CEDH · CASELAW;JUDGMENTS;COMMITTEE;ENG — 19 janvier 2017

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UKRAINE   (Application no. 4772/06)                   JUDGMENT         STRASBOURG   19 January 2017         This judgment is final but it may be subject to editorial revision. In the case of Komarov v. Ukraine, The European Court of Human Rights (Fifth Section), sitting as a Committee composed of:   André Potocki, President,   Ganna Yudkivska,   Síofra O’Leary, judges, and Anne-Marie Dougin, Acting Deputy Section Registrar, Having deliberated in private on 13 December 2016, Delivers the following judgment, which was adopted on that date: PROCEDURE 1.     The case originated in an application (no. 4772/06) against Ukraine lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Ukrainian national, Mr Vladimir Georgiyevich Komarov (“the applicant”), on 16 January 2006. 2.     The Ukrainian Government (“the Government”) were represented by their Agents, most recently Mr I. Lishchyna of the Ministry of Justice. 3.     The applicant alleged that he had not received adequate medical care in detention, that the conditions of his pre-trial detention had been inhuman, that his defence rights had been violated, and that his son had been unlawfully detained between 13 and 14 September 2003. 4.     On 26 June 2012 the application was communicated to the Government. THE FACTS I.     THE CIRCUMSTANCES OF THE CASE 5.     The applicant, a former police officer, was born in 1962 and lives in Zaporizhzhya. He is also acting on behalf of his son, V., who was born in 1991. A.     Criminal proceedings against the applicant 6.     On 13 September 2003 four people, including the applicant, were apprehended by officers of the Zaporizhzhya office of the Security Service of Ukraine ( Служба Безпеки України – “the SBU”) in Novokateshchino village while attempting to transport opiate drugs with a view to selling them on. They were taken to the SBU’s premises for questioning. After being informed of his privilege against self-incrimination, the applicant made a written statement to the effect that he had appeared at the crime scene by chance, at the request of a friend with whom he and his son had been looking for a place to fish. 7.     Later the same day criminal proceedings were instituted against the applicant and two other people on suspicion of illegal production, storage and sale of drugs. 8.     On 14 September 2003 criminal proceedings were instituted against the applicant and the two others on suspicion of membership of an organised crime group. 9.     On the same date the applicant was arrested. Having been informed of his procedural rights as a suspect, he refused to give evidence without a lawyer present. 10.     On 15 September 2003 the applicant’s wife hired a lawyer, G., to represent the applicant. 11.     On 16 September 2003 the applicant’s pre-trial detention was ordered by a court. 12.     On 19 September 2003 the applicant requested that G. be admitted to the proceedings as his lawyer. 13.     On the same date, in the presence of his lawyer, the applicant denied his involvement in the crime. 14.     On 23 September 2003, in the presence of his lawyer, the applicant was charged with drug-related crimes and questioned. He did not want to be informed of his rights and stated that he would not give any evidence during the pre-trial investigation. 15.     On 2 October 2003 the applicant was questioned in the presence of his lawyer. He provided some biographical details as well as information on his family status, state of health and place of residence. 16.     On 18 November 2003 the applicant was again questioned in the presence of his lawyer. 17.     On 15 December 2003 all the criminal proceedings against the applicant were joined. 18.     On 18 December 2003 the applicant was questioned in the presence of his lawyer. He did not confess to the crimes. 19.     On 22 and 23 December 2003 confrontations between the applicant and his co-accused were conducted with his lawyer present. 20.     On 24 December 2003 amended charges were brought against the applicant in his lawyer’s presence. The applicant pleaded not guilty. 21.     On 6 February 2004 the applicant’s wife was admitted to the proceedings as the applicant’s lay representative. 22.     On 10 February 2004, upon his written consent, the applicant was questioned without a lawyer. 23.     On 9 March 2004 the criminal case against the applicant and his co ‑ accused was sent to the Leninsky District Court of Zaporizhzhya (“the District Court”). During the trial the applicant pleaded not guilty. He maintained that the case had been fabricated by his enemies and that all the evidence had been falsified and was inadmissible. In fact, he, a retired police officer, had been arrested in the company of drug addicts with whom he had been in contact as an advisor to the local police. They might have been producing drugs for their own use. He further claimed that his case should benefit from being examined in camera by a judge who had security clearance, to protect State secrets concerning the functioning of his network of informants. 24.     In May 2004 F., a lawyer hired by the applicant’s wife, was admitted to the proceedings to represent the applicant. 25.     On 25 October 2005, after having heard the case in public hearings, the District Court convicted the applicant and his co-defendants of drug ‑ related offences. The applicant was sentenced to eight-and-a-half years’ imprisonment and the confiscation of his personal property was ordered. 26.     The applicant, represented by his lawyer and his wife, appealed. He repeated his arguments advanced at trial and complained that he had been unable to defend himself properly during the trial as he had been reticent in order to safeguard confidential information concerning the network of informants. He also complained of various procedural breaches in the collection of evidence. He alleged, with no further details, that he had had no access to a lawyer from the first questioning and, even after his lawyer had been allowed access, the authorities had tried to carry out a number of investigative steps without the lawyer present. 27.     On 26 April 2006 the Zaporizhya Regional Court of Appeal allowed the defence’s request to have the proceedings held in camera to prevent public disclosure of information concerning the network of informants and required all the defence lawyers and representatives to undergo security clearance to continue taking part in the proceedings. The applicant’s wife did not receive security clearance in time for the appeal hearing and did not attend it. 28.     On 22 June 2006 the Court of Appeal upheld the trial court’s judgment. 29.     On 18 December 2007, following a prior appeal by the applicant, the Supreme Court of Ukraine quashed this decision and remitted the case for fresh consideration. It noted, in particular, that the applicant’s right to defence had been breached since the applicant’s wife had been unable to take part in the appeal hearing. It further found that the Court of Appeal had addressed the parties’ arguments in a summary way only, while it should have given detailed explanations in response to those arguments. 30.     On 22 December 2008 the Court of Appeal reviewed the case in the presence of the applicant’s wife. It upheld the applicant’s conviction, reduced his sentence to eight years’ imprisonment and ordered the confiscation of his personal property. The conviction was mainly based on the records of the crime-scene inspection and the testimonies of the applicant’s co-defendants, which the trial court found to be corroborated by witness statements, and other evidence in the case. 31.     On 2 July 2009 the Supreme Court of Ukraine rejected the applicant’s request for leave to appeal on points of law. B.     Events related to the applicant’s son 32.     The applicant’s twelve-year-old son was with him when he was apprehended on 13 September 2003. He was taken with him to the SBU and remained in the same room with the applicant for most of the time. No other family members were informed of the boy’s whereabouts. 33.     On the morning of 14 September 2014, after the applicant had been formally arrested, his son was returned to his mother. 34.     On 3 January 2004 the applicant’s wife lodged a criminal complaint with the Zaporizhzhya regional prosecutor’s office (“the prosecutor’s office”) in which she alleged, inter alia , that her son had been unlawfully detained at the SBU’s premises between 13 and 14 September 2003. 35.     On 9 February 2004, having questioned the applicant and the SBU officers, the prosecutor refused to institute criminal proceedings as it had been established that no pressure had been applied to the applicant’s son and that he had been able to move freely and had not been deprived of his liberty. It was further noted that the applicant had not complained of the SBU staff’s attitude towards his son. 36.     On 20 April 2004 the applicant’s son challenged the above decision before the Prosecutor General. 37.     In April 2004 the applicant and his wife lodged another complaint concerning the alleged unlawful detention of their son with the prosecutor’s office. 38.     On 7 May 2004 the prosecutor’s office, having questioned the applicant, his wife and son, as well as the SBU officers and some witnesses, refused to institute criminal proceedings in respect of the above complaint, having found no corpus delicti in the officers’ actions. It was established during the relevant investigation that the applicant’s son had been taken to the SBU’s premises at the applicant’s request and had not been arrested or detained and had been returned to his relatives as soon as the decision to arrest the applicant had been taken; and that the applicant had raised no complaints during his son’s stay at the SBU. It was also noted in the relevant resolution that the applicant’s wife had refused to provide her son’s medical file to prove her allegations concerning the worsening of his state of health and that there had been a contradiction in the applicant’s statements and between his and his son’s account of events. The prosecutor thus concluded that the allegations of unlawful deprivation of liberty or of other violations of the applicant’s son’s rights appeared to be ill-founded. He noted that no intention on the part of the officers to interfere with the applicant’s son’s personal security, specifically his freedom of movement, had been established. Likewise, there had been no evidence that the applicant’s son had been subject to any form of pressure or ill-treatment. 39.     On 11 May 2004 the applicant’s wife and son instituted civil proceedings against the SBU before the Zhovtnevy District Court of Zaporizhzhya claiming damages for the unlawful detention of her son. Following a request of the applicant’s wife of 15 October 2004, her civil claim was joined to the criminal proceedings against the applicant. 40.     On 23 July 2004 the deputy prosecutor of Zaporizhzhya Region quashed the resolution of 7 May 2004 as being premature, given that no evidence regarding the applicant’s son’s state of health had been obtained. 41.     On 31 July 2004, having questioned the applicant’s son’s doctors who had observed him in the course of his care previously, the prosecutor again refused to institute criminal proceedings for the same reasons as before. It was noted, inter alia , that none of the doctors had observed any worsening of the applicant’s son’s state of health and that no worsening of his health had been evident from his medical file either. 42.     On 14 October 2004 the prosecutor’s office instituted disciplinary proceedings against two officers of the SBU for their negligence towards the applicant’s son. It noted, inter alia , that the applicant’s son had not been formally arrested (затриманий ) but had been kept at the SBU’s premises for no reason and no measures had been taken to return him to his relatives. The prosecutor further observed that the applicant’s son had not been subject to any form of ill-treatment. He also stressed the fact that the applicant’s arrest report had been drafted only the next day after the applicant’s initial arrest, in breach of the requirements of the domestic law. This resolution had been sent to the SBU for relevant measures to be taken. 43.     On 27 October 2004 the SBU informed the prosecutor’s office that the respective officers could no longer be disciplined as the one-year statutory time-limit had expired. It was also observed in that letter that no violations of domestic law by the SBU officers had been established by a number of investigations into the events complained of and that the applicant’s son had stayed with the applicant at the SBU’s premises from 13   to 14 September 2003 at the applicant’s own request. 44.     On 5 November 2004 the applicant’s wife complained to the Prosecutor General about the prosecutor’s decision of 31 July 2004. 45.     On 25 October 2005, when convicting the applicant, the District Court delivered a separate ruling, in which it listed the procedural violations committed by the investigating authorities in the criminal proceedings against the applicant. The fact that the applicant’s son had remained in the SBU’s premises for about twenty-four hours after the applicant’s initial arrest, without his relatives having been informed of his whereabouts and with no medical assistance provided in view of the stress he had been under, was listed among the violations referred to by the court. The Chief of the SBU in Zaporizhzhya was invited by the court to take appropriate measures in view of the above mentioned violations. 46.     On 25 January 2006 the applicant appealed to the Ordzhonikidzevsky District Court of Zaporizhzhya against the prosecutor’s refusal of 31 July 2004 to institute criminal proceedings against the SBU officers. 47.     On 3 April 2006 the applicant’s complaint was left without consideration on the merits. The court noted in this connection that the relevant investigation files had been joined to the criminal case against the applicant and that therefore the prosecutor’s decision was not subject to appeal outside of those criminal proceedings. 48.     During the proceedings in his criminal case before the Court of Appeal and the Supreme Court the applicant and his wife repeatedly requested, referring to the separate ruling of 25 October 2005 by the District Court (see paragraph 45 above), that measures be taken to bring the respective officers to trial for the unlawful detention of their son. The case file does not suggest that in their appeals the applicant or his wife claimed damages in this connection. 49.     On 22 December 2008, in its judgment upholding the applicant’s conviction, the Court of Appeal observed that the complaint related to the unlawful detention of the applicant’s son had been considered by the prosecutor’s office and no corpus delicti under criminal law had been found on the part of the SBU officers. The court made no separate ruling in this connection. The Supreme Court did not address this issue in its decision of 2 July 2009. II.     Conditions of the applicant’s detention in Zaporizhzhya Pre-Trial Detention Centre no. 10 (“the SIZO”). 50.     The applicant was detained in the SIZO from 17 September 2003 to 14 July 2006 and from 18 March 2008 to 24 February 2009. A.     The applicant’s account 51.     According to the applicant, the conditions of his detention were grossly inadequate. The cells were overcrowded. In particular, a cell measuring 3.8   square metres with one bed could be occupied by eight to ten persons. As a result, detainees had to take turns to sleep. A bucket, which served as a toilet, was located in plain sight one metre away from the eating area. It had no cover and was emptied only once a day. The ventilation was very poor. The cell smelled of excrement, was filled with cigarette smoke and was damp, in particular as the detainees washed and dried their laundry there. It was also infested with cockroaches, lice and bedbugs. The shower, which had lukewarm water, was available only once every ten days. Access to natural daylight was severely limited because of a dense grill on the window. The electric lighting was so dim that it was impossible to read or write without damage to the eyes. The food was meagre and insufficient to meet the detainees’ nutritional needs. Outside walks were available only on a scarce and irregular basis. Detainees sick with contagious diseases, such as tuberculosis, venereal diseases, pediculosis and scabies, were held in the same cells as healthy detainees and not provided with medical assistance. As a result, the applicant also contracted scabies and other skin diseases. B.     The Government’s account 52.     According to the information provided by the Government, the applicant had been held in the following cells while in the SIZO: cell no. 18 – 21.87 sq. m ( intended for eight detainees ); cell no. 65 – 10.99 sq. m (intended for four detainees); cell no. 70 – 20.4 sq. m (intended for four detainees); cell no. 36 – 12.05 sq. m (intended for four detainees). 53.     The conditions in those cells had been adequate and the space per detainee had not been less than 2.5 sq. m, as provided for by the relevant domestic legislation. All the cells had been equipped with a toilet and a ventilation system. Running water and mains drainage had been available. They noted, referring to the relevant documents, that there had never been a cell measuring 3.8 sq. m in the SIZO. 54.     The Government further stated, referring to the relevant domestic regulations, that detainees had been provided with appropriate food and linen and had had weekly access to shower facilities and one-hour daily walks. They contested the statement that the applicant had shared a cell with smokers and those suffering from infectious diseases, pointing to the applicant’s failure to provide the respective evidence and called attention to the fact that there had been a special isolation wing in the SIZO for detainees suffering from such diseases. 55.     On 10 March 2006, following the applicant’s complaints concerning the improper conditions of his detention in the SIZO, the prosecutor’s office carried out an inspection visit there and found the applicant’s complaint to be partially substantiated. It found, inter alia , that some cells – not the ones in which the applicant had been detained – and utility rooms had been in poor sanitary condition and had been infested by cockroaches; and that the cell space for persons infected with tuberculosis had not been in compliance with the relevant domestic standards. The SIZO governor was instructed to remedy the situation. No evidence in support of the applicant’s allegations of improper nutrition and poor lighting had been found. III.     Medical care provided to the applicant in pre ‑ trial detention A.     The applicant’s medical treatment in the SIZO 56.     On 15 May 2001, following retirement from the police service, the applicant underwent a medical examination and was diagnosed with osteochondrosis, chronic gastritis in remission, chronic hepatitis, chronic pancreatitis, trichromatic anomalies, uric acid diathesis and adiposity of the first degree. According to the applicant, he was advised to undergo inpatient treatment twice a year and to appear before a special panel to decide on whether he had to be assigned disability status in view of his illnesses. He submitted that the relevant medical examination had been scheduled for the end of September 2003 but had not been carried out as he had been arrested. 57.     Upon his arrival at the SIZO the applicant underwent a medical examination during which he raised no complaints about his state of health. His medical file contained a certificate, issued on 14 September 2003 by an emergency hospital, stating that he was suffering from ischaemic heart disease, cardiosclerosis, angiosclerosis of the coronary vessels, symptomatic hypertension, and chronic bronchitis. In view of the available information on the applicant’s illnesses, he was put on the list for regular medical check-ups and was prescribed medical treatment. 58.     On 20 and 23 September, 1 October, 17 November and 24 December 2003, 11 November 2004 and 4 July and 1 December 2005 the applicant complained to the SIZO medical unit of headaches and, on some occasions, of heart pain and dizziness. He was diagnosed with first- or second-degree hypertension and received antihypertensive medication. His blood pressure was subsequently regularly monitored and, when necessary, antihypertensive treatment was provided. 59.     On 20 November 2003, 24 and 30 May and 4 July 2004 and 5 July 2005 the applicant complained to the SIZO medical unit of skin eruptions and itching. He was diagnosed with dermatitis and was provided with the necessary medical treatment. 60.     On 9 October 2003 the applicant was examined by a panel composed of the head of the SIZO medical unit, a general practitioner and a physiotherapist. He was diagnosed with hypertension and prescribed the relevant treatment. 61.     In October 2003 the applicant was registered for follow-up care ( диспансерний облік ) in respect of his hypertension. He underwent urine and blood tests which revealed no pathology. 62.     On 1 March 2004 the applicant underwent a medical check-up. He was diagnosed with second-degree hypertension and nephropathy and was prescribed the relevant medical treatment. It was also recommended that the applicant consult an ophthalmologist and a neuropathologist. 63.     On 15 March 2004 the applicant was examined by a neuropathologist from a regional psychiatric hospital located in prison no. 20 and by an ophthalmologist from a civil hospital. The medication prescribed following the examination was administered to the applicant by the SIZO. 64.     On 30 March 2003, 27 August 2004, 24 February, 23 August and 14   December 2005 the applicant underwent X-ray examinations of his lungs and heart, which revealed no problems. 65.     On 23 April 2004, following a request from the applicant’s lawyer, the applicant was examined by the chief neurosurgeon of the Zaporizhzhya Regional Hospital. The prescribed medication was provided to the applicant by the SIZO medical unit. 66.     On 14 and 23 June 2004 the applicant was examined by a neuropathologist. He was diagnosed with second-degree hypertension and nephropathy and was prescribed vascular and antihypertensive medication. 67.     On 29 October 2004 the applicant underwent a medical check-up. He complained of recurrent headaches and dizziness and was diagnosed with second-degree hypertension and nephropathy. Antihypertensive medications were prescribed. 68.     On 7 November 2005 the applicant was examined by a dermatologist. He was diagnosed with neurogenic dermatitis and prescribed the relevant medication. He was also advised to consult a psychiatrist. 69.     On 28 November 2005 the applicant underwent a medical check-up. He complained of headaches and dizziness. His second-degree hypertension was confirmed following the examination and the relevant treatment was prescribed. 70.     On 2 January 2006 the applicant was examined by a dermatologist and was diagnosed with dermatitis. He was advised to continue the treatment prescribed previously. 71.     On 24 January 2006 the applicant was examined by a panel of SIZO physicians comprised of a psychiatrist, a dermatologist and a general practitioner. He was diagnosed with hypertension, chronic gastritis, chronic pancreatitis in remission, chronic hepatitis in remission, heartburn and a hypertensive neurocirculatory dystonia. The relevant medical treatment was prescribed. 72.     On 10 February 2006 the applicant underwent a medical check-up and was diagnosed with arterial hypertension and hypertensive encephalopathy. The relevant treatment was prescribed. The applicant was further advised to consult a neuropathologist and an ophthalmologist. 73.     On 15 February 2006 the applicant was examined by a medical panel comprised of SIZO and civil-institution physicians (an ophthalmologist, a general practitioner and a neuropathologist). He was diagnosed with symptomatic arterial hypertension and an uncomplicated cerebral crisis. It was concluded that the applicant’s state of health did not necessitate inpatient medical treatment. 74.     On 1 November 2006, when serving his prison term in prison no. 45, the applicant was examined by a group of disability experts and recognised as falling into the third (mildest) category of disability for a one-year period. Outpatient treatment for the illnesses he had been suffering from was recommended. B.     Complaints related to the applicant’s health in detention 75.     From 15 December 2003 the applicant’s wife lodged a number of complaints with the SBU, prosecutors, courts and other State authorities alleging, inter alia , that the applicant had been unlawfully arrested and detained; that his health was in a critical condition; and that no relevant medical treatment could have been provided to him within the SIZO. She therefore requested that the preventive measure in respect of the applicant be changed and that he be immediately released from detention. 76.     On 22 December 2003 and 9 January 2004, after a number of enquiries, the SBU informed the applicant’s wife that the applicant’s state of health was compatible with detention and that the SIZO had all the necessary facilities to provide the applicant with qualified medical assistance. 77.     On 3 February 2004 the applicant’s wife complained about the above conclusions before the Prosecutor General. 78.     On 2 June 2004, in reply to the applicant’s lawyer’s query about the medical assistance provided to the applicant, the SIZO informed the lawyer that his state of health was compatible with detention and that he was under the regular supervision of the SIZO medical staff. They further submitted that it was at the court’s discretion to allow medical examination of the applicant by medical specialists from civil institutions. 79.     On 15 August 2004 the applicant’s wife asked the prosecutor’s office to provide truthful information about the applicant’s state of health and stated that adequate medical assistance could not be provided to the applicant in the SIZO in view of the absence of the relevant medical specialists at the detention facility. In the light of this, she asked that the applicant undergo a medical examination in a civil medical institution. 80.     On 24 November 2004 the prosecutor, having conducted an investigation into the matter and having studied the applicant’s medical file, replied to the applicant’s wife that her complaint appeared to be unfounded and that adequate medical assistance was being provided to the applicant in the SIZO. 81.     On 4 July 2005 the applicant’s lawyer lodged an application with the District Court requesting that a medical examination of the applicant by neurologists from civil hospitals be ordered. 82.     On 7 September 2005, following enquiries made by the court upon the lawyer’s request, the SIZO provided the court with a certificate, according to which the applicant was under the permanent supervision of the SIZO medical unit and did not necessitate medical examination by specialists other than those practising in the SIZO. It was further noted that his state of health was compatible with detention as none of his diagnoses were on the list of the illnesses, provided for by law, for which early release was possible. The applicant challenged this conclusion before the Office of the Prosecutor General alleging, inter alia , that the certificate had been forged and issued unlawfully by an unauthorised and unqualified medical officer. To verify the applicant’s complaint, the Zaporizhzhya regional prosecutor’s office conducted enquiries and ordered, inter alia , that the applicant be examined by different medical specialists. 83.     On 24 January 2006, in compliance with the prosecutor’s order, the applicant was medically examined by a panel of SIZO physicians (see paragraph 71 above). It was established in the course of that examination that the applicant had been under the close supervision of the SIZO medical unit and, when the need had arisen, of outside doctors; that twice a year, owing to his diseases, he had undergone a medical checkup; that all his complaints had been adequately addressed; and that his state of health had been compatible with detention. It was further established in the course of the prosecutor’s enquiries that the medical certificate of 7   September 2005 had been issued by an authorised person and had contained objective information and had correctly referred to the applicant’s state of health. 84.     On 2 and 23 February 2006, on the basis of the above conclusions, the prosecutor’s office informed the applicant that no violations on the part of SIZO medical staff had been established. 85.     On 13 February 2006 the applicant again complained to the Prosecutor General regarding the allegedly forged certificate of 7 September 2005. 86.     On 3 March 2006, following further enquiries into the applicant’s complaint and another medical examination of the applicant (see paragraph 73 above), the prosecutor’s office informed him that his allegations appeared to be groundless. IV.     RELEVANT DOMESTIC LAW A.     Constitution of Ukraine 87.     The relevant provisions of the Constitution provide: Article 59 “Everyone has the right to legal assistance. Such assistance is provided free of charge in cases envisaged by law. Everyone is free to choose the defender of his or her rights. In Ukraine, advocates shall act to ensure the right to a defence against accusation and to provide legal assistance in deciding cases in courts and other State bodies.” Article 63 “A person shall not bear responsibility for refusing to testify or to explain anything about himself or herself, or members of his or her family or close relatives in the degree determined by law. A suspect, an accused, or a defendant has the right to a defence ...” B.     Civil Code of 2003 (in force as from 1 January 2004) 88. Article 1174 of the Civil Code provides that the damage sustained as a result of unlawful decisions, actions or inactivity by a State official shall be indemnified by the State irrespective of the guilt of that official. 89.     Article 1176 of the Civil Code provides for the right to compensation for damage sustained as a result of unlawful decisions, actions or inactivity on the part of authorities responsible for pre-investigation inquiries and pre-trial investigations, prosecutors’ offices and courts. Paragraph 5 of the Article provides that any damage other than that listed in the preceding paragraphs of the Article shall be indemnified under the general procedure. THE LAW I.     ALLEGED VIOLATION OF ARTICLE 3 OF THE CONVENTION IN RESPECT OF THE APPLICANT 90.     The applicant complained that the conditions of his pre-trial detention in the SIZO, including the physical, sanitary and health-care arrangements, had been incompatible with Article 3 of the Convention, which reads as follows: “No one shall be subjected to torture or to inhuman or degrading treatment or punishment.” A.     Alleged poor conditions of the applicant’s detention in the SIZO 1.     Admissibility 91.     The Government submitted that the applicant had failed to exhaust domestic remedies in respect of his complaints concerning some aspects of the material conditions of his detention. In particular, he could have raised with the prosecutor’s office his complaints concerning the toilet, the lack of fresh air, the water supply and the humidity in the cells. 92.     When commenting on the merits of the applicant’s complaint, the Government further claimed that the applicant’s submissions had been vague and general and not supported by any evidence. They noted, inter alia , that the applicant had neither specified the cells in which he had been detained, nor the periods of his detention there. He had failed to mention which cells he had described in his submission and had provided no names of cellmates who could have confirmed his submissions. 93.     The applicant did not comment on the Government’s argument and maintained his complaint. 94.     The Court notes in respect of the Government’s non-exhaustion argument that it has already dismissed similar objections by the Government on a number of occasions, finding the remedy referred to by them ineffective on the grounds that it had not been shown that recourse to such proceedings could have brought an improvement in the applicant’s detention conditions because of the structural nature of the problems in the domestic penal system (see, for example, Logvinenko v. Ukraine , no.   13448/07, § 57, 14 October 2010, and Buglov v. Ukraine , no.   28825/02 , § 74, 10 July 2014). The Court sees no reason to depart from that finding in the present case and therefore considers that this complaint cannot be rejected for failure to exhaust domestic remedies. 95.     At the same time, it agrees with the Government that some of the applicant’s complaints are not specific and are not supported by evidence. 96.     Nonetheless, on the basis of the case file, the Court considers that the applicant’s chief grievance – the overcrowding in the SIZO combined with the lack of daily walks – can still be regarded as having a sufficient basis in the circumstances at hand. The Court therefore dismisses the Government’s objection as regards this part of the applicant’s complaint. 97.     To sum up, the Court finds that the applicant’s complaint concerning overcrowding in the SIZO is not manifestly ill-founded within the meaning of Article 35 § 3 (a) of the Convention and is not inadmissible on any other grounds. It must therefore be declared admissible. The Court rejects the remainder of the applicant’s complaints concerning the poor material conditions of his detention as manifestly ill-founded within the meaning of Article 35 §§ 3 (a) and 4 of the Convention. 2.     Merits 98.     The applicant alleged that he had been held in overcrowded cells, with no outdoor exercise provided. 99.   The Government contested this view. They submitted, referring to their factual submissions, that the living space in the cells in which the applicant had been detained had been in compliance with domestic standards. They further stated that the applicant had been entitled by law to a one-hour daily walk. 100.     The Court reiterates that Article 3 of the Convention requires States to ensure that a person is detained in conditions which are compatible with respect for his or her human dignity and that the manner and method of the execution of the measure do not subject him or her to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention (see Kudła v. Poland [GC], no. 30210/96, § 94, ECHR 2000-XI). 101.     The Court reiterates that a serious lack of space in a prison cell weighs heavily as a factor to be taken into account for the purpose of establishing whether the detention conditions described are “degrading” within the meaning of Article 3 of the Convention and may disclose a violation, both alone or taken together with other shortcomings. When the personal space available to a detainee falls below 3 sq. m of floor space in multi-occupancy accommodation in prisons, the lack of personal space is considered so severe that a strong presumption of a violation of Article 3 arises (see, amongst many authorities, Karalevičius v. Lithuania , no.   53254/99, §§   39 ‑ 40, 7   April 2005, and Ananyev and others v. Russia , nos. 42525/07 and 60800/08, §§ 145-147 and 149, 10 January 2012, and Muršić v. Croatia [GC], no.   7334/13, §§ 136-139, 20 October 2016). This presumption will normally be capable of being rebutted only if the following factors are cumulatively met: (1) the reductions in the required minimum personal space of 3 sq. m are short, occasional and minor; (2)   such reductions are accompanied by sufficient freedom of movement outside the cell and adequate out-of-cell activities; (3) the applicant is confined in what is, when viewed generally, an appropriate detention facility, and there are no other aggravating aspects of the conditions of his or her detention (see Muršić, cited above , §§   130, 133 and 134). 102.     The Court notes that   in the present case the available evidence indicates that during his stay in the SIZO the applicant lacked personal space. In particular, as reported by the Government, the cells in which the applicant had been detained allowed from 2.55 to 3.01 sq. m of floor space per inmate. The Government did not actually state how many inmates had occupied these cells at the relevant time. 103.     Furthermore, given that the cells also contained sanitary facilities, the personal space available to detainees was further reduced. 104.   Even assuming that the applicant had a one-hour daily walk, as suggested by the Government, the Court further observes that for most of the day the applicant and his cellmates had no freedom of movement and were confined to their cells. 105.     Given the aforementioned and in the light of its case-law (see, among other authorities, Muršić , cited above , §§   136   -   141; Gorbatenko v.   Ukraine, no. 25209/06, § 139, 28 November 2013; and Iglin v. Ukraine , no. 39908/05, §§ 51-52, 12   January 2012), the Court finds that the conditions of the applicant’s detention in the SIZO, in particular the lack of personal space afforded to the applicant, combined with the lack of access to outdoor activities for almost four years of his detention, amounted to degrading treatment. Accordingly, there has been a violation of Article 3 of the Convention in this respect. B.     Alleged inadequacy of the medical assistance provided to the applicant in the SIZO 1.     Admissibility 106.     The Government did not comment on the issue of the admissibility of this part of the application. 107.     The Court notes that this complaint is not manifestly ill-founded within the meaning of Article 35 § 3 (a) of the Convention. It further notes that it is not inadmissible on any other grounds. It must therefore be declared admissible. 2.     Merits (a)     The parties’ submissions 108.     The applicant complained that his state of health had sharply deteriorated in the SIZO. In particular, his chronic diseases had become active, his eyesight had worsened, and he had suffered regular hypertensive crises. He submitted that his state of health had necessitated inpatient treatment in a civil hospital as no specialists “in his disease[s]” had been available at the SIZO and adequate assistance could not therefore have been provided to him in that facility. He stated in this connection that the SIZO medics had made incorrect conclusions about his state of health. As a result, he had been later assigned disability status. 109.     The Government referred to the applicant’s medical file and stated that from the very beginning of his detention the applicant had been under the close supervision of the medical unit of the SIZO in view of the illnesses he had contracted before his detention there. He had undergone regular medical examinations, including by civil doctors, and his numerous health complaints had been rapidly and adequately addressed. They noted that the applicant had failed to produce evidence that he had been refused treatment on a particular occasion or that the treatment had been inadequate or had led to the worsening of his state of health. 110.     Lastly, the Government submitted that the applicant’s complaints at domestic level concerning his poor state of health had not been linked to the inadequacy of his treatment but rather to the need to release him from detention. 111.     The applicant maintained his complaint without addressing the Government’s arguments. (b)     The Court’s assessment 112.     The Court reiterates that in accordance with Article 3 of the Convention the State must ensure that a person is detained in conditions which are compatible with respect for his or her human dignity, that the manner and method of the execution of the measure do not subject him or her 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 or her health and well-being are adequately secured (see Kalashnikov v. Russia , no. 47095/99, §   95, ECHR 2002 ‑ VI). 113.     However, the Court has held that Article 3 of the Convention cannot be interpreted as ensuring that every detainee should receive medical care at the same level as “in the best civil clinics” (see Mirilashivili v.   Russia (dec.), no.   6293/04, 10 July 2007). It has further held that it is “prepared to accept that, in principle, the resources of medical facilities within the [prison] system are limited compared to those of civil clinics” (see Grishin v.   Russia, no.   30983/02, §   76, 15   November 2007). On the whole, the Court takes a flexible approach 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). 114.     The Court further notes that the “adequacy” of medical care remains a difficult element to determine. The mere fact that a detainee is seen by a doctor and prescribed a certain form of treatment cannot automatically lead to the conclusion that the medical care provided was adequate (see Hummatov v. Azerbaijan , nos. 9852/03 and 13413/04, §   116, 29 November 2007). The authorities must also ensure that a comprehensive record is kept of the detainee’s state of health and his treatment while in detention (see, for example, Khudobin v. Russia , no.   59696/00, § 83, ECHR   2006-XII), that the diagnoses and care are prompt and accurate (see Hummatov , cited above, § 115, and Melnik v.   Ukraine , no.   72286/01, §§   104-106, 28 March 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 curing the detainee’s diseases or preventing their aggravation, rather than addressing them on a symptomatic basis (see Hummatov , cited above, §§   109 and 114; Sarban v.   Moldova , no. 3456/05, § 79, 4 October 2005; and Popov v.   Russia , no.   26853/04, § 211, 13 July 2006). The authorities must also show that the necessary conditions were created for the prescribed treatment to be actually followed through (see Hummatov , cited above, §   116, and Holomiov v.   Moldova , no. 30649/05, § 117, 7 November 2006). 115.     Turning to the circumstances of the present case, the Court notes that before being placed in detention the applicant was diagnosed with a number of illnesses which warranted medical supervision and care (see   paragraphs 56 and 57 above). 116.     The Court further notes that the applicant’s complaint concerning a sharp deterioration of his health in detention was not specific. Accordingly, and given the long history of his illnesses and the lack of information on his part as to how and how often the diseases manifested themselves before his detention and how they were treated, the Court finds it difficult to establish whether and to what extent the applicant’s health deteriorated in the SIZO and to what extent that deterioration, if any, had resulted from the inadequacy of the medical assistance in detention, rather than being the natural course of his medical conditions (see, for example, Rudenko v.   Ukraine , no. 5797/05, § 94, 25 November 2010). 117.     At the same time, it is apparent from the applicant’s detailed medical record submitted by the Government that the SIZO administration expressly recognised the applicant’s need for specialised treatment, in particular with regard to his hypertension (see paragraphs 57 and 61 above) and the applicant’s health was continuously supervised while in detention. On numerous occasions the applicant was seen by various specialists, including a neurologist, a neurosurgeon and an ophthalmologist from civil institutions, and he underwent regular medical check-ups and tests in view of his illnesses. None of the applicant’s health problems of which he had complained to the SIZO medical unit appears to have remained untreated. The applicant did not contest these submissions and did not dispute or criticise the Government’s statement that he had been provided with medical treatment in accordance with the established diagnoses. Furthermore, there is no evidence and it was not persuasively argued that the SIZO doctors had acted in bad faith or that the treatment provided had been ineffective. The Court notes the specu