European Court of Human Rights

On 1 August 2008 the applicant, who was then in the thirtieth or thirty-first week of pregnancy, was admitted to a municipal maternity hospital showing symptoms of rhesus incompatibility and excess amniotic fluid (polyhydramnios). She signed a consent form for a Caesarean section without sterilisation. During surgery the doctors also identified a rupture of the uterus, without bleeding. Given the applicant’s age, 28 years, the doctors decided to suture the rupture and keep the uterus. However, given earlier surgical interventions on the uterus, the Caesarean section and the hysterography (repair of the uterus), the doctors decided that there was a real risk that the uterus would rupture in a future pregnancy, which could endanger the applicant’s life, and that therefore she should be sterilised. According to the applicant, she was told the day after the surgery that she had been sterilised, but she was not given any further details about what the procedure meant. Two years later the applicant and her husband decided to have a child and as she could not get pregnant, she saw a gynaecologist, who explained that she could only get pregnant via in vitro fertilisation because she had been sterilised during the Caesarean section in 2008.

ECHR 2023/8 Case of Y.P. v. Russia, 20 September 2022, no. 43399/13 (Third Section) The Facts On 1 August 2008 the applicant, who was then in the thirtieth or thirty-first week of pregnancy, was admitted to a municipal maternity hospital showing symptoms of rhesus incompatibility and excess amniotic fluid (polyhydramnios). She signed a consent form for a Caesarean section without sterilisation.
During surgery the doctors also identified a rupture of the uterus, without bleeding. Given the applicant's age, 28 years, the doctors decided to suture the rupture and keep the uterus. However, given earlier surgical interventions on the uterus, the Caesarean section and the hysterography (repair of the uterus), the doctors decided that there was a real risk that the uterus would rupture in a future pregnancy, which could endanger the applicant's life, and that therefore she should be sterilised.
According to the applicant, she was told the day after the surgery that she had been sterilised, but she was not given any further details about what the procedure meant. Two years later the applicant and her husband decided to have a child and as she could not get pregnant, she saw a gynaecologist, who explained that she could only get pregnant via in vitro fertilisation because she had been sterilised during the Caesarean section in 2008. and that she had received no adequate response at the domestic level in that connection. She relied on Article 8, which protects the right to respect for her private life.

General Principles
The Court reaffirms that although the right to health is not as such among the rights guaranteed under the Convention and the Protocols thereto, the High Contracting Parties have, parallel to their positive obligations under Article 2 of the Convention, a positive obligation under Article 8, firstly, to have in place regulations compelling both public and private hospitals to adopt appropriate measures for the protection of their patients' physical integrity and, secondly, to provide victims of medical negligence with access to proceedings in which they may, where appropriate, obtain compensation for damage. Furthermore, the Court reiterates that in the sphere of medical assistance, even where the refusal to accept a particular treatment might lead to a fatal outcome, the imposition of medical treatment without the consent of a mentally competent adult patient would interfere with his or her right to physical integrity.

Application of the General Principles to the Present Case
The Court observes that the relevant consent form, which the applicant signed prior to her Caesarean section, explicitly excluded sterilisation. It cannot accept the argument that the applicant's sterilisation had been performed as an expansion of the Caesarean section, and that therefore the applicant could be regarded as having consented to it. It emphasises that sterilisation is not a procedure that can be routinely carried out as part, or as an expansion, of a Caesarean section or of any other medical intervention, unless the patient has given her express, free and informed consent to that particular procedure. The only exception concerns emergency situations in which medical treatment cannot be delayed and the appropriate consent cannot be obtained.
As the facts reveal, no such emergency was established in the present case. The Court further notes that sterilisation as such is not, in accordance with generally recognised standards, a life-saving medical intervention. Since the applicant was a mentally competent adult patient, her informed consent was a prerequisite to the procedure, even assuming that the latter was a necessity from a medical point of view. It further notes that at the time of the medical intervention in question the applicant was only 28 years old, that is, at her full reproductive age, and that she was permanently deprived of her natural reproductive capacity.
It remains to be ascertained whether the applicant was afforded an effective remedy capable of providing her with an adequate judicial response in connection with the damage she suffered. The Court observes that the applicant brought a civil claim against the maternity hospital, seeking compensation in respect of non-pecuniary damage in connection with her sterilisation. The national courts examined and dismissed that claim at two levels of jurisdiction. By refusing to establish the doctors' responsibility for the applicant's sterilisation without her express, free and informed consent, with reference to the medical necessity of that intervention, the national courts in essence endorsed an approach in conflict with the principle of the patient's autonomy. The Court also observes that the applicant was not afforded any redress in this connection.
The foregoing considerations are sufficient to enable the Court to conclude that the applicant suffered an infringement of her right to respect for her private life as a result of the doctors' failure to seek and obtain her express, free and informed consent as regards her sterilisation, in line with the domestic law. Moreover, the remedy in place did not make it possible to have the responsibility of the doctors established and to obtain redress for the infringement of her right to respect for her private life. There has accordingly been a violation of Article 8 of the Convention.
For these reasons, the Court holds, unanimously, that there has been a violation of Article 8 of the Convention; declares, by a majority the remainder of the application inadmissible.
Concurring opinion of Judge Elósegui, highlighting some elements of the judgment in relation to the right to informed consent; partly dissenting opinion of Judge Serghides, who disagrees with the majority's finding that Article 3 is not applicable; similarly, partly dissenting opinion of Judge Pavli. ECHR 2023/9 Case of S.F. K. v. Russia, 11 October 2022, no. 5578/12 (Third Section) The Facts On 28 April 2010, the applicant was informed that she was in the fourth or fifth week of pregnancy. Her parents insisted that she terminate the pregnancy after her partner and would-be father of the child was arrested on suspicion of having committed a violent crime.
On 1 May 2010 the applicant's parents took her to a hospital to undergo an abortion. According to the applicant, she protested strongly and cried, but her father hit her on the head and threatened to beat her and throw her out of the car in order to make her miscarry.
The applicant and her parents arrived at the maternity department of the local hospital. According to the applicant, she had clearly stated to a nurse and a gynaecologist that she did not wish to terminate her pregnancy. The doctor and the nurse had then attempted to persuade her to have an abortion, but she had strongly objected.
The doctor and the nurse then accompanied the applicant and her mother to an operating theatre. The nurse and the applicant's mother left the room, and the applicant asked the doctor to let her continue with the pregnancy, but to tell her parents that she had allowed the abortion to be performed; the doctor replied that she was unable to do so, as the applicant would not be able to keep her pregnancy a secret, and the lie would be exposed. The applicant's mother then entered the room and stated that the applicant's father, who was waiting outside, would kill both of them (that is to say, the applicant and her mother) if she refused to undergo the abortion. According to the applicant, she had seriously feared for her life, and therefore she had relented and let the doctor, assisted by the nurse, perform the abortion. The applicant's parents took her home immediately after the surgery.
Neither before nor after the abortion did the applicant receive any information, sign any documents or undergo any medical examinations or tests.
She lodged a number of complaints against her parents and the medical personnel, but no criminal proceedings were ever instituted as the relevant authorities found that no elements of a crime could be established and that her parents "had acted in the best interests of their child".
She has since had two miscarriages and was declared infertile in 2017.

Alleged Violation of Article 3 of the Convention
The applicant complained that her abortion and the manner in which it had been carried out, including by the use of coercion, and the absence of medical care of the requisite standard before and after the abortion had amounted to inhuman and degrading treatment in breach of Article 3 of the Convention, which forbids inhuman or degrading treatment.
The Court finds that the circumstances in which the applicant's pregnancy was aborted reached the threshold of severity to attract the protection of Article 3.
It further notes that the situation under examination was the result of the actions of the applicant's parents as well as those of a doctor and a nurse of a public hospital.
Substantive Limb of Article 3 (Infliction of Inhuman and Degrading Treatment) It must be observed that the respondent State bears no direct responsibility under the substantive limb of Article 3 of the Convention in respect of the acts of the applicant's parents, who are private individuals. It is undisputed in the present case that the abortion took place in a public hospital and was performed by a doctor and a nurse employed by this public hospital. These findings are sufficient for the Court to conclude that the respondent State bears the direct responsibility under Article 3 of the Convention on account of the inhuman and degrading treatment to which the applicant was subjected.
The Court observes that the applicant's abortion was carried out against her will and in breach of all the applicable medical rules. Such a forced abortion undergone in these circumstances was contrary to the applicant's human dignity. It was an egregious form of inhuman and degrading treatment which not only resulted in a serious immediate damage to her health -that is the loss of her unborn child -but also entailed long-lasting negative physical and psychological effects.
Accordingly, there has been a violation by the respondent State of the substantive head of Article 3.

Procedural Limb of Article 3 (Lack of Effective Investigation)
The Court reiterates that where an individual claims on arguable grounds to have suffered acts contrary to Article 3, that Article requires the national authorities to conduct an effective official investigation to establish the facts of the case and identify and, if appropriate, punish those responsible.
In the present case, the applicant lodged complaints with various lawenforcement authorities in an attempt to have criminal proceedings instituted against her parents and the relevant health professionals in connection with the forced interruption of her pregnancy. Although a number of facts proving the credibility of the applicant's assertions were established, including the fact that she had been taken to the relevant hospital by her parents, her pregnancy had been aborted and the procedure at issue had been performed by the medical personnel of the relevant hospital, no criminal proceedings in that connection were ever instituted. In particular, the relevant authorities considered that the applicant's parents had "had no malicious intent" and had "believed that they had acted in the best interests of their child". They also found that there had been no constituent elements of offences punishable under the specific Articles of the Russian Criminal Code in the acts of the doctor who had performed the surgery.
In the present case, the criminal-law mechanisms proved clearly ineffective in respect of the applicant's complaint about the forced abortion both as regards her parents' actions and as regards the actions of the medical personnel of the relevant hospital. In the latter connection, the Court further notes that, in the absence of any findings made in the context of criminal-law mechanisms, the hospital refused to hold the relevant doctor liable in disciplinary proceedings.
Lastly, as regards the civil proceedings brought by the applicant against the hospital, the Court reiterates its constant case-law stating that compensation awarded in civil proceedings could not be considered sufficient for the fulfilment of the State's positive obligations under Article 3 of the Convention, as such a civil remedy is aimed at awarding damages rather than identifying and punishing those responsible.
The Court finds that the State has failed to discharge its duty to investigate the ill-treatment that the applicant had endured. It consequently finds a violation of the procedural head of Article 3 of the Convention.
For these reasons, the Court holds, by five votes to two, that there has been a violation of Article 3, under its substantive limb, and, unanimously, that there has been a violation of Article 3, under its procedural limb.
Partly dissenting opinion of Judges Roosma and Lobov, denying that the acts of the medical personnel concerned were performed within their professional functions and thus can to be imputed to the respondent State.
ECHR 2023/10 Case of Kornicka-Ziobro v. Poland, 20 October 2022, no. 23037/16 (First Section) The Facts The applicant's husband, who was seventy years old, died on 2 July 2006 from heart failure at the university clinic. He had been admitted to the clinic for emergency treatment on 22 June 2006 and underwent several procedures, including coronary angiography and coronary angioplasty with implantation of stents. He was treated by four leading specialists from the clinic. Although medication was administered and resuscitation attempts were made, applicant's husband nevertheless died. The applicant considered that her husband's death had been result of medical negligence.

Alleged violation of Article 2 of the Convention
The applicant complained of a breach of her right to a thorough and effective investigation into her husband's death. She relied on Article 2 which protects the right to life.

General Principles
The Court has interpreted the procedural obligation of Article 2 in the context of health care as requiring States to set up an effective and independent judicial system so that the cause of death of patients in the care of the medical profession, whether in the public or the private sector, can be determined and those responsible held accountable.
The required form of investigation varies according to the nature of the interference with the right to life. While, in some exceptional situations, where the fault attributable to the health-care providers went beyond a mere error or medical negligence, the Court has considered that compliance with the procedural obligation must include recourse to criminal law, in all other cases where the infringement of the right to life or to personal integrity is not caused intentionally, the procedural obligation does not necessarily require the provision of a criminal-law remedy. In cases concerning unintentional infliction of death and/or lives being put at risk unintentionally, the Court reiterates that the requirement to have in place an effective judicial system will be satisfied if the legal system affords victims (or their next-of-kin) a remedy in the civil courts, either alone or in conjunction with a remedy in the criminal courts, enabling any responsibility to be established and any appropriate civil redress to be obtained. Where agents of the State or members of certain professions are involved, disciplinary measures may also be envisaged.
Moreover, the compliance with the procedural requirement of Article 2 is to be assessed on the basis of several essential parameters. These elements are inter-related and each of them, taken separately, does not amount to an end in itself, as is the case in respect of the requirements for a fair trial under Article 6. They are criteria which, taken jointly, enable the degree of effectiveness of the investigation to be assessed. It is in relation to this purpose of an effective investigation that any issues, including that of promptness and reasonable expediency, must be assessed. The essential parameters include the following: (a) the investigation must be thorough, which means that the authorities must take all reasonable steps available to them to secure the evidence concerning the incident, always make a serious attempt to find out what happened and not rely on hasty or ill-founded conclusions to close their investigation or to use as the basis of their decisions; (b) even where there may be obstacles or difficulties preventing progress in an investigation, a prompt response by the authorities is vital for public safety and in maintaining public confidence in their adherence to the rule of law and in preventing any appearance of collusion in, or tolerance of, unlawful acts. The proceedings must also be completed within a reasonable time; (c) is generally necessary that the domestic system set up to determine the cause of death or serious physical injury be independent. This means not only a lack of hierarchical or institutional connection but also a practical independence implying that all persons tasked with conducting an assessment in the proceedings for determining the cause of death or physical injury enjoy formal and de facto independence from those implicated in the events. In a case such as the present one, where various legal remedies, civil as well as criminal, are available, the Court will consider whether the remedies taken together as provided for in law and applied in practice, could be said to have constituted legal means capable of establishing the facts, holding accountable those at fault and providing appropriate redress to the victim. The choice of means for ensuring the positive obligations under Article 2 is in principle a matter that falls within the Contracting State's margin of appreciation.

Application of Those Principles in the Instant Case
The Court observes that the Polish legal system provides, in principle, two main avenues of recourse for victims alleging illegal acts attributable to the State or its agents, namely a civil procedure and a request to the prosecutor to open a criminal investigation. Moreover, the applicant could also institute proceedings in order to establish the disciplinary liability of the medical practitioners concerned by initiating a procedure provided for by the laws governing the professional liability of physicians. On this basis the Court concludes that the Polish legal system offers litigants remedies which, in theory, meet the requirements of the procedural obligations under Article 2.
In the case at hand the applicant used only the criminal-law remedy. The Court discerns two principal stages of the proceedings. The first began in August 2006 with the launch of the criminal investigation into the events. The Court notes that the case was clearly complex. In the course of the proceedings the authorities collected numerous and extremely voluminous medical opinions and other extensive evidential material. The prosecuting authorities discontinued the proceedings on three occasions, concluding, in extensively reasoned decisions, that no medical malpractice or other offence had been committed. The Court considers that as regards this stage of the proceedings, they were thorough and concluded within a reasonable time.
The applicant nevertheless decided to pursue her allegations of medical malpractice by lodging a subsidiary bill of indictment against four doctors of the university clinic on 21 June 2011. This marks the beginning of the second stage of the proceedings, which is still pending. The Court observes that the course of the proceedings has been influenced by the sustained efforts made by the applicant and her sons to prove their allegations that the applicant's husband's death was caused by medical malpractice by four doctors of the clinic. They used their procedural rights as a victim party and, later, auxiliary prosecutors, appealed against decisions and adduced international private medical opinions seeking to disprove the medical evidence already obtained. In consequence, new and more extensive medical evidence had to be adduced on each occasion.
It is further to be noted that since 2018 the case has been pending at the appellate stage before the regional court. Up to March 2022 the court held forty-two hearings at which it heard evidence from five expert witnesses. Throughout the entire appellate proceedings the court was confronted with an exceptionally difficult task of taking and hearing inordinately complex -and seemingly partly inconsistent -medical expert evidence. In view of the foregoing and considering that the authorities conducting criminal proceedings must ensure the equality of rights of the victim and the defendants in criminal proceedings, the Court cannot see any marked failure to carry out an "effective and thorough investigation" on the part of the authorities.
The Court finds that the domestic courts did provide the applicant with answers based on an in-depth assessment and clarified the events surrounding the alleged medical malpractice. It observes that the criminal proceedings were not marked with inactivity; rather, huge efforts were made by the prosecutors, experts, and courts dealing with this case, complexity of which has grown exponentially with every passing year. The Court reiterates that compliance with the procedural obligation under Article 2 requires a joint assessment of several essential parameters. Thus, in contrast to a situation where solely the excessive length of the proceedings is examined under Article 6 § 1, it is not merely the reasonableness of the length of the proceedings which is in issue here. In the absence of any apparent lack of thoroughness in the authorities' examination of the circumstances surrounding the death of the applicant's husband, the overall length of the criminal proceedings against the doctors does not suffice to find the respondent State liable under its procedural obligation arising from Article 2 of the Convention.
The Court further notes that the applicant has not attempted to make use of the civil remedy available under Polish law. Nor were any proceedings instituted concerning the medical practitioners' disciplinary liability. Consequently, although the criminal proceedings against the doctors have not yet been concluded, it cannot be said that the legal domestic system in the present case failed to deal adequately with the applicant's case. Accordingly, there has been no violation of that provision in the present case.
For these reasons, the court holds, by six votes to one, that there has been no violation of Article 2 of the Convention.
Partly dissenting opinion of Judge Balcerzak, concluding that the required standard of promptness has not been complied with. Moldova, 22 November 2022, no. 44394/15 (Second Section) The Facts

ECHR 2023/11 Case of G.M. and others v. The Republic of
The three applicants are affected by intellectual disabilities of varying levels of severity and have been institutionalised in a neuropsychiatric residential asylum ("the asylum") for different periods of time. During their stays in the asylum they were raped on various occasions by F.S., the head doctor of one of the units. The first and third applicants claim to have become pregnant after being raped by F.S. and all three applicants claim to have been subjected to forced abortions. All three applicants also claim that after the forced abortions, intrauterine contraceptive devices were implanted without their consent inside their uteruses to prevent further pregnancies.

Alleged violation of Article 3 of the Convention
Relying on Article 8 (which protects the right to privacy), the applicants complained that they had been subjected to involuntary abortions and birthcontrol measures and that the authorities had failed to carry out an effective investigation into the circumstances of these events. The Court, however, considers that the invasive medical interventions, combined with the applicants' vulnerability due to their gender, disability and institutionalisation, are sufficiently serious to come within the scope of Article 3 of the Convention (which forbids inhuman or degrading treatment) and decides to examine the case from that standpoint.
Article 3 imposes a primarily negative obligation on States to refrain from inflicting serious harm on persons within their jurisdiction. However, States also have positive obligations under Article 3, which comprise, first, an obligation to put in place a legislative and regulatory framework of protection; secondly, in certain well-defined circumstances, an obligation to take operational measures to protect specific individuals against a risk of treatment contrary to that provision; and, thirdly, an obligation to carry out an effective investigation into arguable claims of infliction of such treatment. Generally speaking, the first two aspects of these positive obligations are classified as "substantive", while the third aspect corresponds to the State's positive "procedural" obligation.

The Obligation to Carry Out an Effective Investigation
The Court is called upon to first examine whether the applicants' complaints of ill-treatment were adequately investigated by the authorities.
The Court observes that the domestic authorities promptly initiated a preliminary inquiry into the allegations of the applicants, interviewing them and certain medical staff at the asylum and the maternity hospital. The preliminary inquiry partially confirmed the applicants' statements. However, no criminal investigation has been initiated to assess the credibility of the claims, clarify the circumstances of the case and identify those responsible. The inquiry had relied essentially on the content of the first and second applicants' medical files and did not attempt to check their accuracy. It simply focused on whether the facts revealed the elements of various criminal offences, none of which appear to concern non-consensual medical interventions. Neither did the inquiry attempt to investigate beyond the medical files whether the alleged medical interventions had left traces on the applicants' bodies. The Court therefore concludes that the authorities failed to carry out an effective investigation into the applicants' allegations of ill-treatment despite it having been reopened on four occasions following their appeals. The inquiry did not factor in the applicants' vulnerability, or the gender and disability aspects of their complaints concerning institutionalised medical violence against them. Therefore, there has been a violation of the procedural limb of Article 3 in respect of all three applicants.
The Obligation to Put in Place an Appropriate Legislative and Regulatory Framework The Court has to examine whether the applicants, who were intellectually disabled but not deprived of legal capacity, were subjected to invasive medical interventions without giving their informed consent and, in connection with this, to assess the adequacy of the legal framework governing the conduct of doctors in carrying out the said medical interventions, as well as the adequacy of the legal framework governing the conduct of the authorities in investigating the applicants' complaints.
The Court notes that states have a heightened duty of protection towards persons with intellectual disabilities who, like the applicants in the present case, have been placed in the care of a public institution which is responsible for ensuring their safety and well-being, have no family, have not been deprived of their legal capacity and have no legal representative, and who are therefore in a particularly vulnerable situation. This is all the more so in respect of the protection of their reproductive rights. The Court will now examine whether sufficient legal safeguards existed to effectively protect women with intellectual disabilities from forced abortions and birth-control measures.
The Court notes that the text of the Moldovan law established a system of presumed consent for all medical interventions which did not "pose significant risks for the patient or which [were] not likely to violate his or her intimacy" and that, in any case, the presumed consent was to be confirmed in writing by the doctor in the patient's medical file. Since at least July 2007, the law required written consent for an extensive list of medical interventions. There are explicit legal provisions concerning one's freedom to decide on maternity and reproduction and the prohibition of restrictions on one's rights purely on grounds of mental health. The 1994 ministerial order authorised the termination of pregnancies in cases of medical contraindications, such as intellectual disability of any degree of severity. This order did not contain any reference to the patient's consent, unlike its updated 2020 version, but it seems to imply that in respect of persons with mental-health disorders, related documents would be communicated between medical institutions (psychiatric asylum and medical committee for the termination of pregnancies) directly, without the involvement of the patient.
In view of the nature of the medical interventions, the Court considered that the applicants' actual consent had been required under domestic law with written confirmation by the doctor or the patient in the medical file. The Court finds striking the conclusion to the contrary of the domestic authorities and the medical professionals.
The Court observes the paternalistic tone of the 1994 ministerial order concerning termination of pregnancies in respect of persons with intellectual disabilities. On the one hand, the order indicated intellectual disability as a contraindication for pregnancy without any further assessment of medical risks, which by itself is contrary to international standards. On the other hand, the order excluded the women concerned from the communication of their medical documents between medical institutions altogether, which reflects the limited extent to which a woman with mental disabilities is involved in the decision-making process concerning her own pregnancy.
The Court finds that the Government failed to demonstrate the existence of any legal provisions, safeguards and mechanisms meant to support persons like the applicants, who were intellectually disabled but had not been deprived of their legal capacity, to express valid and fully informed consent for medical interventions, especially in respect of abortions and contraception. Even the 2020 updated national standards seem to transfer the decision to the legal representative. In this connection, it has not been shown by the Government that there existed any practice to provide persons with intellectual disabilities with information in a manner accessible to them.
The interviews with medical staff reflect a paternalistic attitude towards the applicants, considering as they did that it was normal for the decision to terminate the pregnancy to have been taken by a doctor in the psychiatric asylum or by the medical committee without the applicants' consent.
Furthermore, while the situation should improve with the national implementation of the Istanbul Convention, which requires the criminalisation of forced abortion, the Court finds that the domestic criminal law does not provide effective protection against such invasive medical interventions carried out without the patient's valid consent.
All in all, the Court finds that the existing legal framework falls short of the requirement inherent in the State's duty to establish and apply effectively a system providing protection to women living in psychiatric institutions against serious breaches of their integrity, contrary to Article 3 of the Convention.

The Obligation to Protect the Applicants' Physical Integrity The Complaints Concerning the Termination of the Pregnancies
It is undisputed that the first and second applicants had their pregnancies terminated at the maternity hospital after being sent there by the asylum. The Court has not been presented with any evidence of consent in respect of the first applicant. In respect of the second applicant, it is to be noted that the domestic authorities were unable to conclude that she had indeed signed the respective consent form. Even assuming that she did sign the form, in the absence of any legal safeguards to assist her in expressing a valid consent and in view of her vulnerability owing to her intellectual disability, despite retaining full legal capacity, the Court is not convinced that a simple handwritten letter "M." could constitute a validly expressed consent for the termination of her pregnancy.
In respect of the third applicant, the national authorities found that her allegations were unsubstantiated because her medical file did not contain any record of a pregnancy. The Court observes that the difficulty in determining whether there is any substance to the third applicant's allegations of ill-treatment stemmed from the authorities' failure to investigate her complaints effectively. They have limited their inquiry to her medical file, establishing thus that she had never been pregnant. However, witness statements revealed, on the one hand, that abortions among women at the asylum were common practice and, on the other hand, that she had indeed been pregnant at a certain point in time. The proven rape of multiple residents of the asylum (including the third applicant), the forced abortions carried out on the other applicants, and the deficiencies in the legal framework leads the Court to conclude in favour of her version of events. The Court therefore finds that there has been a violation of Article 3 in respect of the third applicant as well.

The Complaints Concerning the Birth-Control Measures and Inability to Procreate
As regards the applicants' complaints concerning the birth-control measures, the difficulty in determining whether there is any substance to the first applicant's allegations of ill-treatment also stems from the authorities' failure to investigate her complaints effectively. The Court notes that the Government have failed to produce any evidence to cast doubt on her submission that the foreign body described by her doctor had been a contraceptive device implanted in her body while she was under State control in the asylum. The Court therefore considers that fact proven and concludes that there has been a violation of the substantive limb of Article 3 of the Convention in respect of the first applicant on that account. In view of this finding, the Court considers that it is not necessary to examine separately the first applicant's complaint concerning her inability to procreate.
The second and third applicants are still residents of the asylum. The second applicant submitted that in 2014 a contraceptive coil had been extracted from her body but failed to provide the Court with any evidence. Likewise, the third applicant did not submit any evidence or details in support of her allegation that she had been fitted with an intrauterine contraceptive device. Therefore, the Court cannot draw a conclusion as to whether the second and third applicants have been subjected to forced contraception. It concludes that there has not been a violation of the substantive limb of Article 3 of the Convention in their respect on that account.
For these reasons, the court, unanimously, holds that there has been a violation of Article 3 of the Convention both in its procedural limb as regards the forced abortions and forced contraception in respect of all three applicants and in its substantive limb as regards the forced abortions in respect of all three applicants, and concerning the forced contraception in respect of the first (but not the second and third) applicant.