Introduction

On July 9, 2026, the European Court of Human Rights (ECtHR) filed the judgment in Federico and Raddi v. Italy Case (application no. 5053/24), condemning Italy for the violation of Article 2 (right to life) and Article 3 (prohibition of inhuman and degrading treatment) of the European Convention on Human Rights (ECHR). The case originates from the dramatic death of the young A.R., who died from septic shock at the age of just twenty-eight in Turin Hospital, following a serious and unstoppable organic deterioration suffered during pre-trial detention in the Turin prison. The ruling of the Strasbourg Court highlights the persistent structural deficiencies in Italian prison healthcare, condemns the serious underestimation of the prisoner's clinical condition, the dramatic lack of diagnostic and therapeutic coordination, and the slowliness in initiating hospitalization. The ECtHR strongly reaffirms the principle established in its case law that the prisoner's vulnerability imposes on the State a specific positive obligation to proactive, prompt, and effective protection of his health and life.

The facts of the case

On April 28, 2019, A.R. entered the Turin prison. Upon admission, the twenty-eight-year-old weighed 76 kilograms and suffered from drug addiction, anxiety, and depression. He underwent a psychiatric evaluation the following day and was placed on a program to manage his withdrawal symptoms, supplemented by weekly psychological sessions starting on May 28, 2019. However, since July 2019, his health had steadily deteriorated. On July 1, A.R. reported a loss of appetite, and on July 8, he recorded his first weight loss of 4 kilograms.

Over summer, his weight loss continued rapidly. On August 6, 2019, his weight dropped to 68.5 kilograms, and the following day, a physiatrist diagnosed general weakness related to anorexia.The National Guarantor for Prisoners and Persons Deprived of Personal Liberty (National Guarantor) immediately alerted the prison administration. The authorities' response, on August 20, 2019, ruled out serious pathologies and rejected the request for external psychological support. On September 6, 2019, a psychiatric consultation revealed a weight of 60 kilograms (a loss of 15 kilograms since admission and 50 kilograms since 2017). Although anorexia nervosa was ruled out, the specialist ordered weekly weight monitoring.

During a five days period of disciplinary isolation, which took place between October 18 and 23, 2019, A.R. expressed profound concern due to his continued and progressive physical deterioration. On November 16 and 17, the inmate suffered two fainting spells due to hypotension. In response to a further inquiry from the National Guarantor, on November 19, 2019, the prison authorities characterized the weight loss as a manipulative strategy aimed at obtaining secondary benefits.

On November 20, 2019, the prison health department requested admission to the detention ward of Turin Hospital. However, the transfer was scheduled for December 10, 2019, due to the unavailability of beds. Meanwhile, since November 30, A.R. had been confined to a wheelchair, and on December 4, his weight dropped to 51.55 kilograms. On December 5, he was taken to the infirmary and on December 6, he was rushed to the emergency room after yet another loss of consciousness, where he was later discharged.

On December 10, 2019, A.R. refused hospitalization against medical advice. On December 13, his condition worsened: admitted to the emergency room with a lung infection, he lapsed into a coma on December 14, and died on December 30, 2019, of septic shock. The criminal investigation, initiated following a complaint from the National Guarantor, saw the appointment of three medical experts: while the first expert report excluded liability, the second and third established a causal link between the weight loss and the death, criticizing the diagnostic delays and lack of coordination. Nonetheless, upholding the prisoner's refusal to be admitted on December 10, the Turin Preliminary Investigations Judge (GIP) ordered the case to be closed on October 9, 2023.

The legal issues raised

Following the dismissal of the criminal proceedings, A.R.'s parents, Rosalia Federico and Mario Raddi, filed an application with the ECtHR on 6 February 2024. The applicants alleged violations of Article 2 (right to life) and Article 3 (prohibition of inhuman and degrading treatment) of the Convention, due to the inadequacy, discontinuity, and delays in the medical care provided to their son during his detention, as the factors that led to his death.

The Italian government raised a preliminary objection based on failure to exhaust domestic remedies, arguing that the family should have filed a civil action for damages after the criminal case was dismissed. On the merits, the government maintained that the care provided had been adequate, attributing the event to the prisoner's uncooperative conduct, characterized by a voluntary refusal of food, occasional refusal of medication, and the refusal to be admitted to the hospital on December 10, 2019.

The main legal issues examined by the Court concerned: the effectiveness of the civil action for the purposes of admissibility; the scope of the positive obligations to protect life and health under Articles 2 and 3 of the ECHR; and, finally, the relevance of the prisoner's uncooperative conduct in the face of the authorities' prolonged inertia.

The Court's reasoning and decision

The First Section of the ECHR, ruling unanimously as a Committee, rejected the Government's objection and found a violation of Articles 2 and 3 of the Convention.

On admissibility, the Court recalled the principle expressed in Nicolae Virgiliu Tanase v. Romania, reiterating that when an appropriate remedy has already been activated, the use of a further remedy for the same purpose is not required. The criminal investigation was initiated on the initiative of the National Guarantor in compliance with the procedural obligations set forth in Articles 2 and 3 ECHR (similarly to what happened in the case Fabbri and Others v. San Marino). Since the family members participated in the investigative phase and opposed the case's dismissal, and since the Government failed to demonstrate a greater effectiveness of the civil route, the state's objection was rejected.

On the merits, the Court reiterated that the State has a positive obligation to protect the health of prisoners by virtue of their vulnerable condition, citing key judgments Roman v. Belgium and Blockade v. Russia, where the lack of adequate medical care in prison is classified as inhuman and degrading treatment. The judges noted that the devastating weight loss (from 76 to 51.55 kilograms) played a direct causal role in the young man's death, as confirmed by the official expert reports.

The Court noted serious delays and gaps in care. Despite the inmate's requests and the National Guarantor's reports, the administration failed to conduct specialized tests to identify the causes of his health deterioration. Weight monitoring was ordered weekly only in September and daily in December, when the situation had already reached critical levels.

The judges rejected the government's argument that the weight loss was voluntary. Recalling Yakovlyev from Ukraine, the Court clarified that even in the face of potential refusal of food, the authorities must ascertain the real reasons and ensure rigorous monitoring. Regarding the prisoner's lack of cooperation, the Court recalled that cooperation is only an element of evaluation and does not relieve the State of its duties (see Epure v. Romania; Karakhanyan v. Russia), noting that drug refusals had been occasional and occurred in isolation or in the final phase of detention.

Regarding the December 10, 2019, refusal of admission, the Court noted that the need for hospitalization had been established as early as November 20, when the patient's conditions were already serious. Nevertheless, the authorities had accepted a three-week delay due to a lack of beds, without making the necessary efforts to find immediate accommodation.

On the basis of the above assessment, the Court therefore condemned Italy for violating Article 2 (right to life) and Article 3 (prohibition of inhuman and degrading treatment) of the ECHR.

Pursuant to Article 41 of the Convention, the Court awarded the parents jointly 6,790 euros in pecuniary damage, 20,000 euros in non-pecuniary damage and 1,000 euros in legal costs.

The implications for the Italian legal system

The Federico and Raddi v. Italy judgment has systemic significance for the Italian penitentiary system. The ruling highlights how the transfer of prison medicine to the National Health Service (NHS) presents critical operational issues, linked to the lack of coordination between healthcare personnel and prison administration and the shortage of dedicated beds in hospital detention wards.

Particularly significant is the warning against attributing symptoms of health deterioration to mere manipulative behavior by the inmate, an approach that ultimately paralyzes therapeutic intervention. Furthermore, the ruling enhances the role of the National Guarantor, establishing that failure to respond to its requests constitutes a violation of the Convention's obligations.

Finally, the decision condemns the closure of the investigations into deaths in custody based solely on the  uncooperative attitude of detainees, requiring the investigating bodies to rigorously evaluate the state's medical omissions in light of Article 2 ECHR.

Conclusion

The Federico and Raddi v. Italy judgment constitutes a severe reminder for the penitentiaries institutes nationwide. The protection of life and health in places of deprivation of liberty cannot suffer bureaucratic delays linked to organizational shortcomings. To ensure the effectiveness of Article 27 of the Constitution and the principles of human rights contained in the ECHR and binding on Italy, timely and integrated prison healthcare, capable of placing the dignity of the human person at the center, is needed.