Source: http://www.ipsofactoj.com/DecidedCases/international/2005A/part06/int2005A(06)-002.htm
Timestamp: 2019-02-24 02:54:36
Document Index: 456056387

Matched Legal Cases: ['art 6', 'Application No 43348', 'Application No 41874', 'Application No 46553', 'Application No 13669', 'Application No 17868', 'Application No 25629', 'UKHL ', 'Application No 40900', 'EWCA ', 'Art.32', 'Art.33']

N v Sec of State for Home Department [HL]
IpsofactoJ.com: International Cases [2005A] Part 6 Case 2 [HL]
The history of the appellant's proceedings can be summarised shortly. On 28 March 2001 the Secretary of State refused her application for asylum. On 10 July 2002 the adjudicator, Mr. Paul Norris, dismissed the appellant's appeal from that asylum decision. But he allowed her appeal on the ground that to return her to Uganda would be a breach of her Convention right under article 3 of the European Convention. He said that on the evidence her case for protection under article 3 was 'overwhelming'.
On 20 February 2003 the Immigration Appeal Tribunal allowed an appeal by the Secretary of State. The appellant appealed to the Court of Appeal. The court, comprising Laws, Dyson and Carnwath LJJ, held unanimously that the tribunal's conclusion was flawed for want of legally sufficient reasons: [2004] 1 WLR 1182. But by a majority, comprising Laws and Dyson LJJ, the appeal was dismissed on the ground that the appellant's evidence did not bring her case within that 'extreme' class of case to which it must belong if a claim based on article 3 is to succeed: paras 43 and 49. Carnwath LJ would have remitted the case to the tribunal for re-determination.
In interpreting the Convention, as any other treaty, it is generally to be assumed that the parties have included the terms which they wished to include and on which they were able to agree, omitting other terms which they did not wish to include or on which they were not able to agree. Thus particular regard must be had and reliance placed on the express terms of the Convention, which define the rights and freedoms which the contracting parties have undertaken to secure. This does not mean that nothing can be implied into the Convention. The language of the Convention is for the most part so general that some implication of terms is necessary, and the case law of the European Court shows that the court has been willing to imply terms into the Convention when it was judged necessary or plainly right to do so. But the process of implication is one to be carried out with caution, if the risk is to be averted that the contracting parties may, by judicial interpretation, become bound by obligations which they did not expressly accept and might not have been willing to accept. As an important constitutional instrument the Convention is to be seen as a 'living tree capable of growth and expansion within its natural limits' (Edwards v Attorney General for Canada [1930] AC 124, 136 per Lord Sankey LC), but those limits will often call for very careful consideration.
Against this background the court will determine whether the applicant's deportation to Zambia would be contrary to article 3 in view of her present medical condition. In so doing the court will assess the risk in the light of the material before it at the time of its consideration of the case, including the most recent available information on her state of health ....
The court accepts the seriousness of the applicant's medical condition. Having regard however to the high threshold set by article 3, particularly where the case does not concern the direct responsibility of the contracting state for the infliction of harm, the court does not find that there is a sufficiently real risk that the applicant's removal in these circumstances would be contrary to the standards of article 3. It does not disclose the exceptional circumstances of the D case … where the applicant was in the final stage of a terminal illness, AIDS, and had no prospect of medical care or family support on expulsion to St Kitts.
In these circumstances the court considers that, unlike the situation in the above-cited case of D v United Kingdom or in the case of BB v France ...., it does not appear that the applicant's illness has attained an advanced or terminal stage, or that he has no prospect of medical care or family support in his country of origin. The fact that the applicant's circumstances in Columbia would be less favourable than those he enjoys in the Netherlands cannot be regarded as decisive from the point of view of article 3 of the Convention.
The conclusion that I would draw from this line of authority is that Strasbourg has adhered throughout to two basic principles. On the one hand, the fundamental nature of the article 3 guarantees applies irrespective of the reprehensible conduct of the applicant. It makes no difference however criminal his acts may have been or however great a risk he may present to the public if he were to remain in the expelling state's territory. On the other hand, aliens who are subject to expulsion cannot claim any entitlement to remain in the territory of a contracting state in order to continue to benefit from medical, social or other forms of assistance provided by the expelling state. For an exception to be made where expulsion is resisted on medical grounds the circumstances must be exceptional. In May 2000 Mr. Lorezen, a judge of the Strasbourg court, observed at a colloquy in Strasbourg that it was difficult to determine what was meant by "very exceptional circumstances". But subsequent cases have shown that D v United Kingdom is taken as the paradigm case as to what is meant by this formula. The question on which the court has to concentrate is whether the present state of the applicant's health is such that, on humanitarian grounds, he ought not to be expelled unless it can shown that the medical and social facilities that he so obviously needs are actually available to him in the receiving state. The only cases where this test has been found to be satisfied are D v United Kingdom, where the fatal illness had reached a critical stage, and BB v France where the infection had already reached an advanced stage necessitating repeated stays in hospital and the care facilities in the receiving country were precarious. I respectfully agree with Laws LJ's observation in the Court of Appeal, para 39, that the Strasbourg court has been at pains in its decisions to avoid any further extension of the exceptional category of case which D v United Kingdom represents.
Where there is credible medical evidence that return, due to the medical facilities in the country concerned, would reduce the applicant's life expectancy and subject him to acute physical and mental suffering, in circumstances where the UK can be regarded as having assumed responsibility for his care.
So what is the test to be derived from the decision in D v United Kingdom (1997) 24 EHRR 423 and the cases which followed? In D the court first acknowledged that article 3 had in the past been applied only to expulsions where the risk of ill-treatment "emanates from the intentionally inflicted acts of the public authorities in the receiving country or from those of non-State bodies in that country when the authorities there are unable to afford him appropriate protection"; it "reserved to itself sufficient flexibility" to address the application of article 3 in other contexts; but it emphasised that in such other contexts it must subject all the circumstances to the most rigorous scrutiny, "especially the applicant's personal situation in the expelling State" (para 49). The Court therefore set out to determine whether there was a real risk that the applicant's removal would be contrary to the standards in Article 3 "in view of his present medical condition" (para 50). In doing so, it noted
that the applicant was "in the advanced states of a terminal and incurable illness" (para 51);
that his illness had reached a "critical stage" (para 53);
that the abrupt withdrawal of his present treatment facilities "will entail the most dramatic consequences for him", would "reduce his already limited life expectancy" and "subject him to acute mental and physical suffering" (para 52); and
that the United Kingdom had assumed responsibility for treating his condition for some years (para 53).
It emphasised that "aliens who .... are subject to expulsion cannot in principle claim any entitlement to remain on the territory of a Contracting State in order to continue to benefit from medical, social or other forms of assistance provided by the expelling State .... " (para 54). However "in the very exceptional circumstances of this case and given the compelling humanitarian considerations at stake" implementation of the decision to remove him would be a violation of Article 3 (para 54).
.... it does not appear that the applicant's illness has attained an advanced or terminal stage, or that he has no prospect of medical care or family support in his country of origin.
According to established case-law aliens who are subject to expulsion cannot in principle claim any entitlement to remain in the territory of a Contracting State in order to continue to benefit from medical, social or other forms of assistance provided by the expelling State. However, in exceptional circumstances an implementation of a decision to remove an alien may, owing to compelling humanitarian considerations, result in a violation of Article 3.
.... I would hold that the application of article 3 where the complaint in essence is of want of resources in the applicant's home country (in contrast to what has been available to him in the country from which he is to be removed) is only justified where the humanitarian appeal of the case is so powerful that it could not in reason be resisted by the authorities of a civilised state.
The inequality of medical treatment was not the criterion adopted by the Court as medical equipment in the Member States of the United Nations is, alas, not all of the same technological standard; the case of D, however, is concerned not with hospital treatment in general, but only with the deportation of a patient in the final stages of an incurable disease.
In my view, therefore, the test, in this sort of case, is whether the applicant's illness has reached such a critical stage (i.e. he is dying) that it would be inhuman treatment to deprive him of the care which he is currently receiving and send him home to an early death unless there is care available there to enable him to meet that fate with dignity. This is to the same effect as the text prepared by my noble and learned friend, Lord Hope of Craighead. It sums up the facts in D. It is not met on the facts of this case.
Having regard however to the high threshold set by article 3, particularly when the case does not concern the direct responsibility of the Contracting State for the infliction of harm, the court does not find that there is a sufficiently real risk that the applicant's removal in these circumstances would be contrary to the standards of article 3. It does not disclose the exceptional circumstances of the D case .... where the applicant was in the final stage of a terminal illness, AIDS, and had no prospect of medical care or family support on expulsion to St Kitts.
the formulation of anti-retroviral drugs Ms N is currently taking are not available in Uganda. Ms N's HIV virus already has some resistance and in the future she will require a change of anti-retrovirals which is likely to include other drugs not available in Uganda. If she returns to Uganda although anti-retrovirals are available in parts of the country she would not have the full treatment required and would suffer ill-health, pain, discomfort and an early death as a result.
I have no doubt at all that if she is forced to return to Uganda her life span will be dramatically shortened from potentially decades of high quality life to almost certainly less than 2 years.
This case has nothing to do with torture or punishment. The question for present purposes is whether deporting the appellant in the circumstances outlined would be subjecting her to inhuman or degrading treatment. I shall refer to such treatment generically as article 3 ill-treatment: it seems unhelpful in a case like this to attempt any sub-classification although the Strasbourg jurisprudence sometimes suggests it — see, for example, Pretty v United Kingdom (2002) 35 EHRR 403 at para 52.
However in exercising their right to expel such aliens Contracting States must have regard to article 3 of the convention which enshrines one of the fundamental values of democratic societies. It is precisely for this reason that the court has repeatedly stressed in its line of authorities involving extradition, expulsion or deportation of individuals to third countries that article 3 prohibits in absolute terms torture or inhuman or degrading treatment or punishment and that its guarantees apply irrespective of the reprehensible nature of the conduct of the person in question.
.... It is for the respondent State therefore to secure to the applicant the rights guaranteed under article 3 irrespective of the gravity of the offence which he committed.
It is true that this principle has so far been applied by the court in contexts in which the risk to the individual of being subjected to any of the proscribed forms of treatment emanates from intentionally inflicted acts of the public authorities in the receiving country or from those of non-State bodies in that country when the authorities there are unable to afford him appropriate protection.
Against this background the court will determine whether there is a real risk that the applicant's removal would be contrary to the standards of article 3 in view of his present medical condition. In so doing the court will assess the risk in the light of the material before it at the time of its consideration of the case, including the most recent information on his state of health.
The court notes that the applicant is in the advanced states of a terminal and incurable illness. At the date of the hearing, it was observed that there had been a marked decline in his condition and he had to be transferred to a hospital. His condition was giving rise to concern. The limited quality of life he now enjoys results from the availability of sophisticated treatment and medication in the United Kingdom and the care and kindness administered by a charitable organisation. He has been counselled on how to approach death and has formed bonds with his carers.
The abrupt withdrawal of these facilities will entail the most dramatic consequences for him. It is not disputed that his removal will hasten his death. There is a serious danger that the conditions of adversity which await him in St Kitts will further reduce his already limited life expectancy and subject him to acute mental and physical suffering. Any medical treatment which he might hope to receive there could not contend with the infections which he may possibly contract on account of his lack of shelter and of a proper diet as well as exposure to the health and sanitation problems which beset the population of St Kitts. While he may have a cousin in St Kitts no evidence has been adduced to show whether this person would be willing to or capable of attending to the needs of a terminally ill man. There is no evidence of any other form of moral or social support. Nor has it been shown whether the applicant would be guaranteed a bed in either of the hospitals on the island which, according to the Government, care for AIDS patients.
In view of these exceptional circumstances and bearing in mind the critical stage now reached in the applicant's fatal illness, the implementation of the decision to remove him to St Kitts would amount to inhuman treatment by the respondent State in violation of article 3.
Against this background the court emphasises that aliens who have served their prison sentences and are subject to expulsion cannot in principle claim any entitlement to remain on the territory of a Contracting State in order to continue to benefit from medical, social or other forms of assistance provided by the expelling State during their stay in prison.
Article 3 enshrines one of the fundamental values of democratic societies and constitutes an absolute prohibition on article 3 ill-treatment irrespective of how reprehensibly the applicant may have behaved.
Notwithstanding that ordinarily a state is entitled to extradite, expel or deport aliens, whether to honour extradition treaties, combat crime, safeguard its own population, or more generally in the interests of immigration control, the exercise of such a power may itself in certain circumstances constitute article 3 ill-treatment. This will be so if the applicant would be at substantial risk of article 3 ill-treatment in the receiving country (a proposition previously established by the Court in cases such as Soering v United Kingdom (1989) 11 EHRR 439 and Chahal v United Kingdom (1997) 23 EHRR 413) or even exceptionally (as on the facts of D itself) if the applicant's removal would sufficiently exacerbate the suffering flowing from a naturally occurring illness (see for this formulation of the nature of the violation, Pretty at para 52).
In this latter exceptional class of case the Court will assess whether the applicant's removal is itself properly to be characterised as article 3 ill-treatment in the light of the applicant's present medical condition. The mere fact that the applicant is fit to travel, however, is not of itself sufficient to preclude his removal being characterised as article 3 ill-treatment.
An alien otherwise subject to removal cannot in principle claim any entitlement to remain in order to benefit from continuing medical, social or other assistance available in the contracting state.
In Henao v The Netherlands (App No 13669/03, 24 June 2003) the court contrasted the position of that applicant, an AIDS sufferer, with D (and with the applicant in BB v France — a case held admissible by the Commission (App No 39030/96) but, following the French Government's agreement not after all to remove the applicant, not then adjudicated upon by the Court because it saw "no reason of public policy to proceed with the case [since in D] the Court [had already] explained the nature and extent of the obligations under the Convention": (para 39 of the Court's judgment of 7 September 1998, Reports 1998-VI, p2595)):
unlike the situation in the above-cited case of D v United Kingdom or in the case of BB v France ...., it does not appear that the applicant's illness has attained an advanced or terminal stage, or that he has no prospect of medical care or family support in his country of origin. The fact that the applicant's circumstances in Colombia would be less favourable than those he enjoys in the Netherlands cannot be regarded as decisive from the point of view of article 3 of the Convention.
In stating in all three of these cases that "it does not appear that the applicant .... has no prospect of medical care or family support" in his own country, the Court was very far from saying that the applicant was likely to be able to access and afford treatment and support remotely comparable to that enjoyed in the contracting state. On the contrary, the evidence before the Court suggested that in reality this was unlikely. The Court found only that "the required treatment is in principle available in Colombia, where the applicant's father and six siblings reside" (Henao p8); "adequate treatment is available in Tanzania, albeit at a considerable cost .... the applicant is in principle at liberty to settle at a place where medical treatment is available .... it is clear that he has many siblings in the country. It therefore appears that the family links have not been completely severed and that, consequently, the applicant would not be unable to seek the support of his relatives upon return to Tanzania" (Ndangoya pp12/13); "adequate treatment is in principle available in Togo, albeit at a possibly considerable cost .... His mother and a younger brother are residing [in Togo]" (Amegnigan p9). (It is convenient to note at this stage that Uganda is said to be one of the most advanced African countries in the treatment of AIDS and that, although the appellant has lost five of her siblings to HIV-related illnesses and would herself clearly have the very greatest difficulty in accessing and paying for the necessary treatment, she has some 10 or 12 relatives still living in Uganda.)
This brings me to the second colloquy on the European Convention on Human Rights and the protection of refugees, asylum-seekers and displaced persons, held at Strasbourg in May 2000, and in particular the keynote presentation made by Mr. Lorenzen, a judge at the E Ct HR. Under the heading "Cases where there is a lack of adequate medical treatment" Mr. Lorenzen stated that the leading case was D, that "the difficulty was to determine what was to be understood by 'very exceptional circumstances'", that "it was too early to say whether the Court would take a restrictive line or whether it would be willing to adopt a more liberal line", that the position remained unclear following BB v France, Tatete v Switzerland (App No 41874/98) and SCC v Sweden (App No 46553/99); that "it was therefore necessary to await the outcome of the pending cases in order to have a better picture", and that:
this type of case presented a challenge to the court, which was not easily solved. On the one hand, no one could reasonably deny that compelling humanitarian considerations demanded that persons suffering from serious diseases should be given appropriate treatment that was unavailable in their country of origin. The protection under article 3 was consistently held to be absolute in the case law of the Court: those in need of it were entitled to it despite individual circumstances, such as, for example the fact that the applicant's stay in the host country was short. On the other hand, the consequences of granting an absolute right for seriously ill persons to remain in the host country to get treatment, provided they had managed to set foot there, were very far reaching.
I do not pretend to find the precise reasoning by which the Court has come to its conclusion entirely convincing or satisfactory. The contrasts which the Court has struck between D and the recent cases are, as I have already shown,
first that D's illness had attained its terminal stage and
secondly that D, unlike the later applicants, had no prospect of medical care or family support on return home.
It is perhaps not, however, self-evidently more inhuman to deport someone who is facing imminent death than someone whose life expectancy would thereby be reduced from decades to a year or so. Nor, as already suggested, has there generally been a sound evidential basis for supposing that much if anything in the way of medical care or family support would be available to the applicants on return.
The reality is that the medicine has developed hugely since D and that a quite different problem now presents itself from that presented by D. The choice now is between allowing the patient to remain in the host state to enjoy decades of healthy life at the expense of that state — an expense both in terms of the cost of continuing treatment (the medication itself being said by the Intervener to cost some £7,000 per annum) and any associated welfare benefits, and also in terms of immigration control and the likely impact of such a ruling upon other foreign AIDS sufferers aspiring to these benefits — and deporting the patient to a life of rapidly declining health leading to a comparatively early death.
Is that test satisfied here? Much though I would prefer not to have to make this decision, I for my part feel driven to answer no to this question. This was, of course, the answer given by the majority below (consistently with earlier Court of Appeal decisions on the point — see in particular K v Secretary of State for the Home Department [2001] Imm AR 11) — and, although Carnwath LJ dissented, he did so only on the basis that the decision might be affected by a fuller factual examination. Altogether more importantly, however, this is the answer which, as I have sought to demonstrate, all the recent Strasbourg case law clearly suggests the E Ct HR would now give to these questions and, as I began by saying, this House ought largely to be guided by the jurisprudence of that Court.
D v United Kingdom (1997) 24 EHRR 425
Ahmed v Austria (1996) 23 EHRR 278
BB v France, 9 March 1998, RJD 1998-VI
MM v Switzerland, Application No 43348/98, 14 September 1998
Tatete v Switzerland, Application No 41874/98, 18 November 1998
SCC v Sweden, Application No 46553/99, 15 February 2000
Henao v The Netherlands, Application No 13669/03, 24 June 2003
Ndangoya v Sweden, Application No 17868/03, 22 June 2004
Amegnigan v The Netherlands, Application No 25629/04, 25 November 2004
In re B [2005] UKHL 19
Karara v Finland, Application No 40900/98, 29 May 1998
Limbuela v Secretary of State [2004] QB 1440
Gezer v Secretary of State for the Home Department [2004] EWCA Civ 1730
K v Secretary of State for the Home Department [2001] Imm AR 11
United Nations Convention on the Status of Refugees 1951: Art.32, Art.33
July 2004 UNAIDS report