Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER
Case No: UI-2024-000481

First-tier Tribunal No: HU/00498/2023

THE IMMIGRATION ACTS

Decision & Reasons Issued:

27th June 2025

Before

UPPER TRIBUNAL JUDGE SHERIDAN

Between

The Secretary of State for the Home Department
Appellant
and

Robert Kumbirai Mavhura
(NO ANONYMITY ORDER MADE)
Respondent

Representation:
For the Appellant: Ms R Tariq, Senior Home Office Presenting Officer
For the Respondent: Ms K Renfrew, Counsel instructed by MTC Solicitors

Heard at Field House on 13 June 2025

DECISION AND REASONS
1. I have referred to the parties as they were designated in the First-tier Tribunal. Accordingly, references in this decision to “the appellant” are to Mr Mavhura and to “the respondent” are to the Secretary of State.
2. By my decision issued on 30 October 2024 I set aside the decision of the First-tier Tribunal (Judge of the First-tier Tribunal Wood) promulgated on 26 November 2023. I now remake that decision.
Introduction
3. The appellant is a citizen of Zimbabwe who claims that removing him to Zimbabwe would violate Article 3 of the ECHR because:
(a) he suffers from schizophrenia and is dependent on medication and treatment he receives in the UK;
(b) he would be unable to continue accessing the necessary treatment and medication in Zimbabwe; and
(c) in the absence of treatment and medication that he requires he would suffer a serious, rapid and irreversible decline in his health and/or would take his own life.
4. In addition, the appellant claims that removing him to Zimbabwe would breach Article 8 of the ECHR because it would entail a disproportionate interference with his private life in the UK.
5. For the reasons set out below, I have allowed the appeal on Article 3 grounds. It has therefore not been necessary for me to consider Article 8.
Relevant Law
6. In article 3 medical cases there is a two-stage test. The first stage - referred to in the case law as “the initial threshold test”- is that the appellant must adduce evidence capable of demonstrating (the burden of proof being on him) that he is a seriously ill person who would face a real risk on account of the absence of (or lack of access to) appropriate treatment in the receiving state (in this case, Zimbabwe) of being exposed to a serious, rapid and irreversible decline in his health resulting in intense suffering or a significant reduction his life expectancy.
7. The second stage, which is only applicable if the threshold test is met, concerns the returning state (i.e. the UK) providing evidence to dispel any serious doubts raised by the appellant’s evidence.
8. AM (Art 3; health cases) Zimbabwe [2022] UKUT 00131 (IAC) provides a clear and succinct summary and explanation of the test in the following terms:
1. In Article 3 health cases two questions in relation to the initial threshold test emerge from the recent authorities of AM (Zimbabwe) v Secretary of State for the Home Department [2020] UKSC 17 and Savran v Denmark (application no. 57467/15):
(1) Has the person (P) discharged the burden of establishing that he or she is “a seriously ill person”?
(2) Has P adduced evidence “capable of demonstrating” that “substantial grounds have been shown for believing” that as “a seriously ill person”, he or she “would face a real risk”:
[i] “on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment,
[ii] of being exposed
[a] to a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering, or
[b] to a significant reduction in life expectancy”?
2. The first question is relatively straightforward issue and will generally require clear and cogent medical evidence from treating physicians in the UK.
3. The second question is multi-layered. In relation to (2)[ii][a] above, it is insufficient for P to merely establish that his or her condition will worsen upon removal or that there would be serious and detrimental effects. What is required is “intense suffering”. The nature and extent of the evidence that is necessary will depend on the particular facts of the case. Generally speaking, whilst medical experts based in the UK may be able to assist in this assessment, many cases are likely to turn on the availability of and access to treatment in the receiving state. Such evidence is more likely to be found in reports by reputable organisations and/or clinicians and/or country experts with contemporary knowledge of or expertise in medical treatment and related country conditions in the receiving state. Clinicians directly involved in providing relevant treatment and services in the country of return and with knowledge of treatment options in the public and private sectors, are likely to be particularly helpful.
4. It is only after the threshold test has been met and thus Article 3 is applicable, that the returning state’s obligations summarised at [130] of Savran become of relevance – see [135] of Savran.
Issues in dispute in respect of Article 3 ECHR
9. At the hearing, Ms Tariq accepted that the appellant is a “seriously ill person”. She also accepted that, in the absence of any treatment, he would face a serious, rapid and irreversible decline in his health resulting in intense suffering. Accordingly, the only issue in dispute, in respect of the “initial threshold test”, was whether there would be an absence of – or the appellant would be unable to access – sufficient treatment in Zimbabwe to avoid there being a real risk of intense suffering or death.
10. The second stage (i.e. the UK’s obligation to dispel serious doubt) was also in dispute: Ms Tariq argued that, in the event the initial threshold test was met, the appeal should be dismissed because the respondent had done enough to dispel the doubts about the availability of treatment raised by the appellant.
The Evidence
11. The appellant was not called to give oral evidence and the hearing proceeded by way of submissions only. There was a 946 page bundle containing, inter alia, evidence about the appellant’s mental health and the availability of treatment in Zimbabwe.
12. In respect of the appellant’s mental health the most significant document in the bundle is a psychiatric report by Dr Obuaya dated 20 May 2025. Ms Tariq did not question the reliability of this evidence or dispute any aspect of it. Dr Obuaya’s evidence, in summary, is that the appellant suffers from paranoid schizophrenia for which he receives effective treatment by way of a monthly injection of aripiprazole. She notes that the appellant has been compliant with this treatment but has, previously, not been compliant with oral medication. She also notes that the injection (which is administered by a health professional) provides an opportunity for a regular review. Dr Obuaya states that there has been a good response to the treatment, that the appellant has been fully compliant with the treatment, and has had a good response; but that his insight into the nature of his illness and indicators of relapse is poor. Dr Obuaya also highlights the importance to the appellant of a supportive environment, which she states is provided by his family and the community mental health team. She states that in the absence of treatment it is likely that the appellant will experience a relapse of his schizophrenic illness.
13. Other evidence in the bundle indicates what a relapse might entail. This is summarised in paragraph 23 of Ms Renfrew’s skeleton argument, where she characterises the records from 2017 until the appellant started receiving regular medication and treatment as manifesting in:
“psychosis, unpredictable and unsafe behaviours, neglect of self-care (eating, washing, changing clothes) self-harm, suicidal ideation and suicide attempts. Between October 2019 to March 2020, when his aripiprazole was commenced, he was sectioned in hospital because of repeated attempts at taking his own life”.
14. There was no dispute between the parties as to the evidence as to the appellant’s condition prior to commencing treatment with aripiprazole.
15. With respect to the availability of treatment in Zimbabwe, an important document in the bundle (which was relied on by Ms Tariq in her submissions) is the respondent’s CPIN of April 2021 on “Zimbabwe: medical treatment and healthcare” (“the 2021 CPIN”), where at paragraphs 5.1.1 and 5.1.3 the following is stated:
“5.1.1 The research paper, Mental health in Zimbabwe: a health systems analysis, published in The Lancet Psychiatry in November 2017, but with research undertaken in 2016, observed:
‘[Mental health] Facilities exist. Policies are relatively progressive. Research is extensive. The workforce is motivated. Yet, missing pieces in the mental health system prevent the vast majority of Zimbabwe from accessing proper mental health care. The main missing pieces are funding and resources, creating a host of issues such as the inability to implement most of the Mental Health Act, poor staffing, drug shortages, and overcrowded hospitals and prisons.
‘For instance, a majority of nurses and occupational therapists who specialize and train in mental health are either: 1) diverted to other careers, or 2) driven to practice outside of Zimbabwe because of drastically low salaries, leaving only five clinical psychologists and 15 of 150 registered occupational therapists practicing mental health in Zimbabwe’s public sector. ‘Patients who can access mental health care do not have medications to treat their illnesses. Due to drug shortages, many psychiatrists prescribe all patients—regardless of their disorder—the same out-dated, unspecific drug, often rife with side effects.
‘Funding and resources are only two of the missing pieces of Zimbabwe’s promising but incomplete mental health systems. There are other missing parts: Nurses are trained; opportunities are missing. Diagnoses are accurate; medications are not. Patients seek help; they are treated for headaches and high blood pressure, not the mental illness root cause.’”
….
“5.1.3: The research paper, Mental health in Zimbabwe: a health systems analysis, observed:
‘Medications for mental disorders in the public sector are ‘free’ but unavailable. Alternatively, patients are given unaffordable prescriptions to source at their own cost in the private sector.’ The research paper also commented that facilities lack food and water, bedding and medicine.”
16. Annex A to the CPIN lists available medication according to MedCOI. Aripiprazole is not in the list.
Analysis
17. Ms Tariq accepts (a) that the appellant is a seriously ill person; and (b) that there is a real risk he will experience intense suffering or death in the absence of medication/treatment. Accordingly, this case turns on the availability of treatment and medication in Zimbabwe. The appellant does not need to be able to access the same (or the equivalent) treatment that he receives in the UK. Nor does the treatment need to be as good as that which he currently receives. The threshold in Article 3 will not be met if the appellant will be able to access treatment and medication that is merely sufficient to prevent him experiencing intense suffering or death.
18. The unchallenged evidence of Dr Obuaya indicates that the appellant (a) receives regular injections of aripiprazole; and (b) relies on structured and organised support from medical professionals and family to be able to effectively access the medication and treatment he receives. The 2021 CPIN (in particular at paragraphs 5.1.1-5.1.3) indicates that neither aripiprazole nor structured support will be available in Zimbabwe. Considered together, the evidence of Dr Obuaya and the CPIN is amply sufficient to demonstrate that the initial threshold test is met.
19. As the initial threshold test is satisfied, it falls to the respondent to dispel doubts. The evidence submitted by the respondent to dispel doubts consists of a report headed: “Response to an Information Request, Zimbabwe: Mental healthcare and treatment for schizophrenia dated 9 February 2023”. The report sets out a summary of what was requested as follows:
“Can schizophrenia be treated, and is aripiprazole or alternative drugs available?
Is there any mental healthcare treatment available in Mutare?
What information is available on the affordability of healthcare/medication in Zimbabwe and is there state-funded care?”
20. The answers to these questions in the report are:
“CPIT was unable to find information about psychiatric-care facilities in Mutare, from the sources consulted”.
“CPIT was unable to find recent specific information (2022-2023) about psychiatric-care for schizophrenia, from the sources consulted.”
“CPIT was unable to find recent specific information (2022-2023) about the availability of aripiprazole and alternative drugs, from the sources consulted”.
21. The respondent’s report – plainly - does not dispel the doubts raised by the evidence adduced by the appellant. Ms Tariq relied on the 2021 CPIN; but this, too, does not dispel doubts, as it indicates not only that the medication the appellant relies on is unavailable but that suitable medication is unlikely to be accessible: see para. 5.1.1 of the 2021 CPIN (set out above) where, inter alia, it is said that patients “are treated for headaches and high blood pressure, not the mental illness root cause”.
22. In these circumstances, I am satisfied that the appellant has established that deporting him to Zimbabwe would breach Article 3 ECHR.
23. As I have found that deporting the appellant to Zimbabwe would breach Article 3, it has not been necessary to consider Article 8 ECHR.
Notice of Decision
24. The Upper Tribunal previously found an error of law and set aside the decision of the First-tier Tribunal. I now remake the decision and allow the appeal on human rights (Article 3) grounds.

D. Sheridan

Judge of the Upper Tribunal
Immigration and Asylum Chamber

24.6.2025