Appeals judges at the International Criminal Court in The Hague rejected a request to release former Philippine President Rodrigo Duterte from custody on health grounds.
The decision keeps the octogenarian in detention as he faces charges of crimes against humanity related to killings during his war on drugs.
Duterte's lawyers argued that his infirmity and cognitive decline make continued detention cruel, but the court found the lower chamber's October ruling reasonable.
The former president did not attend the hearing.
The charges stem from November 1, 2011, when Duterte was mayor of Davao City, to March 16, 2019, following the Philippines' withdrawal from the ICC.
Court filings indicate Duterte instructed and authorized violent acts, including murders, against alleged criminals such as drug dealers and users.
Judges determined that releasing him posed risks of flight, evasion of trial, and intimidation of witnesses.
These risks could not be mitigated by transfer to another member state's custody.
In September, a pretrial hearing was postponed for a full medical assessment.
Duterte's team plans to reintroduce the release request after a medication examination next month.
The court also ruled that the Philippines' withdrawal cannot shield individuals from justice for crimes already under consideration.
Human rights groups and victims' families welcomed the ruling.
The National Union of Peoples’ Lawyers stated that detention ensures safety for victims and witnesses.
The current Philippine government respects the ICC's decision, according to presidential Communications Secretary Claire Castro.
Duterte's family accepted the outcome with peaceful hearts and pledged continued support.
Vice President Sara Duterte, his daughter, released a statement affirming ongoing work with the defense team.
Estimates of deaths during Duterte's presidency vary, with police citing over 6,000 and human rights groups claiming up to 30,000.
Duterte has been detained in The Hague for more than eight months since his March arrest.