YZ v The Secretary of State for the Home Department

I have made an anonymity order in this case because of an order dated 28 June 2022 in Family Court proceedings by HHJ Edwards which prevents the public disclosure of the names of parties (which includes the appellant, his ex-wife and his son) in those proceedings without the permission of the Family Court. An order for disclosure in this appeal of Family Court documents was made; however, the Family Court did not give permission for the disclosure of the parties’ names.

This is not a full summary of the appellant’s background and is taken from information provided by both parties to the appeal. Nothing in this section should be construed as amounting to a finding of fact. All findings are set out below under the hearing ‘Findings and reasons’.

The appellant is a citizen of Morocco. He appeals the decision made on 2 February 2024 to refuse his human rights claim.

The appellant arrived in the United Kingdom on 5 September 2009 with leave to enter as a spouse valid until 1 December 2011. On 29 June 2011 the respondent wrote to the appellant advising him of a decision to curtail his leave to remain following advice that his relationship with his wife had broken down.

On 14 March 2012 the appellant was remanded in custody in relation to allegations made by his ex-wife. He was found not guilty of all offences on 17 September 2012. The appellant remained detained under immigration powers.

On 24 September 2012 the appellant made a human rights claim, which was refused on 26 October 2012. The respondent states that there was a right of appeal, which the appellant exercised and that the appeal was dismissed on 24 January 2013. The appellant states that the application was refused and certified meaning that there was not right of appeal against the decision. It appears that the appellant may be confusing this decision with one made on 31 January 2023 in relation to a different application.

In late 2012, the appellant was arrested and charged with offences relating to a refusal to cooperate with the redocumentation process. The appellant was acquitted of those charges on 6 February 2013.

The appellant made an application for leave to remain as a victim of domestic violence on 19 March 2013. The application was rejected on 20 March 2013. It appears that the respondent then reconsidered the appellant’s case, as on 30 October 2014, she notified him that she had decided to grant him discretionary leave to remain. It is unclear whether leave to remain was in fact granted, as on 4 December 2014, the appellant made submissions on human rights grounds. The respondent states that leave to remain was granted on 5 December 2014, valid until 5 June 2015.

On 4 June 2015 the appellant made an application for indefinite leave to remain as a victim of domestic violence. The application was refused on 27 August 2015 without a right of appeal. The appellant challenged that decision by way of an application for administrative review on 7 September 2015. The respondent maintained her decision on 23 September 2015.

The appellant lodged an application for judicial review on 27 November 2015 challenging the decision made on 27 August 2015. Permission to proceed with the claim for judicial review was refused on 10 February 2016. The appellant renewed his application, and permission was refused at an oral hearing on 31 March 2016.

On 7 April 2016 the appellant made an application for leave to remain on human rights grounds. The application and the application for a fee waiver which accompanied it were rejected on 9 May 2016. The appellant submitted a further application for leave to remain on human rights grounds on 21 June 2016. The application was successful and the appellant was granted leave to remain on 1 December 2016, valid until 1 June 2019.

The appellant made an application for a fee waiver on 29 May 2019, and on 5 July 2019 his application was approved. He then submitted his application for further leave to remain on 2 August 2019. On 31 January 2023 the application for leave to remain was refused and certified under section 94 of the Nationality, Immigration and Asylum Act 2002 (the 2002 Act).

The appellant notified the respondent of his intention to challenge by way of judicial review the refusal and certification of the decision of 31 January 2023. The appellant sent letters before claim on 2 February 2023 and again on 12 May 2023. In the meantime, on 14 February 2023, he also made an application for leave to remain on human rights grounds.

The respondent replied to letters before claim on 16 February 2023 and 18 May 2023 respectively. She maintained her decision in the letter dated 16 February 2023 and declined to provide a substantive response in the letter dated 18 May 2023 because the appellant’s second letter before claim was outside the three month deadline for issuing a claim for judicial review.

The appellant lodged a claim for judicial review on 30 May 2023. The claim for judicial review was settled by consent when the respondent agreed to withdraw her decision, to reconsider her decision and to consider the appellant’s application for leave to remain submitted on 14 February 2023. On 2 February 2024, the applications made on 2 August 2019, and 14 February 2023 were refused. It is that decision which is the subject of this appeal. The appellant lodged his appeal on 14 February 2024.

After lodging his appeal, the appellant sent a letter before claim to the respondent putting her on notice of his intention to challenge a refusal to accept the continuity of his lawful residence. The respondent replied to the letter before claim on 26 February 2025 maintaining her position that the appellant’s lawful residence is not continuous.

The appellant issued a claim for judicial review on 19 May 2025. Permission to proceed was refused on the papers on 12 June 2025, with the Upper Tribunal finding that the appellant’s statutory appeal was the appropriate forum in which to challenge the respondent’s position in relation to his lawful residence.

In her letter dated 2 February 2024 the respondent gave the following reasons for her decision:

The respondent carried out two reviews, giving the following reasons for maintaining her decision:

The appellant asserts that his removal will give rise to a real risk that he will suffer treatment contrary to article 3 of the ECHR on account of his mental health. He also claims that he would face very significant obstacles to his integration in Morocco and/or that his removal would amount to a disproportionate breach of his rights pursuant to article 8 of the ECHR.

The appellant has made several key arguments in support of his position, including that he has accrued 10 years lawful residence in the United Kingdom and that his removal would cause an interference with his family life with his son.

At present, the appellant is not permitted to have any contact with his son. This is pursuant to an order of the Family Court. For this reason, the appellant’s arguments about family life are limited to his removal causing an interference with his ability to re-establish a relationship with his son once his son turns 18 and is no longer subject to the order of the Family Court. He cannot rely on any of the provisions of the Immigration Rules relating to parental relationships with children.

The appellant’s ability to satisfy paragraph 276B of the Immigration Rules based on ten years’ continuous lawful residence was not before me. The respondent did not accept that the appellant’s lawful residence was continuous due to a gap between 27 August 2015 and 1 December 2016. Whether the appellant may now satisfy paragraph 276B of the Rules is a new matter, which has not been considered by the respondent and where there is no consent for me to consider it in this appeal. The appellant’s ability to satisfy paragraph 276B of the Immigration Rules is therefore not before me in this appeal.

The appellant attended the hearing and gave evidence in English. I have considered the oral evidence and submissions, together with the following documents (which were contained in the hearing bundle) in reaching my decision:

Mr De Melo made two applications, firstly for an anonymity order and secondly for a direction treating the appellant as a vulnerable witness. I granted both applications. My reasons for granting the anonymity order are set out above. I agreed that the appellant should be treated as a vulnerable witness based on the medical evidence before me. No specific adjustments were sought; however, I indicated that breaks could be taken whenever required and directed Ms Jeena to ensure that any questions put in cross-examination were simple and clear; and confined to a single issue; and directed that no tag questions should be asked.

AM (Zimbabwe) v SSHD [2020] UKSC 17provides that to establish a breach of article 3 of the ECHR on medical grounds, the appellant must demonstrate that he would face a real risk, on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment, of being exposed to a serious, rapid and irreversible decline in his state of health resulting in intense suffering or a significant reduction in life expectancy. The threshold for an article 3 breach is high, and a minimum level of severity must be shown. Whether the minimum level of severity is met is relative and depends on all the circumstances of the case.

In relation to article 3, the burden of proof is on the appellant to show substantial grounds that he faces a real risk of treatment breaching article 3. Once the appellant has done so, the respondent can seek to counter it by obtaining evidence to dispel any serious doubts that the appellant may face an article 3 breach. If serious doubts persist after examining the respondent’s evidence, the respondent must obtain individual and sufficient assurances from the receiving state that appropriate treatment will be available and accessible before the appellant can be removed.

The provision of the Immigration Rules applicable in this case is paragraph PL5.1(b) of Appendix Private Life.

It is for the appellant to show on the balance of probabilities that he satisfies the provisions of the Rules.

In so far as he relies on article 8 outside the Rules it is for the appellant to show that article 8(1) of the ECHR is engaged and if so, it is for the respondent to show that the decision was in accordance with the law, made in pursuance of a legitimate aim and that it was proportionate to the legitimate aim. The standard of proof is the balance of probabilities. Sections 117A to 117D of the 2002 Act are relevant to any assessment under article 8 of the ECHR outside the Rules.

It was agreed at the outset that the issues for determination in the appeal are as follows:

The respondent had three reports from Dr Nuwan Galappathie, as well as medical evidence from the appellant’s GP records. Despite this, she fails to make a clear finding as to whether the appellant is a seriously ill person for the purposes of article 3 of the ECHR.

I take judicial notice of the fact that Dr Galappathie has interim conditions placed on his licence to practice, which includes a restriction on taking new instructions as an expert witness, other than for patients under his care at Coveberry Oldbury (Rehabilitation Hospital). The conditions on his licence were most recently maintained on 20 September 2026. Dr Galappathie remains registered and licenced to practice. The conditions were imposed by the Medical Practitioners Tribunal Service pending an investigation into Dr Galappathie by the General Medical Council. The respondent has not raised any concerns about any of Dr Galappathie’s three reports in this appeal and there is nothing to suggest that his reports were prepared during a period covered by the investigation of the General Medical Council. I have considered Dr Galappathie’s qualifications and experience and find that he is appropriately qualified to provide an expert report regarding the appellant’s mental health. I find that I can place weight on all three of Dr Galappathie’s reports.

Having considered the medical evidence from all sources before me, I find that the appellant is a seriously ill person. He has been assessed as meeting the diagnostic criteria for personality disorder; Post Traumatic Stress Disorder (PTSD); recurrent depressive disorder, (episode in January 2024 severe), with psychotic symptoms; and autism spectrum disorder. Dr Galappathie considers that the appellant is a person with chronic, complex health needs. He is treated with three psychiatric medicines: Venlafaxine, Risperidone; and Mirtazapine.

Dr Galappathie’s evidence is consistent with that of the appellant’s GP, which is set out in a letter dated 7 July 2021 and the appellant’s medical records. While I accept that the most recent medical evidence, I had before me dates back to April 2024; I am satisfied that the appellant’s conditions are chronic and that they persisted at the date of hearing.

I now move on to consider whether the appellant will face a real risk, on account of the absence of appropriate treatment in Morocco or the lack of access to `such treatment, of being exposed to a serious, rapid and irreversible decline in his state of health resulting in intense suffering or a significant reduction in life expectancy.

In a case involving mental ill health, it is not necessary that the deterioration be irreversible or permanent in the strict sense. Rather, in such a case, the focus is on whether removal would expose the person to intense suffering, acute relapse, psychotic deterioration, self-harm or suicide risk, in other words, the foreseeable consequences of removal for the individual in the receiving state, in light of the general situation there and the individual’s personal circumstances (Paposhvili v Belgium [2016] ECHR 1113; Savran v Denmark [2021] ECHR 1025).

Dr Galappathie conducts a comprehensive review of the available medical and psychiatric evidence available in his first report dated 16 December 2021 and in his two addendum reports of 10 January 2023 and 4 January 2024. I do not repeat that here, but wish to note some points of significance:

I have considered the medical evidence from all sources, and I find that being unable to access the treatment and support he currently receives would lead to a real risk that the appellant would suffer from the risks identified by Dr Galappathie in his most recent report. Nothing in that report has been challenged by the respondent. Those risks are reasonably foreseeable on the basis of the evidence before me and include destabilisation of his personality disorder; increased instability of the features of his autism spectrum disorder; increased paranoia, paranoid thoughts, and delusional beliefs; worsening emotional dysregulation leading to a high risk of self-harm and suicide; increased frequency of flashbacks and nightmares; worsening low mood and associated symptoms; and worsening anxiety.

This must in my view be considered in the light of the appellant’s two previous suicide attempts and the likely lack of protective factors that would exist for the appellant in Morocco. I accept and give weight to Dr Galappathie’s opinion that a deterioration in the appellant’s mental health would lead to a high risk of self-harm and suicide.

I find that the foreseeable consequences of a deterioration in the appellant’s condition include:

The respondent rejects the evidence of Dr Rebwar Fatah on the basis that it is generic and not tailored to the appellant’s circumstances. This is a curious objection given that the very same could be said of the evidence relied on by the respondent. The respondent did not challenge any of Dr Fatah’s evidence and did not adduce any additional evidence on which she relies to counter it. There was no challenge to Dr Fatah as an appropriately qualified expert, and I find that he is. I find that he is aware of and has in fact complied with his duty as an expert. Dr Fatah has provided usable hyperlinks to the source material on which he relies, in contrast to the respondent. I find that I can place weight on his evidence.

Dr Fatah addresses several matters in his evidence, and I do not accept the respondent’s criticism that it is overly generic and therefore not relevant to the appellant’s particular circumstances. Dr Fatah sets out his instructions and they indicate that he was specifically instructed to consider the appellant’s particular background, including his background, culture, gender, education, social status, age, likely lack of means, origin from Khouribga, experiences in Morocco and the UK, his diagnoses, specifical vulnerabilities, and history of mental disorders. This is a far more individualised consideration than the respondent has given to the appellant’s circumstances in the evidence on which she relies, which I turn to below.

Dr Fatah gives an overview of the mental health system in Morocco, which is split into public and private sectors. Treatment in the private sector is said to be expensive and draws the country’s best doctors; while provision in the public sector is of low quality and has poor outcomes. Dr Fatah states that 60% of all mental health resources are allocated to Casablanca. The cost of treatment is a barrier when accessing mental healthcare and while the government took steps to reduce the price of 70 medicines in 2022, Dr Fatah states that the cuts generally only affect a small subsection of medications treating specific chronic illnesses.

Dr Fatah states that stigmatisation of those with mental illness is common due to a poor understanding of mental illness, which is commonly believed to be associated with magic, supernatural creatures or the devil. People with mental illness face stigmatisation and social exclusion, even from their families. This is notwithstanding a high prevalence of mental ill health.

In relation to the availability of resources for those with autism, Dr Fatah states that there is a lack of specialised services. There is no reference in Dr Fatah’s evidence about services for adults; what evidence there is focuses on services for children. There is no evidence that services for children would be appropriate or effective for an adult, given their very different social circumstances and therefore the difficulties they are likely to need support with.

Dr Fatah comments on the availability of mental healthcare in the appellant’s home area and notes that evidence is very limited, with most evidence relating to Casablanca. Dr Fatah states that he found one report relating to facilities in the appellant’s home area, which states that the facilities are in a state of disrepair or imminent collapse. Dr Fatah provides information about one NGO providing psychological care in Khouribga, but states that it is at a facility for those with physical disabilities and is provided in tandem with physical rehabilitation services. This is not relevant to the appellant’s conditions or needs.

Dr Fatah confirms that the appellant’s three psychiatric medications are available in Morocco, although it is not clear whether his specific dose of Mirtazapine is available. Dr Fatah states that the lack of affordability is a key issue when considering access to medication. Private pharmacies are generally well-stocked according to Dr Fatah, but at a higher cost. Dr Fatah also notes that due to a lack of regulation of supply routes for the distribution of medication, poor quality of medicine is an issue.

On the question of destitution, Dr Fatah cites evidence which shows that more than 700,000 Moroccans are homeless and that in 2022, 1.5 million people were affected by poverty and a further 2.04 million suffered from vulnerability. Dr Fatah notes the link between homelessness and poverty and poor mental health in Morocco. He notes a press report from 2023 which highlighted an increase in the number of suicides among destitute beggars living on the streets.

The respondent’s position is that treatment is available in Morocco and relies on Country Information Note, Morocco, Version 1.0, dated July 2021. She did not provide a copy of that document in her bundle and failed to provide a hyperlink to the report in the decision appealed. There are no Country Policy and Information Notes available for Morocco on the GOV.UK website as at the date of this decision. The Country Information Note relied on refers to The World Health Organisation’s (WHO) Mental Health Atlas 2017. Again, she did not provide a copy of that document or a hyperlink through which the document could be accessed. The evidence contained in the WHO Mental Health Atlas relied on is now nine years old.

Even taking the passages cited as an accurate representation of the evidence, it is key to note that while there is reference to treatment for PTSD, there is no mention at all of autism spectrum disorder, personality disorder, or depression with psychotic features, or the ability to tailor treatment appropriately to ensure that it is effective for those with those conditions.

The evidence relied on by the respondent shows that the mental health care system is unable to meet demand for treatment; that mental health is poorly integrated into primary health care; and that often admission is the only option because of the point at which people often seek help. It states that counselling and behavioural treatment are exclusively available in private facilities. This is significant for the appellant, as he receives monthly support from a specialist autism support worker and it has been recommended that he should have tailored psychological therapy.

The respondent relies on some more recent evidence relating to treatment for PTSD which is dated 5 April 2022. She did not provide a copy of the evidence or a hyperlink at which it could be accessed. It apparently includes evidence dating back to 2020, so its continued reliability is not clear. What it shows is that treatment and care for PTSD is available, in a mix of private and public facilities. What it does not show is whether that treatment and care can meet the appellant’s complex needs given his other conditions.

I note the following about the respondent’s position. Firstly, the evidence does not show that there are any services available in the appellant’s home area. Secondly, the evidence does not contain any information about access to medication. Thirdly, the respondent does not consider the position if medication is available, but the appellant cannot access it because he is destitute or lacks the additional support he requires. Fourthly, the respondent does not consider the appellant’s individual circumstances or how they may affect his ability to access and/or afford medication.

The appellant has the conditions outlined above. His presentation is described as complex and he requires treatment with medication, as well as other support including from a specialist autism support worker. Therapy which is tailored to his circumstances and conditions has been recommended; however, it is not clear whether the appellant is receiving or has received such therapy.

The medical evidence shows that stressors and impactful life events have a significant and detrimental effect on the appellant’s well-being and mental health. He has required admission to hospital under the provisions of the Mental Health Act 1983 to keep him safe and for assessment of his needs, and ongoing treatment as a voluntary in-patient once his detention ended. Notwithstanding his in-patient treatment and the support that he received at the time, he continued to have suicidal thoughts and took a significant overdose when he was once again overwhelmed by events in 2016.

I have considered the appellant’s evidence about his circumstances in Morocco. I accept that he was raised by his grandparents and that he referred to his grandmother as ‘mum’. I also accept that the appellant has had no contact with his family since he visited Morocco in 2018 to attend his grandmother’s funeral. There is no evidence that his family have any understanding of his circumstances or, if they are, that they are able or willing to provide him with any support. To assume that simply because he is a family member they would be willing to help given the lack of involvement in his life for many years would be speculative and not based on the evidence. I do not make such a finding. I find that the appellant would therefore be returning to Morocco alone and without family support.

The respondent makes much of the fact that the appellant stayed with a friend in Morocco in 2018. I accept the appellant’s evidence that this was following a chance meeting at the airport; that he stayed with the friend for 5 days while he was in the country; that it was not prearranged; and that he had not had contact with him in the United Kingdom. There is no evidence that this friend is able or willing to offer the appellant accommodation or any other kind of support on return and again, to find that he would, would be speculative and not based on the evidence. The appellant does not appear to have any other friends to whom he could turn for support in Morocco. His evidence is that they are living abroad and not in Morocco. I accept the appellant’s evidence that he is not in contact with anyone in Morocco. The appellant’s lack of social ties is consistent with the age at which he left Morocco, the length of his absence, and most importantly the medical evidence about his social functioning.

The appellant was in receipt of Employment and Support Allowance between September 2016 and July 2021. It is not clear how he is currently supported; however, there is no evidence that he is employed, and I note that he has been studying. I find that based on his circumstances and his inability to work; it is unlikely that he has financial resources that he could take with him to Morocco. I take judicial notice of the fact that he may be eligible for financial assistance under the voluntary returns scheme; however, the appellant’s circumstances as set out in the medical evidence, including his desire to re-establish a relationship with his son, make it highly unlikely in my view that he would seek to avail himself of the voluntary returns scheme and I find that this financial support would not in practice be available to him.

The appellant’s evidence is that he has a limited employment history. He stated in his oral evidence that he worked as a sales assistant in the United Kingdom for about four or five months after his arrival in the United Kingdom. He stated that he was a youth worker in Morocco, stating that he helped with the running of activities at a youth club. He stated that he was not paid much, essentially pocket money.

Ms Jeena asked the appellant why he could not use his qualifications obtained in the United Kingdom to obtain employment on return to Morocco. The appellant stated that it would be very difficult for him. He explained that most of the time he is housebound and that his medication affects him. He expressed concern about the stigma he would face because of his conditions in Morocco. This is consistent with Dr Fatah’s evidence.

The appellant stated that all his qualifications were obtained by distance learning except his CELTA qualification (teaching English as a foreign language). He explained that he attended once a week while studying for that qualification and that his tutors were aware of his difficulties. He stated that he had one to one support; that if he was feeling unwell or unable to cope, he was able to leave; he was able to sit at the back of the classroom; and was not required to join in work that was completed in pairs. He said that in total he thought he had attended about 20 times and the rest of the course was completed through distance learning. It is clear therefore that although the appellant has obtained qualifications, that fact is not, of itself, indicative of an ability to engage in employment using those qualifications.

The appellant has no recent employment record, and he has not been employed since his mental health problems arose. He has not been employed since his autism diagnosis and this must be viewed in the context of return to Morocco where he has not lived for 17 years; where there is evidence of stigma surrounding mental illness and a lack of understanding of disorders such as autism; where the appellant would be competing for work with Moroccans with employment records and without his particular difficulties; and where he does not have the kind of existing social ties that would be a source of any meaningful support in finding work.

There was no evidence before me about the existence of or eligibility criteria for social assistance schemes in Morocco. Given his length of absence, if they do exist and are based on contributions having been made, it appears unlikely that the appellant would be eligible, but I make no finding on this.

I find that the appellant would be destitute on return to Morocco. I find that the appellant would not have the means to meet his essential living needs (including accommodation) on return and that his ability to find employment capable of providing an income sufficient to meet them within a reasonable timescale is very limited if not entirely absent.

The appellant has been absent from Morocco for many years. Given his particular circumstances, I find that it is more likely than not that he would seek to return to his home area where he at least has some familiarity with life there albeit that his knowledge is not recent. This is based on the evidence about the appellant’s difficulty in coping with change and unfamiliarity. There is no evidence before me that mental health services appropriate to meet the appellant’s needs are available in his home area. The one service mentioned by Dr Fatah does not appear to be suitable. In such circumstances, I find it is likely that the appellant would be obliged to seek help from the private sector, for which he would have to pay. I rely on my findings above about his likely destitution and find that the appellant would not be able to meet the cost of his treatment.

The respondent does not address what measures would be available to ensure continuity of the appellant’s treatment on return. The appellant has not lived in Morocco for at least 17 years, and I find that he is unlikely to have any knowledge of how to access specialist medical treatment there. There is no evidence before me as to whether there are any eligibility criteria for free treatment, such as having paid tax/other relevant contributions. Given his lengthy absence from Morocco and the lack of an employment history there, it appears unlikely that the appellant would satisfy any contribution based eligibility criteria.

Based on my findings above, I conclude as follows:

I have addressed the evidence relied on by the respondent above. The respondent has not provided any evidence as to what measures will be put in place or available to the appellant to ensure that appropriate treatment will be available and accessible to the appellant on return so that he does not suffer the foreseeable consequences outlined above.

I therefore find for the reasons set out above, that the appellant’s removal would give rise to a real risk that the appellant’s rights pursuant to article 3 of the ECHR will be breached.

Given my decision in respect of article 3 of the ECHR, it is not strictly necessary for me to go on and consider this.

I rely on my findings above at paragraphs 38 to 67 above. I find that the appellant’s particular circumstances, taken cumulatively, mean that he would face very significant obstacles to his integration in Morocco. I find that the combination of his conditions means that while he may be familiar with the culture and customs of Morocco and have an understanding of how life in society is carried on there, his capacity to participate in it is severely restricted. Similarly, the appellant’s capacity to form the kind of relationships and ties that will give substance to his family and/or private life within a reasonable timescale is also severely restricted.

This is not a situation where the appellant can take active steps to avoid or mitigate the obstacles he will face. He is not in contact with anyone who can assist him ahead of his removal and will have no support on arrival.

I find that the appellant has established private life in the 17 years he has resided in the United Kingdom. The respondent’s decision causes an interference with the appellant’s enjoyment of his private life, and I find that the likely consequences of such interference are sufficiently serious as to engage article 8(1) of the ECHR. I find that the respondent’s decision was made in accordance with the law and that it was made in pursuance of a legitimate aim.

Pursuant to the Court of Appeal’s decision in TZ (Pakistan) and PG (India) v SSHD [2018] EWCA Civ 1109 because the appellant’s claim engages article 8(1), the fact that he satisfies the Immigration Rules is positively determinative of his article 8 appeal. In these circumstances I find that the respondent’s decision is therefore disproportionate and is unlawful under section 6 of the Human Rights Act 1998 as being incompatible with the United Kingdom’s obligations under article 8 of the ECHR.