A/HRC/4/28 page 21 and a clean environment, as well as several other human rights, by facilitating the operations of oil companies in Ogoniland. The applicants alleged that the operations of an oil consortium, comprising the Nigerian National Petroleum Company and Shell Petroleum Development Corporation, had contaminated the environment, leading to serious and widespread health problems among the Ogoni people. The African Commission on Human and Peoples’ Rights held that the Ogoni had suffered violations of a number of their human rights, including their rights to health and a clean environment, as a result of the Government’s failure to prevent pollution and ecological degradation. It found that the Government had failed to adequately regulate and monitor the oil consortium. The Commission issued a number of orders, for example, environmental and social impact assessments should be prepared in the future and health and environmental information should be made available. 3. Fulfil 85. The duty to fulfil requires States to adopt appropriate legislative, administrative, budgetary, judicial and other measures towards the full realization of the right to health.72 86. In Purohit and Moore v. The Gambia, mental health advocates witnessed the inhuman treatment of mental health patients in the psychiatric unit of the Royal Victoria Hospital in the Gambia.73 They submitted a complaint to the African Commission on Human and Peoples’ Rights on behalf of the mental health patients detained in the unit. The principal legislation governing mental health in the Gambia was the Lunatics Detention Act (1917). The complaint pointed out that, from the human rights perspective, this colonial legislation was seriously deficient in numerous respects. The Commission held that the legislation was “lacking in terms of therapeutic objectives”; it was also inadequate to treat only those persons with mental disabilities for whom there were “matching resources and programmes”. The Commission ordered the Government to replace, as soon as possible, the Lunatics Detention Act with a new legislative scheme for mental health that was compatible with the African Charter on Human and Peoples’ Rights, as well as more specific international standards for the protection of persons with disabilities. E. Conclusion 87. These cases illustrate the indispensable role of accountability. Without accountability, a State could use progressive realization and the scarcity of resources as an excuse to do virtually nothing - or to respond to whichever interest group has the loudest voice. Independent, effective and accessible mechanisms of accountability compel a State to explain what it is doing and why and how it is moving, as expeditiously and effectively as possible, towards the realization of the right to health for all. 88. Courts are usually reluctant to intervene. They tend to give the State a wide “margin of discretion”. They are well practised in striking balances between competing interests in a principled but pragmatic way: in the Treatment Action Campaign case, the Constitutional Court held that the Government was not doing all it reasonably could, while in Soobramoney the same Court declined to intervene because the hospital had a fair policy in place. Supported by appropriate legislation, courts can ensure that the interests of the poor and disadvantaged - so often overlooked - are given due weight. In appropriate cases, they have the crucial