 the applicant was diagnosed with urinary tract infection, but no appropriate treatment followed. Several days later the applicant complained to an otolaryngologist of a purulent discharge from his left ear and severe pain. However, medical staff failed to comply with the otolaryngologist ’ s recommendations.
23. At the request of the applicant ’ s wife, on 18 April 2014 he was examined by a panel consisting of the deputy head of the prison hospital and several prison doctors. The commission found that the applicant did not suffer from bodily function impairment warranting his release.
24. On several occasions the applicant ’ s wife complained to the Prosecutor General and to the prison authorities, requesting an independent medical assessment. In their replies the authorities informed her that allegations of lack of adequate medical assistance had not been confirmed, and thus there were no grounds to order the applicant ’ s medical examination.
25. However, on 29 July 2014 a medical panel of the prison hospital, having confirmed the applicant ’ s earlier diagnosis, recommended his early release. In August 2014 the applicant ’ s wife lodged a motion for his release before the Privolzhskiy District Court of Kazan.
26. At the hearing held on 14 November 2014 the District Court heard the applicant ’ s attending prison doctor who stated that he had not and could not receive adequate treatment in respect of his multiple sclerosis in detention and that such treatment could only be provided in a specialised hospital, in particular in the Republican diagnostic centre of demyelinised illnesses. On the same day the District Court dismissed the motion for release. The applicant ’ s lawyer appealed.
27. In the meantime, on 15 December 2014 the applicant was transferred to correctional colony no. 9 in the Chuvashia Republic to continue serving his sentence. Three days later, following a visual medical examination, he was admitted to medical unit no. 21 in the colony which was to determine the issue whether the applicant ’ s condition called for his early release. According to the applicant, colony no. 9 did not employ a neurologist and had no means to deal with a patient of his health.
28. On 13 January 2015 the Supreme Court of the Tatarstan Republic quashed the decision of 14 November 2014 and sent the matter for a new examination to the District Court.
29. During the re- hearing on 19 February 2015 the Povolzhskiy District Court took note of the applicant ’ s transfer to a new colony and decided that it no longer had territorial jurisdiction to examine the applicant ’ s motion for release. The case was sent to the Tsivilsk Town Court in the Chuvashia Republic for further examination.
30. On 13 January 2015 a medical commission comprising three specialists from medical unit no. 21 issued a report finding that the applicant ’ s condition made him eligible for an early release. That report was filed with the Tsivilsk Town Court which on 26 February 2015 authorised the applicant ’ s release, having relied on the report of 13 January 2015 and statements by the head of medical unit no. 21. The latter had testified to the gravity of the applicant ’ s condition and the impossibility to provide him with adequate treatment or permanent general care and assistance in detention. The applicant was released on 11 March 2015 and taken by an ambulance to a hospital in Kazan.
2. Additional documents from the parties
31. The applicant provided the Court with expert opinions issued on 21 March and 5 August 2014 by neurologist M. from the Republican Medical Institute. Having examined the applicant and studied his medical file, the expert recorded negative dynamics in the applicant ’ s neurological condition, and found that he had not received the drugs necessary to treat his multiple sclerosis. The doctor recommended that the applicant undergo specific treatment in the Institute or in foreign hospitals, and noted that the lack of such treatment could lead to irreversible deterioration of the applicant ’ s health and eventually to his death.
32. The Government produced, in addition to the documents submitted by them in response to the Court ’ s Rule 39 request, a number of certificates signed by the staff and administration of the prison hospital, as well as by a fellow inmate. According to those certificates, the applicant was provided with the necessary care in the hospital. Medical staff fed him three times a day, washed his face and ears every morning, cut his hair and nails, changed his bedding, and showered him once a week. Nurses gave him enemas and changed his catheter bag as often as necessary.
Provisions governing the quality of medical care afforded to detainees
33. Russian law gives detailed guidelines for the provision of medical assistance to detained individuals. These guidelines, found in joint Decree no. 640/190 of the Ministry of Health and Social Development and the Ministry of Justice on the Organisation of Medical Assistance to Individuals Serving Sentences or Remanded in Custody (“the Regulation”), enacted on 17 October 2005, are applicable without exception to all detainees. In particular, section III of the Regulation sets out the initial steps to be taken by the medical staff of a detention facility on the admission of a detainee. On arrival at a temporary detention facility all detainees should have a preliminary medical examination before they are placed in a cell shared by other inmates. The aim of the examination is to identify individuals suffering from contagious diseases and those in need of urgent medical assistance. Particular attention should be paid to individuals suffering from contagious conditions. No later than three days after the detainee ’ s arrival at the detention facility he or she should receive an in ‑ depth medical examination, including an X-ray. During the in-depth examination a prison doctor should register the detainee ’ s complaints, study his medical and personal history, record any injuries and recent tattoos, and schedule additional medical procedures if necessary. A prison doctor should also authorise laboratory analyses to identify sexually transmitted diseases, HIV, tuberculosis and other illnesses.
34. Subsequently detainees should receive medical examinations at least twice a year or following a detainee ’ s complaints. If a detainee ’ s state of health has deteriorated, medical examinations and assistance should be provided by the detention facility medical staff. In such cases a medical examination should include a general check-up and additional tests, if necessary, with the participation of the relevant specialists. The results of the examinations should be recorded in the detainee ’ s medical file. The detainee should be given full information on the results of the medical examinations.
35. Section III of the Regulation also sets out the procedure to follow in the event that the detainee refuses to undergo a medical examination or treatment. For each refusal, an entry should be made in the detainee ’ s medical record. A prison doctor should give a full explanation to the detainee of the consequences of his refusal to undergo the medical procedure.
36. Any medicines prescribed for the detainee must be taken in the presence of a doctor. In a limited number of circumstances, the head of the detention facility medical department may authorise his medical staff to hand over a daily dose of medicines to the detainee to be taken unobserved.
37. The Internal Regulations of Correctional Institutions, in force since 3 November 2005, deal with every aspect of inmates ’ lives in correctional institutions. In particular, paragraph 125 of the Regulations provides that inmates who are willing and able to pay for it may receive additional medical assistance. In such a situation, medical specialists from a State or municipal civilian hospital are to be called to the medical unit of the correctional institution where the inmate is being detained.
38. Government Decree no. 54 of 6 February 2004 regulates medical examinations of convicts eligible for early release on health grounds. The same Decree contains a list of illnesses precluding a convict from serving the sentence. In particular, the Decree indicates that individuals suffering from progressive infectious, demyelinating and degenerative diseases of the central nervous system, accompanied by organic lesions of the dorsal and cervical brain with stable impairment of body functions (severe paralysis and paresis accompanied by reduced sensitivity, pelvic and trophic dysfunctions, or apparent akinetic-rigid syndrome) may be dispensed from serving the remainder of their sentences (§ 21).
III. RELEVANT INTERNATIONAL REPORTS AND DOCUMENTS
A. Recommendation Rec(2006)2 of the Committee of Ministers to member states on the European Prison Rules, adopted on 11 January 2006 at the 952nd meeting of the Ministers ’ Deputies (“the European Prison Rules”)
39. The European Prison Rules provide a framework of guiding principles for health services. The relevant extracts from the Rules read as follows:
39. Prison authorities shall safeguard the health of all prisoners in their care.
Organisation of prison health care
40.1 Medical services in prison shall be organised in close relation with the general health administration of the community or nation.
40.2 Health policy in prisons shall be integrated into, and compatible with, national health policy.
40.3 Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.
40.4 Medical services in prison shall seek to detect and treat physical or mental illnesses or defects from which prisoners may suffer.
40.5 All necessary medical, surgical and psychiatric services including those available in the community shall be provided to the prisoner for that purpose.
Medical and health care personnel
41.1 Every prison shall have the services of at least one qualified general medical practitioner.
41.2 Arrangements shall be made to ensure at all times that a qualified medical practitioner is available without delay in cases of urgency ...
41.4 Every prison shall have personnel suitably trained in health care.
Duties of the medical practitioner
42.1 A medical practitioner or a qualified nurse reporting to such a medical practitioner shall see every prisoner as soon as possible after admission, and shall examine them unless this is obviously unnecessary ...
42.3 When examining a prisoner the medical practitioner or a qualified nurse reporting to such a medical practitioner shall pay particular attention to ...
b. diagnosing physical or mental illness and taking all measures necessary for its treatment and for the continuation of existing medical treatment. ..
43.1 The medical practitioner shall have the care of the physical and mental health of the prisoners and shall see, under the conditions and with a frequency consistent with health care standards in the community, all sick prisoners, all who report illness or injury, and any prisoner to whom attention is specially directed ...
46.1 Sick prisoners who require specialist treatment shall be transferred to specialised institutions or to civilian hospitals when such treatment is not available in prison.
46.2 Where a prison service has its own hospital facilities, they shall be adequately staffed and equipped to provide the prisoners referred to them with appropriate care and treatment.”
B. 3 rd General Report of the European Committee for the Prevention of Torture (“the CPT Report”)
40. The complexity and importance of health-care services in detention facilities was discussed by the European Committee for the Prevention of Torture in its 3 rd General Report (CPT/Inf (93) 12 - Publication Date: 4 June 1993). The following are extracts from the Report:
“33. When entering prison, all prisoners should without delay be seen by a member of the establishment ’ s health care service. In its reports to date the CPT has recommended that every newly arrived prisoner be properly interviewed and, if necessary, physically examined by a medical doctor as soon as possible after his admission. It should be added that in some countries, medical screening on arrival is carried out by a fully qualified nurse, who reports to a doctor. This latter approach could be considered as a more efficient use of available resources.
It is also desirable that a leaflet or booklet be handed to prisoners on their arrival, informing them of the existence and operation of the health care service and reminding them of basic measures of hygiene.
34. While in custody, prisoners should be able to have access to a doctor at any time, irrespective of their detention regime ... The health care service should be so organised as to enable requests to consult a doctor to be met without undue delay ...
35. A prison ’ s health care service should at least be able to provide regular out ‑ patient consultations and emergency treatment (of course, in addition there may often be a hospital-type unit with beds) ... Further, prison doctors should be able to call upon the services of specialists.
As regards emergency treatment, a doctor should always be on call. Further, someone competent to provide first aid should always be present on prison premises, preferably someone with a recognised nursing qualification.
Out-patient treatment should be supervised, as appropriate, by health care staff; in many cases it is not sufficient for the provision of follow-up care to depend upon the initiative being taken by the prisoner.
36. The direct support of a fully-equipped hospital service should be available, in either a civil or prison hospital ...
38. A prison health care service should be able to provide medical treatment and nursing care, as well as appropriate diets, physiotherapy, rehabilitation or any other necessary special facility, in conditions comparable to those enjoyed by patients in the outside community. Provision in terms of medical, nursing and technical staff, as well as premises, installations and equipment, should be geared accordingly.
There should be appropriate supervision of the pharmacy and of the distribution of medicines. Further, the preparation of medicines should always be entrusted to qualified staff (pharmacist/nurse, etc.) ...
39. A medical file should be compiled for each patient, containing diagnostic information as well as an ongoing record of the patient ’ s evolution and of any special examinations he has undergone. In the event of a transfer, the file should be forwarded to the doctors in the receiving establishment.
Further, daily registers should be kept by health care teams, in which particular incidents relating to the patients should be mentioned. Such registers are useful in that they provide an overall view of the health care situation in the prison, at the same time as highlighting specific problems which may arise.
40. The smooth operation of a health care service presupposes that doctors and nursing staff are able to meet regularly and to form a working team under the authority of a senior doctor in charge of the service ... ”
I. ALLEGED BREACH OF ARTICLE 34 OF THE CONVENTION
41. The applicant complained that the Government ’ s failure to have his medical examination performed with a view to answering the three questions asked by the Court had been in breach of the interim measure indicated by the Court under Rule 39 and had thus violated Article 34 of the Convention, which reads as follows:
“The Court may receive applications from any person, non-governmental organisation or group of individuals claiming to be the victim of a violation by one of the High Contracting Parties of the rights set forth in the Convention or the Protocols thereto. The High Contracting Parties undertake not to hinder in any way the effective exercise of this right.”
Rule 39 of the Rules of Court provides:
“1. The Chamber or, where appropriate, its President may, at the request of a party or of any other person concerned, or of its own motion, indicate to the parties any interim measure which it considers should be adopted in the interests of the parties or of the proper conduct of the proceedings before it.
2. Where it is considered appropriate, immediate notice of the measure adopted in a particular case may be given to the Committee of Ministers.
3. The Chamber may request information from the parties on any matter connected with the implementation of any interim measure it has indicated.”
42. The Government submitted that there had been no violation of the applicant ’ s right under Article 34 by the correctional institutions of Tatarstan.
43. The applicant disagreed. He referred to principles established by the Court in cases pertaining to Article 34 of the Convention and Rule 39 of the Rules of the Court. He further pointed out that the authorities had failed to comply with the Court ’ s request under Rule 39 that he should be subjected to an examination by medical specialists independent of the penal system. The medical examination carried out in April 2014 had not been independent, and the commission had not included a neurologist or an epileptologist. The commission ’ s interpretation of the applicable domestic law had been erroneous, and their findings had not been in accordance with the medical evidence. The Government ’ s failure to immediately subject the applicant to an independent medical examination had stripped him of procedural guarantees under Article 34, since he had had no opportunity to rely on an independent expert report.
44. The applicant further submitted that after his case had been communicated to the Government staff of the correctional colony and the prison hospital had threatened him, to force him to withdraw his application before the Court. The applicant argued that such conduct had also constituted a violation of his right of individual petition.
45. The Court reiterates that, pursuant to Article 34 of the Convention, Contracting States undertake to refrain from any act or omission that may hinder the effective exercise of the right of individual application, and this has been consistently reaffirmed as a cornerstone of the Convention system (see Mamatkulov and Askarov v. Turkey [GC], nos. 46827/99 and 46951/99, § 102, ECHR 2005 ‑ I). Although the object of Article 34 is essentially that of protecting an individual against any arbitrary interference by the authorities, it does not merely compel States to abstain from such interference. In addition to this primarily negative undertaking, there are positive obligations inherent in Article 34 requiring the authorities to furnish all necessary facilities to make possible the proper and effective examination of applications. Such an obligation will arise in situations where applicants are particularly vulnerable (see Naydyon v. Ukraine, no. 16474/03, § 63, 14 October 2010; Savitskyy v. Ukraine, no. 38773/05, § 156, 26 July 2012; and Iulian Popescu v. Romania, no. 24999/04, § 33, 4 June 2013).
46. According to the Court ’ s established case-law, a respondent State ’ s failure to comply with an interim measure entails a violation of the right of individual application (see Mamatkulov and Askarov, cited above, § 125, and Abdulkhakov, cited above, § 222). The Court cannot emphasise enough the special importance attached to interim measures in the Convention system. Their purpose is not only to enable an effective examination of the application to be carried out, but also to ensure that the protection afforded to the applicant by the Convention is effective; such measures subsequently allow the Committee of Ministers to supervise the execution of the final judgment. Interim measures thus enable the State concerned to discharge its obligation to comply with the final judgment of the Court, which is legally binding by virtue of Article 46 of the Convention (see Mamatkulov and Askarov, cited above, § 125; Shamayev and Others v. Georgia and Russia, no. 36378/02, § 473, ECHR 2005 ‑ III; Aoulmi v. France, no. 50278/99, § 108, ECHR 2006 ‑ I; and Ben Khemais v. Italy, no. 246/07, § 82, 24 February 2009).
47. The crucial significance of interim measures is further highlighted by the fact that the Court issues them, as a matter of principle, only in truly exceptional cases and on the basis of a rigorous examination of all the relevant circumstances. In most of these cases the applicants face a genuine threat to life and limb, with the ensuing real risk of grave, irreversible harm in breach of the core provisions of the Convention. The vital role played by interim measures in the Convention system not only underpins their binding legal effect on the States concerned, as upheld by the established case-law, but also commands that the utmost importance be attached to the question of the States Parties ’ compliance with the Court ’ s indications in that regard (see, inter alia, the firm position on that point expressed by the States Parties in the Izmir Declaration and by the Committee of Ministers in Interim Resolution CM/ResDH(2010)83 in the above-mentioned case of Ben Khemais ). Any laxity on this question would unacceptably weaken the protection of the core rights in the Convention, and would not be compatible with its values and spirit (see Soering v. the United Kingdom, 7 July 1989, § 88, Series A no. 161); it would also be inconsistent with the fundamental importance of the right of individual petition and, more generally, undermine the authority and effectiveness of the Convention as a constitutional instrument of European public order (see Mamatkulov and Askarov, cited above, §§ 100 and 125, and, mutatis mutandis, Loizidou v. Turkey (preliminary objections), 23 March 1995, § 75, Series A no. 310).
48. Article 34 will be breached if the authorities of a Contracting State fail to take all steps which could reasonably be taken in order to comply with the interim measure indicated by the Court (see Paladi v. Moldova [GC], no. 39806/05, § 88, 10 March 2009). It is for the respondent Government to demonstrate to the Court that the interim measure was complied with or, in an exceptional case, that there was an objective impediment which prevented compliance and that the Government took all reasonable steps to remove the impediment and to keep the Court informed about the situation (see Paladi, cited above, § § 92-106, and Aleksanyan v. Russia, no. 46468/06, § § 228- 32, 22 December 2008, in which the Court concluded that the Russian Government had failed to honour their commitments under Article 34 of the Convention as a result of their failure to promptly transfer a seriously ill applicant to a specialised hospital and to subject him to an examination by a mixed medical panel including doctors of his choice, in disregard of an interim measure imposed by the Court under Rule 39 of the Rules of Court ).
49. The Court reiterates that it is of the utmost importance for the effective operation of the system of individual application instituted by Article 34 that applicants should be able to communicate freely with the Court without being subjected to any form of pressure from the authorities to withdraw or modify their complaints. In this context, “pressure” includes not only direct coercion and flagrant acts of intimidation, but also other improper indirect acts or contacts designed to dissuade or discourage applicants from using a Convention remedy. The issue of whether or not a disputed measure taken by authorities amounts to unacceptable practices from the standpoint of Article 34 must be determined in the light of the particular circumstances of the case (see, among other authorities, Poleshchuk v. Russia, no. 60776/00, § 31, 7 October 2004; Akdivar and Others v. Turkey, 16 September 1996, § 105, Reports of Judgments and Decisions 1996 ‑ IV; Aksoy v. Turkey, 18 December 1996, § 105, Reports 1996-VI; and Kurt v. Turkey, 25 May 1998, § 159, Reports 1998 ‑ III).
2. Application to the present case
50. Turning to the circumstances of the present case, the Court notes that on 12 February 2014 it indicated to the Russian Government, under Rule 39 of the Rules of Court, in the interests of the parties and the proper conduct of the proceedings before the Court, that the applicant should be immediately examined by medical experts independent of the penal system, including by a neurologist and an epileptologist. The experts were to be asked whether the treatment and physical care the applicant was receiving were adequate for his condition, whether his current state of health was compatible with detention in the conditions of a correctional colony or a prison hospital, and lastly whether the applicant ’ s current condition required him to be admitted to a specialised hospital or released. The Government responded by submitting a typed copy of the applicant ’ s medical history prepared by the detention authorities; certificates issued by the head of the applicant ’ s correctional colony and the head of the Service for the Execution of Sentences in the Tatarstan Republic; and a copy of the report drawn up on 25 December 2013 by a medical commission, comprising the head, a deputy head and a senior inspector of the medical unit of the Service for the Execution of Sentences in the Tatarstan Republic, and a deputy head of the prison hospital of correctional colony no. 2. The Government themselves also answered the three questions put forward by the Court.
51. Following the communication of the case, the Government insisted that they had fully complied with the interim measure. The Court is not convinced by the Government ’ s argument. It reiterates that the aim of the interim measure in the present case, as formulated in the Court ’ s decision of 12 February 2014, was to obtain an independent medical expert assessment of the state of the applicant ’ s health, the quality of the treatment he was receiving, and the adequacy of the conditions of his detention for his medical needs. That expert evidence was necessary to decide whether, as the applicant argued, his life and limb were at real risk as a result of the conditions of his detention, including the alleged lack of requisite medical care. In addition, the Court was concerned by the contradictory nature of the medical reports prepared by the applicant ’ s experts and those commissioned by the prison authorities, which the applicant submitted with his application and his request for an interim measure. The interim measure in the present case was therefore also meant to ensure that the applicant could effectively pursue his case before the Court (see, mutatis mutandis, Shtukaturov v. Russia, no. 44009/05, § 141, ECHR 2008).
52. Whilst the formulation of an interim measure is one of the elements to be taken into account in the Court ’ s analysis of whether a State has complied with its obligations under Article 34, the Court must have regard not only to the letter but also to the spirit of the interim measure indicated (see Paladi, cited above, § 91), and indeed to its very purpose. The main purpose of the interim measure, as indicated by the Court in the present case - and the Government did not pretend to be unaware of it - was to prevent the applicant ’ s exposure to inhuman and degrading suffering in view of his poor health and his remaining in the conditions of an ordinary detention facility that was unable to ensure that he received, as he argued, adequate medical assistance.
53. The report of 25 December 2013 was prepared by a medical commission which only included prison doctors. Although the Court is mindful of the fact that the three experts who comprised the medical commission worked for the Russian penal system and did not specialise in the medical fields relevant to the applicant ’ s major illnesses, it will not consider in detail the experts ’ independence or professional expertise and qualifications. It is more concerned with the fact that the aim of the expert examination, the result of which was set in the report, was to compare the applicant ’ s condition against the exhaustive list of illnesses provided for by the Governmental Decree, which could have warranted his early release. Having limited their assessment to the mere restatement of the applicant ’ s medical history, at no point during the examinations did the three doctors assess the applicant ’ s state of health independently from that list or evaluate whether his illnesses, separately or in combination, given their current symptoms, nature and duration, required additional, case-related medical procedures or even the applicant ’ s transfer to a specialised hospital. Nor did they pay any attention to the quality of the medical care he had been receiving while in detention, or the conditions in which he was being detained. The reports therefore have little relevance to the implementation of the interim measure indicated by the Court to the Russian Government in the present case.
54. The Court further observes that the Government themselves responded to the three questions put forward in the Court ’ s letter of 12 February 2014. The Court notes in this respect that in view of the vital role played by interim measures in the Convention system, they must be strictly complied with by the State concerned. The Court cannot conceive, therefore, of allowing the authorities to circumvent an interim measure such as the one indicated in the present case by replacing the medical expert opinion with their own assessment of the applicant ’ s situation. Yet, that is what the Government have done in the present case. In so doing, the State has frustrated the purpose of the interim measure, which sought to enable the Court, on the basis of a relevant independent medical opinion, to effectively respond to and, if need be, prevent the possible continuous exposure of the applicant to physical and mental suffering in violation of the guarantees of Article 3 of the Convention (see Salakhov and Islyamova v. Ukraine, no. 28005/08, § 222, 14 March 2013.
55. The Government did not demonstrate any objective impediment preventing compliance with the interim measure (see Paladi, cited above, § 92). Consequently, the Court finds that the State has failed to comply with the interim measure indicated by it in the present case under Rule 39 of the Rules of Court.
56. This finding is sufficient for the Court to find that the authorities failed to comply with their obligation under Article 34 of the Convention. Accordingly, the Court does not deem it necessary to deal with the applicant ’ s allegations of pressure put on him with the aim of making him withdraw his application.
II. ALLEGED VIOLATION OF ARTICLE 3 OF THE CONVENTION
57. The applicant complained that he was unable to obtain effective medical care while in detention, which had led to a serious deterioration in his condition, placed him in a life-threatening situation, and subjected him to severe physical and mental suffering, in violation of the guarantees of Articles 2 and 3 of the Convention.
58. The Court, being master of the characterisation to be given in law to the facts of the case, finds that these complaints cover the same ground, and thus finds it appropriate to examine the applicant ’ s allegations solely under Article 3 of the Convention, which reads as follows:
“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”
59. Having referred to the general principles laid down by the Court in a number of judgments concerning the standards of medical care of detainees, the Government stressed that the applicant had received comprehensive medical care in detention. They submitted that the hospital of correctional colony no. 2 had the equipment and medication necessary for the treatment of the applicant ’ s condition. He was properly diagnosed and was placed under dynamic supervision by well - qualified medical staff. His treatment regime was regularly adjusted following the recommendations of doctors who were not employed by the detention facilities, i.e. civil specialists. The authorities were mindful of the applicant ’ s situation and tried to improve the conditions of his detention.
60. The applicant disagreed. He noted that he had only received one drug instead of some thirty drugs prescribed to him. The equipment necessary to diagnose and treat his disease was unavailable at the hospital, and the hospital neurologist did not have the necessary medical qualifications. The applicant further submitted that the information provided by the Government was inaccurate. In particular, he observed that the copy of his medical file did not contain information about his epileptic seizures. The applicant insisted that physical care had been mostly provided to him by other detainees, who had regularly changed his catheter bag and had showered him. Despite the fact that the applicant ’ s condition progressed and that the prognosis for him was negative, the authorities had not taken any steps to alleviate his sufferings and safeguard his life and limb.
61. The Court notes that the applicant ’ s complaint pertains to two distinct periods of his detention. The first period started on 22 February 2012, when the applicant was arrested, and ended on 25 September 2012, when he was released on health grounds. The Court observes that the application was lodged before the Court more than six months after the end of the first period. It follows that this part of the application is inadmissible for non-compliance with the six-month rule.
62. The second period of the applicant ’ s detention started on 8 October 2013, when he was again taken into custody and was placed in correctional colony no. 2. It ended with his release on 11 March 2015. The Court notes that this complaint is not manifestly ill-founded within the meaning of Article 35 § 3 (a) of the Convention and that it is not inadmissible on any other grounds. It must therefore be declared admissible.
(i) As to the Court ’ s evaluation of the facts and burden of proof
63. In cases in which there are conflicting accounts of events, the Court is inevitably confronted, when establishing the facts, with the same difficulties as those faced by any first-instance court. It reiterates that, in assessing evidence, it has adopted the standard of proof “beyond reasonable doubt”. However, it has never been its purpose to borrow the approach of the national legal systems that use that standard. Its role is to rule not on criminal guilt or civil liability but on Contracting States ’ responsibility under the Convention. The specificity of its task under Article 19 of the Convention – to ensure the observance by the Contracting States of their engagement to secure the fundamental rights enshrined in the Convention ‑ conditions its approach to the issues of evidence and proof. In proceedings before the Court there are no procedural barriers to the admissibility of evidence or pre-determined formulae for its assessment. It adopts conclusions that are, in its view, supported by the free evaluation of all evidence, including such inferences as may flow from the facts and the parties ’ submissions. In accordance with its established case-law, proof may follow from the coexistence of sufficiently strong, clear and concordant inferences or of similar unrebutted presumptions of fact. Moreover, the level of persuasion necessary for reaching a particular conclusion and, in this connection, the distribution of the burden of proof, are intrinsically linked to the specificity of the facts, the nature of the allegation made and the Convention right at stake. The Court is also attentive to the seriousness that attaches to a ruling that a Contracting State has violated fundamental rights (see Creangă v. Romania [GC], no. 29226/03, § 88, 23 February 2012, and the cases cited therein).
64. Furthermore, it should be pointed out that Convention proceedings do not in all cases lend themselves to a strict application of the principle affirmanti incumbit probatio. The Court reiterates its case-law under Articles 2 and 3 of the Convention to the effect that where the events at issue lie within the exclusive knowledge of the authorities, as in the case of persons under their control in custody, strong presumptions of fact will arise in respect of injuries, damage and death occurring during that detention. The burden of proof in such a case may be regarded as resting on the authorities to provide a satisfactory and convincing explanation (see Çakıcı v. Turkey [GC], no. 23657/94, § 85, ECHR 1999-IV; Salman v. Turkey [GC], no. 21986/93, § 100, ECHR 2000-VII; and Oleg Nikitin v. Russia, no. 36410/02, § 45, 9 October 2008). In the absence of such an explanation the Court can draw inferences which may be unfavourable for the respondent Government (see, for instance, Orhan v. Turkey, no. 25656/94, § 274, 18 June 2002, and Buntov v. Russia, no. 27026/10, § 161, 5 June 2012 ).
(ii) As regards the application of Article 3 and standards of medical care for detainees
65. The Court reiterates that Article 3 of the Convention enshrines one of the most fundamental values of a democratic society. It prohibits in absolute terms torture or inhuman or degrading treatment or punishment, irrespective of the circumstances and the victim ’ s behaviour (see, for example, Labita v. Italy [GC], no. 26772/95, § 119, ECHR 2000-IV). Ill ‑ treatment must, however, attain a minimum level of severity if it is to fall within the scope of Article 3. The assessment of this minimum is relative: it depends on all the circumstances of the case, such as the duration of the treatment, its physical and mental effects and, in some cases, the sex, age and state of health of the victim (see, among other authorities, Verbinţ v. Romania, no. 7842/04, § 63, 3 April 2012, with further references).
66. Ill-treatment that attains such a minimum level of severity usually involves actual bodily injury or intense physical or mental suffering. However, even in the absence of these, where treatment humiliates or debases an individual, showing a lack of respect for or diminishing his or her human dignity, or arouses feelings of fear, anguish or inferiority capable of breaking an individual ’ s moral and physical resistance, it may be characterised as degrading and also fall within the prohibition of Article 3 (see Pretty v. the United Kingdom, no. 2346/02, § 52, ECHR 2002-III, with further references).
67. The State must ensure that a person is detained in conditions which are compatible with respect for human dignity, that the manner and method of the execution of the measure of deprivation of liberty do not subject him to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention and that, given the practical demands of imprisonment, his health and well-being are adequately secured (see Kudła v. Poland [GC], no. 30210/96, §§ 92-94, ECHR 2000-XI, and Popov v. Russia, no. 26853/04, § 208, 13 July 2006). In most cases concerning the detention of persons who are ill, the Court has examined whether or not the applicant received adequate medical assistance in prison. The Court reiterates in this regard that even though Article 3 does not entitle a detainee to be released “on compassionate grounds”, it has always interpreted the requirement to secure the health and well-being of detainees, among other things, as an obligation on the State to provide detainees with the requisite medical assistance (see Kudła, cited above, § 94; Kalashnikov v. Russia, no. 47095/99, § 95, ECHR 2002-VI; and Khudobin v. Russia, no. 59696/00, § 96, ECHR 2006-XII (extracts)).
68. The “adequacy” of medical assistance remains the most difficult element to determine. The Court insists that, in particular, authorities must ensure that diagnosis and care are prompt and accurate (see Hummatov v. Azerbaijan, nos. 9852/03 and 13413/04, § 115, 29 November 2007; Yevgeniy Alekseyenko v. Russia, no. 41833/04, § 100, 27 January 2011; Gladkiy v. Russia, no. 3242/03, § 84, 21 December 2010; Khatayev v. Russia, no. 56994/09, § 85, 11 October 2011; and, mutatis mutandis, Holomiov v. Moldova, no. 30649/05, § 121, 7 November 2006), and that, where necessitated by the nature of a medical condition, supervision is regular and systematic and involves a comprehensive therapeutic strategy aimed at adequately treating the detainee ’ s health problems or preventing their aggravation (see Hummatov, cited above, §§ 109 and 114; Sarban v. Moldova, no. 3456/05, § 79, 4 October 2005; and Popov, cited above, § 211).
69. On the whole, the Court reserves sufficient flexibility in defining the required standard of health care, deciding it on a case-by-case basis. That standard should be “compatible with the human dignity” of a detainee, but should also take into account “the practical demands of imprisonment” (see Aleksanyan v. Russia, no. 46468/06, § 140, 22 December 2008).
(b) Application of the above principles to the present case
70. Turning to the circumstances of the present case, the Court observes that the applicant is almost totally paralysed and suffers from multiple sclerosis and epilepsy. Relying on a large number of expert opinions, the applicant argued that his condition was extremely serious, or even life ‑ threatening, particularly given that he had not received adequate medical care in detention. He submitted that neither the quality nor the quantity of the medical services he had been provided with corresponded to his needs. In addition, he had been left in unsanitary conditions and without appropriate physical care, which had further aggravated his state of health.
71. The Government disagreed. They drew the Court ’ s attention to the reports prepared by doctors from the prison hospital, as well as the medical certificates issued by the Russian prison authorities. They insisted that the applicant was not suffering from any of the serious illnesses listed in the Governmental Decree, that his condition did not therefore call for his early release, and that the quality of the medical services afforded to him was beyond reproach.
72. The Court has already stressed its difficult task of evaluating the contradictory and even mutually exclusive evidence submitted by the parties in the present case. Its task has been further complicated by the need to assess evidence calling for expert knowledge in various medical fields. In this connection it emphasises that it is sensitive to the subsidiary nature of its role, and recognises that it must be cautious in taking on the role of a first-instance tribunal of fact, where this is not rendered unavoidable by the circumstances of a particular case (see McKerr v. the United Kingdom (dec.), no. 28883/95, 4 April 2000). Nonetheless, where allegations are made under Article 3 of the Convention the Court must apply a “particularly thorough scrutiny” (see, mutatis mutandis, Ribitsch v. Austria, 4 December 1995, § 32, Series A no. 336, and Georgiy Bykov v. Russia, no. 24271/03, § 51, 14 October 2010).
73. The Court has examined a large number of cases against Russia raising complaints of inadequate medical services afforded to inmates (see, among the most recent ones, Koryak v. Russia, no. 24677/10, 13 November 2012; Dirdizov v. Russia, no. 41461/10, 27 November 2012; Reshetnyak v. Russia, no. 56027/10, 8 January 2013; Mkhitaryan v. Russia, no. 46108/11, 5 February 2013; Gurenko v. Russia, no. 41828/10, 5 February 2013; Bubnov v. Russia, no. 76317/11, 5 February 2013; Budanov v. Russia, no. 66583/11, 9 January 2014; and Gorelov v. Russia, no. 49072/11, 9 January 2014 ). In the absence of an effective remedy in Russia to air those complaints, the Court has been obliged to perform a first ‑ hand evaluation of the evidence before it to determine whether the guarantees of Articles 2 or 3 of the Convention had been respected. In that role, paying particular attention to the vulnerability of applicants in view of their detention, the Court has called on the Government to provide credible and convincing evidence showing that the applicant concerned had received comprehensive and adequate medical care in detention.
74. Coming back to the medical reports and opinions submitted by the applicant in the present case, the Court is satisfied that there is prima facie evidence in favour of his submissions, and that the burden of proof should shift to the respondent Government.
75. Having regard to its findings under Article 34 of the Convention, the Court considers that it can draw inferences from the Government ’ s conduct and is ready to apply a particularly thorough scrutiny to the evidence submitted by them in support of their position. It therefore finds that the Government have failed to demonstrate conclusively that the applicant received effective medical treatment for his illnesses while in detention. The evidence submitted by the Government is unconvincing and insufficient to rebut the applicant ’ s account of the treatment to which he was subjected in detention. In such circumstances, the Court will proceed with the examination of the case, attaching particular weight to the medical evidence and expert opinions submitted by the applicant in support of his position. It also takes account of the statements made by the applicant ’ s attending doctors or other medical specialists, including those working for the Russian penitentiary facilities, who on several occasions confirmed the impossibility for the applicant to receive adequate treatment for his multiple sclerosis while in detention.
76. The Court thus finds that the applicant was left without the medical assistance vital for his illnesses, primarily for his multiple sclerosis, a very serious condition threatening his life. It is aware that with multiple sclerosis being an incurable condition, treatment of such patients typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing symptoms to alleviate the patients ’ sufferings. In the applicant ’ s case, the treatment he received was incomplete and the medical supervision afforded to him was insufficient to maintain his health. There was no thorough and continuous evaluation of his condition or adequate diagnosis in response to the increasing number of his health-related complaints. It appears that during the entire period of his detention the applicant had no more than two MRI exams. The Government was not able to cite any additional diagnostic procedures which could have in detail recorded the progress of the applicant ’ s condition and permitted a timely response to the aggravation of his illness. The medical personnel of the detention facilities took no steps to address his concerns or to apply the recommendation of the experts commissioned by the applicant. The Court is particularly concerned that the applicant did not receive the complete drug regimen. Without going into the issue of the medical record forgery, the Court finds that administering of merely a quarter of the prescribed medicines to the applicant was clearly insufficient to address his needs. It also did not find any evidence that at any point during the applicant ’ s detention prison doctors significantly amended or extended his chemotherapy to modify the progress of the disease. There is also unconvincing evidence that prison doctors effectively addressed the applicant ’ s associated effects of the multiple sclerosis, such as pain and bladder control problems, or comprehensively dealt with yet another of the applicant ’ s illnesses, epilepsy. It does not escape the Court ’ s attention that even the physical therapy, so needed for the treatment of the applicant ’ s movement problems, was not provided. The poor quality of the medical services was accentuated by the fact that the applicant was kept in unsanitary detention conditions susceptible to further aggravating his state of health. The Court believes that, as a result of the lack of comprehensive and adequate medical treatment, the applicant was exposed to prolonged mental and physical suffering that diminished his human dignity. The authorities ’ failure to provide the applicant with the medical care he needed amounted to inhuman and degrading treatment within the meaning of Article 3 of the Convention.
77. Accordingly, there was a violation of Article 3 of the Convention.
III. ALLEGED VIOLATION OF ARTICLE 13 OF THE CONVENTION
78. The applicant claimed that he had not had at his disposal an effective remedy to complain about the lack of the adequate medical assistance, as required under Article 13 of the Convention, which reads as follows :
“Everyone whose rights and freedoms as set forth in [the] Convention are violated shall have an effective remedy before a national authority ... ”
79. The Government argued that the applicant had failed to submit any complaints of lack of effective medical care to the Russian courts. He had also failed to challenge in court the authorities ’ refusal to order his medical examination. The Government requested the Court to dismiss the complaint for non-exhaustion of domestic remedies.
80. The applicant maintained his claims. He submitted that on several occasions he and his wife had complained to the prison hospital authorities and to prosecutors and courts, seeking an independent medical examination with a view to determining whether his condition was compatible with detention. The applicant argued that none of the remedies suggested by the Government were effective.
81. The Court considers that the Government ’ s objection as to exhaustion of domestic remedies is closely linked to the substance of the complaint under Article 13 of the Convention and should, therefore, be joined to the merits. The Court further notes that this complaint is not manifestly ill-founded within the meaning of Article 35 § 3 (a) of the Convention and that it is not inadmissible on any other grounds. It must therefore be declared admissible.
82. The Court reiterates that Article 13 guarantees the availability at national level of a remedy to enforce the substance of the Convention rights and freedoms in whatever form they might happen to be secured in the domestic legal order. The effect of this Article is thus to require the provision of a domestic remedy allowing the competent national authority both to deal with the substance of an “arguable” complaint under the Convention and to grant appropriate relief (see, as a classic reference, Boyle and Rice v. the United Kingdom, 27 April 1988, § 54, Series A no. 131).
83. The scope of the Contracting States ’ obligations under Article 13 varies depending on the nature of the applicant ’ s complaint; the “effectiveness” of a “remedy” within the meaning of Article 13 does not depend on the certainty of a favourable outcome for the applicant. At the same time, the remedy required by Article 13 must be “effective” in practice as well as in law, in the sense either of preventing the alleged violation or its continuation, or of providing adequate redress for any violation that has already occurred (see Kudła, cited above, §§ 157-58, and Wasserman v. Russia (no. 2), no. 21071/05, § 45, 10 April 2008).
84. Where the fundamental right to protection against torture and inhuman and degrading treatment is concerned, the preventive and compensatory remedies have to be complementary in order to be considered effective. The existence of a preventive remedy is indispensable for the effective protection of individuals against the kind of treatment prohibited by Article 3 of the Convention. Indeed, the particular importance attached by the Convention to that provision requires, in the Court ’ s view, that the States Parties establish, over and above a compensatory remedy, an effective mechanism in order to put an end to any such treatment rapidly. Had it been otherwise, the prospect of future compensation would have legitimised particularly severe suffering in breach of this core provision of the Convention (see Vladimir Romanov v. Russia, no. 41461/02, § 78, 24 July 2008).
85. Turning to the facts of the present case, the Court notes the Government ’ s argument that the applicant did not attempt to make use of any avenues for exhausting remedies whereas the documents produced by the applicant show that on numerous occasions he and his wife drew the attention of the penitentiary authorities, prosecutors and courts to the applicant ’ s state of health.
86. However, the Court observes that its task in the present case is to examine the effectiveness of the various domestic remedies suggested by the Russian Government, and not merely to determine whether the applicant made his grievances sufficiently known to the Russian authorities. In this connection, the Court reiterates that it has on many occasions examined the effectiveness of the domestic remedies suggested by the Government in cases of applicants complaining of ongoing inadequate medical treatment, such as in the present case. It found, in particular, that in deciding on a complaint concerning breaches of domestic regulations governing the provision of medical care to detainees, the prison authorities would not have a sufficiently independent standpoint to satisfy the requirements of Article 35 of the Convention (see Koryak v. Russia, no. 24677/10, § 79, 13 November 2012, and Dirdizov v. Russia, no. 41461/10, § 75, 27 November 2012 ). The Court also stressed that even though review by a supervising prosecutor plays an important part in securing appropriate medical care in detention, a complaint to the supervising prosecutor falls short of the requirements of an effective remedy, because of the procedural shortcomings that have been previously identified in the Court ’ s case-law (see Koryak, § 8 0 -81, cited above). Having assessed a civil claim for compensation under the tort provisions of the Civil Code, the Court considered that such a claim could not offer an applicant any other redress than a purely compensatory award, and could not put an end to a situation where there is an ongoing violation, such as inadequate medical care (see Reshetnyak v. Russia, no. 56027/10, § § 65-73, 8 January 2013). Moreover, the Court found that such a remedy did not offer reasonable prospects of success, in particular because the award was conditional on the establishment of fault on the part of the authorities, which was extremely improbable in a situation where domestic legal norms prescribed the application of a certain measure, for instance certain conditions of detention or level of medical treatment (see A.B. v. Russia, no. 1439/06, § 96, 14 October 2010 ).
87. In the light of the above considerations, the Court sees no reason to depart from its previous findings, and concludes that the legal avenues put forward by the Government did not constitute an effective remedy that could have been used to prevent the alleged violations or their continuation and provide the applicant with adequate and sufficient redress for his complaints under Article 3 of the Convention.
88. Accordingly, the Court rejects the Government ’ s objection as to the exhaustion of domestic remedies and finds that the applicant did not have at his disposal an effective domestic remedy for his complaint, in breach of Article 13 of the Convention.
IV. APPLICATION OF ARTICLE 41 OF THE CONVENTION
89. Article 41 of the Convention provides:
“If the Court finds that there has been a violation of the Convention or the Protocols thereto, and if the internal law of the High Contracting Party concerned allows only partial reparation to be made, the Court shall, if necessary, afford just satisfaction to the injured party.”
90. The applicant claimed 100,000 euros (EUR) in respect of pecuniary damage, on account of the expenses he would incur after his eventual release to undergo treatment in foreign hospitals.
91. The Government submitted that the claims were unsubstantiated and speculative.
92. Finding no causal link between the damage claimed and the compensation claimed by the applicant, the Court rejects this claim in full.
93. The applicant claimed EUR 50,000 in respect of non-pecuniary damage.
94. The Government submitted that this claim was excessive.
95. The Court, making its assessment on an equitable basis, considers it reasonable to award the applicant EUR 15,0 00 in respect of non-pecuniary damage, plus any tax that may be chargeable.
96. The applicant also claimed 60,567 Russian roubles (RUB) (approximately EUR 900) for costs and expenses incurred before the Court on account of legal representation and postal services.
97. The Government argued that the claim was ill-founded.
98. According to the Court ’ s case-law, an applicant is entitled to the reimbursement of costs and expenses only in so far as it has been shown that these have been actually and necessarily incurred and are reasonable as to quantum. In the present case, regard being had to the documents in its possession and the above criteria, the Court considers it reasonable to award the sum claimed in full, together with any tax that may be chargeable to him on that amount.
99. The Court considers it appropriate that the default interest rate should be based on the marginal lending rate of the European Central Bank, to which should be added three percentage points.