Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER
Case No: UI-2024-003497

First-tier Tribunal No: PA/53658/2022
IA/08781/2022

THE IMMIGRATION ACTS

Decision & Reasons Issued:

On 9th of July 2025

Before

UPPER TRIBUNAL JUDGE HANSON

Between

HM
(ANONYMITY ORDER MADE)
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Mr Draycott, instructed by Duncan Lewis Solicitors.
For the Respondent: Mr Diwnycz, a Senior Home Office Presenting Officer.

Heard at Phoenix House (Bradford) on 4 June 2025

Order Regarding Anonymity

Pursuant to rule 14 of the Tribunal Procedure (Upper Tribunal) Rules 2008, the appellant is granted anonymity.

No-one shall publish or reveal any information, including the name or address of the appellant, likely to lead members of the public to identify the appellant. Failure to comply with this order could amount to a contempt of court.

DECISION AND REASONS
1. The Appellant is a female citizen of Morocco who it is accepted is a vulnerable witness.
2. Before the Upper Tribunal sitting at Bradford on the 27 September 2024 the Secretary of State’s representative conceded the challenge to a decision of a judge of the First-tier Tribunal, on fairness grounds, resulting in that determination being set aside and directions being given for the further hearing of this appeal before the Upper Tribunal.
3. It is fair to say that following the promulgation of the Upper Tribunal decision on 30 September 2024 there has been some delay in getting the matter back for the final substantive hearing. That delay was, however, understandable and properly managed, and was totally beyond the control of either of the parties, their advocates, or the Tribunal.
4. There has been produced for the purpose of this appeal a substantial bundle of additional evidence and the Appellant was hindered in part in providing the same by the delays that arose in relation to obtaining up-to-date medical reports. There are, as a matter of record, numerous case management directions reflecting the situation as a whole although I am satisfied that by the time the appeal reached its hearing the Tribunal and parties had all the documentation necessary to ensure the Appellant received a fair hearing.
5. The Appellant was granted 30 months discretionary leave on 19 September 2022 on the basis of exceptional compassionate circumstances or other compelling reasons. The issue at large in this appeal is whether she is entitled to any other form of leave.
6. The parties have provided their skeleton arguments and in the absence of any cross- examination by the Secretary of State the appeal proceeded by way of submissions only.
The Appellant’s submissions
7. The Appellant’s initial submissions are to be found in Mr Draycott’s skeleton argument of 23 May 2025.
8. The factual history is recorded in the document after which Mr Draycott addresses the two relevant issues.
9. The first issue, risk of re-trafficking, serious harm from the Appellant’s family or prosecution by the Moroccan authorities is addressed it [13] – [14] in the following terms:
13/. It is contended that A would face a real risk of being re-trafficked upon return to Morocco in light of the following objective evidence : (i) the Global Organised Crime Index 2021 for Morocco of 28 September 2021 confirms in respect of ‘People’, ‘criminal actors’, ‘leadership and governance’ and ‘civil society and social protection’ UTB977-981 that the trafficking networks within the country are well established and are linked to senior individuals within the Moroccan Authorities; (ii) the USSD Trafficking in Persons Report Morocco of 19 July 2022 UTB1012-1020 also confirms : ‘the Government did not meet the minimum standards in several key areas. Investigations, prosecutions and convictions of trafficking cases decreased … Prosecution … the Government did not report initiating any investigations, prosecutions or convictions of government officials complicit in human trafficking crimes … Protection … the Government did not provide shelter or psycho-social services specific to the needs of victims of all forms of trafficking … Trafficking People … Traffickers exploit Moroccan adults and children in forced labour and sex trafficking’; and (iii) [25] of CEDAW’s Concluding Observations of 12 July 2022 UTB1002 : ‘the Committee remains concerned … that there is insufficient protection for victims of trafficking, including the availability of specific shelters for victims of trafficking’.
14/. Upon return to Morocco, A will also face significant societal discrimination within the domestic employment market by reason of her gender, which will make her more vulnerable to future exploitation, as confirmed by (i) [26] of the National Human Rights Council of Morocco ‘Parallel of the (CNDH) to CEDAW’ of May 2022 UTB993; and (ii) [33] of CEDAW’s Concluding Observations of 12 July 2022 UTB1004. A further factor that will negate A’s already marginal prospects of obtaining suitable paid employment is her said severe clinical psychiatric conditions, which will mean she is shunned and stigmatized upon return as per : (a) MJT News ‘EESC Report : 48.9% of Moroccans suffer from mental disorders’ of 17 October 2022 UTB1010-1011 : ‘as well as the persistence of harmful social norms and stigmatization of mental illness’ the same source explains … Mental illness in Morocco is still considered a stigma’; and (b) Morocco World News ‘Report : 26% of Moroccans suffered depression at least once in their life’ of 11 October 2022 UTB1009 : ‘the Network also highlighted the ‘stigma, discrimination and violation of human rights’ that Moroccans with mental disorders also suffer from, in a country that fails to prioritise mental health’.
10. In relation to the second issue, Article 3 medical grounds, Mr Draycott submits:
15/. As per [22] of AM (Zimbabwe) -v- Secretary of State for the Home Department (2020) 2 WLR 1152, A’s removal to Morocco will breach her rights under Article 3 ECHR as ‘substantial grounds have been shown for believing that he or she, although not at imminent risk of dying, 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 or her state of health resulting in intense suffering or to a significant reduction in life expectancy’, particularly as Dr Thomas concludes at [115]- [120] of her report of 29 September 2023 UTB369-371 : ‘in her current psychiatric condition which would inevitably worsen in a situation of enforced return … there is … a real likelihood that (A) would not be psychiatrically well enough to readily find and maintain paid work and accommodation and to be self-supporting in Morocco … even if she were to find work, it is unclear how she would manage this in her current mental state in the absence of any state or family support … I consider that she will be at significant risk of further trafficking/exploitation … as … her psychiatric condition will deteriorate further in Morocco as described and that her vulnerability to further abuse/exploitation/trafficking will thus be much heightened … (as A) has a pre-existing vulnerability to trafficking and other forms of exploitation, then it follows that her psychological risk of re-trafficking in the event of return to Morocco will be increased because she will be more psychiatrically vulnerable there ... (A) does indeed classify as a ‘seriously ill person’ based on this examination in terms of her psychiatric health, with an overall serious and chronic mental health condition … (with the result that) the prolongation of her external situation of perceived instability and lack of safety … and the absence of appropriate treatment could lead to ‘a serious, rapid and irreversible decline’ in (A’s) state of mental health in the event of enforced return to Morocco, ‘resulting in intense suffering’ … if unable to access appropriate treatment … and with the inevitable psychiatric deterioration … that deportation from the UK could thus result in a ‘significant reduction in (A’s) life expectancy’ due to augmented suicide risk (and also potentially increased risk of destitution and homelessness again if she cannot be selfsupporting in Morocco). Any further periods of homelessness could also be highly retraumatising for (A) given her reported past traumatic experiences of the same … in her 11 current psychiatric condition, it would be extremely difficult for (A) to successfully relocate to another part of Morocco which she does not know and where she has no social support and where she would have to find work, accommodation, make new friendships and re-start her life there without her husband to support her … (as) her husband would not be able to give up his life in the UK in order to relocate to Morocco with her’.
16/. In terms of A’s ability to access suitable medical treatment upon return, there is little realistic prospect of this, as per [65]-[71] of Dr Zvan Elliott’s said expert report UTB428-430 : ‘(A) would need to begin the registration process for (the new compulsory health insurance AMO Tadamon which is still in the process of implementation) as soon as possible after her arrival … that will require her to register for AMO with a CIN (a national identity card or with the support of two family members in her place of residence, and registration can take around 2 months or more …) … only once she has subscribed to and is in receipt of an AMO affiliation code would (A) have access to all public health services available in Morocco … to obtain these certificates (under the previous Ramed Medical Assistance Scheme), people had to know or be able to ask about the procedure, they needed money to travel from their homes to the municipalities and once there, between different administrative buildings, time to do that but also official documents, such as their … CIN and a Family Booklet. None of this is readily available to people who are functionally and otherwise non-literate. The infrastructure is not customer-friendly, public officials are frequently absent and have haphazard working hours … in addition … those vulnerable to poverty … had to pay a yearly contribution between 120 MAD and 600 MAD (about £10 to £48) in order to access the crumbling, inefficient and inhospitable public care health system. All of my interviewees also complained that with a Ramed card in public hospitals the medical staff would not admit them or give them information about the services they provide unless they paid an unofficial ‘fee’, i.e. give them a bribe … unless they (paid) for all services upfront and bring medication, sheets, pads etc with them, the medical staff will not treat them … despite the fact that the current insurance scheme covers psychiatric services, good mental care generally remains inaccessible for most people … ‘quality mental health and healthcare in Morocco generally remains difficult to obtain for any but those who belong to the country’s upper socio economic classes …’ … consultation with a specialist such as a psychiatrist working in a private clinic costs between 300 MAD and 500 MAD (about £24 to £40) which is approximately what a cheap room costs per month in one of Morocco’s biggest cities’. 12 17/. Further, Morocco World News report of 11 October 2022 UTB1009 also confirms : ‘the network highlighted the Moroccan health system’s lack of financial and human capital, infrastructure, medicine and rehabilitative care ... Morocco possesses only 343 psychiatrists, 214 psychologists, 16 child psychiatrists, 1,335 psychiatric nurses, 14 social assistants and 64 doctors that can provide addiction treatment ... the overall 6% budget allocated to mental health programs does not meet the necessary requirements to implement the health ministry’s reforms’. It is also notable that the above evidence is entirely consistent with the UT’s findings at [140]-[141] of MY(Suicide risk after Paposhvili) [2021] UKUT 00232 (UT) in which in respect of a Moroccan Appellant who suffered from Schizophrenia and PTSD, the UT held : ‘While we accept that there are some medical facilities in Morocco which if accessed are capable of offering some treatment … (those) medical facilities are likely to be inadequate. We find that private facilities would not be affordable to the Appellant… to the extent that treatment might be available, it would certainly not be accessible to this Appellant … it is reasonably likely that he will face destitution and poverty in Morocco’. In light of the above, A has adduced evidence capable of demonstrating a prima facie case that there are substantial grounds for believing that, if she was returned to Morocco, she would be exposed to a real risk of being subjected to treatment contrary to Article 3. R is therefore required to ‘dispel any serious doubts’ as A is not required to prove her case either beyond reasonable doubt or even on a balance of probabilities, which on the facts of this case R is unable to do.
11. On this basis it is submitted the Appellant has discharged the low burden of proof upon her to prove an entitlement to a grant of humanitarian protection or pursuant to Article 3 ECHR.
The Secretary of States submissions in reply
12. The Secretary of State, in her skeleton argument received on 2 June 2025, refers to there being two issues for the Tribunal to decide according to Appellant’s skeleton argument being:
a. Has the Secretary of State of State established that there are good reasons to believe that the appellant will not be subject to either (a) re-trafficking upon return to Morocco, despite her accepted literacy, severe clinical psychiatric conditions, age, poor prospects of obtaining any viable paid employment and past trafficking; and/or (b) persecution and/or serious harm from either her family or the Moroccan Authorities?
b. Has the Appellant established a real risk that removal to Morocco would breach her rights under Article 3 ECHR 1950 on medical grounds.
13. The Secretary of State’s position is that with some minor disagreement regarding where the burden of proof lies it was accepted that they are the issues this tribunal is required to determine.
14. There are a number of preserved findings from the determination of the First-tier Tribunal, which are accepted by the Secretary of State, being:
• That the Appellant suffers from complex PTSD and related mental health issues, is vulnerable and is currently taking Mirtazapine and Phenergan;
• The Appellant was married to A Morocco, but subsequently divorced when her first daughter was only 2 years old, with both of her two daughters being conceived outside of marriage, in respect of which her brothers disapproved;
• It is likely that A was abusive towards the Appellant, including on one occasion raping her, which caused a complex PTSD, along with her trafficking;
• The Appellant’s brothers disapproved of her relationship with A and may believe she has dishonoured them again by travelling to Libya with a man named K, particularly as she did not subsequently marry him;
• Once K abandoned her in Libya, the Appellant felt she was unable to return to Morocco due to its level of gender discrimination and that her family had disapproved of her circumstances, not least as the Appellant’s brother had told K that she was ‘dead to them’ and warned her not to go back to Morocco;
• The Appellant genuinely fears return to Morocco, her eldest brother would not support her upon return and any support offered by her sisters would be patchy and intermittent;
• The Appellant’s husband FH would not be able to obtain a permanent visa to reside in Morocco; and the Appellant’s mental health would deteriorate upon return.
15. The Secretary of State’s position is that the Appellant’s claims to fear her family is not borne out by her own account in her evidence. It was submitted in the skeleton argument that at [18] of her witness statement of 19 January 2023 the Appellant refers to her brother threatening her sister to kick the Appellant out of as she had caused them shame, but self-evidently all the time whilst the Appellant resided in Morocco her brothers were aware of where she was living and could have, at any time, sought to physically harm her. The fact that they did not do so clearly demonstrates that they have never held any intent to physically harm the Appellant, and that whilst the Upper Tribunal has upheld the finding that her brothers clearly disapproved of her actions and warned against returning to Morocco, the evidence clearly demonstrates that they have no intent to physically harm her on return. As such the Secretary of State maintains that on the accepted facts the Appellant had failed to demonstrate that her family would have any interest in harming her on return if they actually became aware of her presence in Morocco, which the Secretary of State does not accept would occur.
16. The Secretary of State also submits that the Appellant’s travel history back to Morocco between 2006 – 2011 further demonstrates that her brothers alleged hold over her family is entirely inconsistent with the accepted account of those visits. At paragraphs 34 and 35 of the January 2023 witness statement the Appellant refers to visits to some of her family for two weeks, including attempts to track down her second daughter. The Secretary of State argue such visits would require considerable resources to arrange, including flights, hotels, a cover story for her daughter, and her mother and sister to explain why they were travelling without male family members to different parts of Morocco, which the Secretary of State submits is inconsistent with the alleged control the brothers held over their mother, and further the Appellant’s claimed emotional vulnerabilities at that time. Whilst the Appellant had claimed her brothers discovered she was in Morocco at one point in time and that she had to flee, the Secretary of State’s asserts this is clearly not an issue of late disclosure but an attempt to cover up what was clearly a major flaw in her claim, and that it was inconsistent that her brothers would seek to harm her when she returned clandestinely to Morocco but made no attempts when they knew where she was when she resided in Morocco.
17. The Respondent also submits that the yearly visits the Appellant undertook to Morocco after she had allegedly come to the attention of the authorities, which the Secretary of State does not accept, demonstrates that her claimed fear of the Moroccan authorities is neither objectively nor subjectively credible. The Secretary of State asserts that on her own account she travelled by herself to and from Morocco and at no point did the authorities demonstrate any adverse interest in her.
18. In respect of the alleged fear of her former husband, the Secretary of State submits that it is evidently not objectively well-founded as there was no evidence he will be aware of her return to Morocco, nor after such a considerable period of time have any ongoing interest in her.
19. In relation to the Appellant’s alleged risk arising from the documentation process in Morocco from the authorities, the Secretary of State submits that the expert report relied upon by the Appellant at [92] is utterly speculative and fails to provide any reasons as to why it concludes that the authorities would question her about her children and if she was married when they were born. The Secretary of State asserts no supporting reason was given for that conclusion which it was submitted contradicts an earlier finding that a legal copy of the family book can be obtained by divorced women at [45] of the report. It is also submitted that as both the children are now adult citizen it is unclear why she would be treated as a single mother as the expert asserts at [46].
20. In relation to the risk of re-trafficking, the Secretary of State submits the authorities in Morocco provide effective protection for those who fear they will be re-trafficked on return, and asserts the Appellant’s skeleton argument is somewhat misleading in its claim that the Respondent must dispel any claims that the Appellant will be re-trafficked on return to Morocco, as the burden of proof clearly lies with the Appellant and not the Respondent. It is also noted, as is accepted, that the Appellant has never been a victim of trafficking in Morocco as the accepted facts are that she was trafficked from Libya.
21. Whilst the Secretary of State accepts that the Appellant suffers from mental health issues it is submitted that she had provided no supporting medical evidence to demonstrate any deterioration in her medical condition. It is noted from her most recent witness statement she is not receiving any medical treatment at the moment other than prescribed medication, and it is submitted there remains unanswered inconsistencies in the medical evidence regarding the extent of her medical issues. This is a reference to the report of Dr Thomas and the Appellant’s GP records in which Dr Thomas refers to a risk of suicide yet the GP records state she is not at risk of suicide. The Secretary of State submits, in any event, that the Appellant would receive adequate medical care on return to Morocco in respect of her mental health issues, or in the alternative that the expert at [69] confirms that a consultation with a private psychiatrist would cost in the region of £24 – £40 which the Secretary of State submits could be paid for by the Appellant’s partner in the UK.
22. The Secretary of State submits that the Appellant was never a victim of trafficking from Morocco and that with the assistance of the authorities, availability of medical support as well as insight into the potential vulnerabilities following her experience of being trafficked, she will not be at risk of re-trafficking on return.
23. In relation to the second issue, the Secretary of State submits in respect of the Appellant’s Article 3 claim this is restricted to a breach of Article 3 on medical grounds, which is accepted.
24. The Secretary of State submits that as the Appellant was granted discretionary leave to remain under section 104 (4) (a) Nationality, Immigration and Asylum Act 2002 the appeal should be treated as abandoned as the Appellant has been granted leave to remain and as the appeal is not pursued on asylum or humanitarian protection grounds, the Article 3 is limited to medical grounds, it is submitted the Appellant cannot pursue a claim under Article 3 ECHR.
Appellants submissions in reply
25. In Mr Draycott’s reply dated 4 June 2025 he refers to the fact the Secretary of State’s skeleton argument did not amount to a proper ‘review decision’ in accordance with the Upper Tribunal’s directions of 14 May 2025, nor properly engage with the submissions made within the Appellant skeleton argument of 23 May 2025 or the evidence contained within the Appellant’s bundle.
26. Even if this is so, that did not warrant the Tribunal not considering the same as that document is clearly that which the Secretary of State wished to reply upon to ensure the Upper Tribunal had an understanding of her position in this appeal.
27. It is submitted by Mr Draycott that the Secretary of State’s contention at [4] – [6] that the Appellant is not at risk from her brothers in Morocco is irreconcilable with the Secretary of State’s acceptance, as noted at [3] of the skeleton argument, that when the Appellant left Morocco for Libya with K who she subsequently did not marry her brothers disapproved of her behaviour and may have considered that it dishonoured their family. Mr Draycott also refers to the fact that the Appellant’s eldest brother had accordingly told K that the Appellant ‘was dead to them’ and warned her not to return to Morocco. It is also submitted it fails to properly consider the fact that the Appellant genuinely fears return to Morocco and that her eldest brother would not support her on return.
28. Mr Draycott also refers to the Appellant’s witness statement of 19 January 2023 at [23] in which she claimed that her brother did not simply make the remark to K but also stated “if I ever came in front of them, they would kill me”. It was submitted that such threats to kill are covered by the Respondent’s concession as it is a claim that was not rejected by the First-tier Tribunal at any point and is part of the evidence as a whole relevant when considering paragraph 339K of the Immigration Rules.
29. In relation to the Secretary of State’s argument that the Appellant’s brothers had the opportunity to attack her prior to leaving Libya in 2005 but failed to do so, even if this is correct, Mr Draycott submits that fails to recognise that the Appellant’s risk profile in relation to her brother’s has continued to heighten since that time given that it is common ground that (i) she conceived her two daughters outside of wedlock of which the brothers disapproved, (ii) although she was married to A she was subsequently divorced, (iii) she moved to Libya with K who she did not subsequently marry, and (iv) whilst in the UK she married a British national partner FK without seeking her family’s approval to do so. It is submitted that the Appellant’s country expert in the report of 25 October 2023 at [29] – [30] shows that the Appellant’s brothers are likely to disapprove of such conduct.
30. In relation to risk posed by the Moroccan Authorities, the Secretary of State’s contention that they would have no interest in asking the Appellant about the birth of the daughters and that any contention to the contrary would be speculative fails to engage with the country expert, Dr Elliot’s conclusion at [43] that for the Appellant to try and apply for a family book as a single mother would be regarded as highly irregular and will be likely to attract adverse attention or widespread disapproval by the relevant officials. It is said that further support for the Appellant’s contention is to be found within the country material at [39 (c)] of the CEDAW ‘Concluding observations on the combined fifth and sixth periodic reports of Morocco’ 12 June 2022 where it is written: ‘The committee remains concerned that … (c) Unmarried mothers, when asserting their rights and the rights of their children, are at risk of being prosecuted for having sexual relations outside marriage’.
31. In relation to the Secretary of State’s position concerning risk of being re-trafficked upon return to Morocco, Mr Draycott submits that as it is common ground that as the Appellant has been the victim of multiple prolonged instances of past persecution/past harm in Morocco, as well as Libya and the UK, as per paragraph 339K the Immigration Rules it is for the Respondent to establish that there are good reasons why this would not be repeated following her removal to Morocco, on the long-standing evidential principle that he who assets bears the burden of proof. It was submitted there was no evidence the Moroccan authorities would regard the Appellant as a victim of trafficking and provide her with support on return, given that the relevant trafficking began in Libya and generally occurred within the UK or, in the alternative, that even if support was given to the Appellant on return the approach of the Moroccan Authorities to victims of trafficking is plainly inadequate, by reference to the US State Department Report, Trafficking in Persons Report, Morocco 24 June 2024. Mr Draycott submits this is a case in which the authorities in Morocco are unlikely to be able to provide additional protection which the Appellant’s particular circumstances reasonably require.
32. In relation to the Appellant’s psychiatric condition, it is submitted the Respondent’s contention that the only assistance the Appellant is receiving is medication for her mental health fails to have regard to Dr Isabel Rose letter of 25 March 2025 which states the Appellant has been signposted to psychological therapies and referred to a social prescriber.
33. In relation to an issue that was of concern to the First-tier Tribunal, which is referred to by the Respondent - namely the relationship between the expert report of Dr Thomas and the Appellant’s GP records, Mr Draycott refers to Dr Thomas’s addendum report of 20 December 2023 where she writes:
‘I consider that real care must also be taken in espousing such a view, as GPs are primary care generalists and are not mental health specialists and hence their opinions should never been seen as superseding those of qualified mental health experts who have undertaken an additional 4-year training in either Clinical Psychology or Psychiatry (as opposed to training in General Medical Practice) and who have addition(al), usually substantive, specialist experience. For example, I have frequently seen PTSD symptoms being wrongly diagnosed by GPs within reviewed medical records as an ‘anxiety disorder’ as the symptoms can appear similar to a non-specialist. GP opinion and records are therefore important, but it is vital, in my view, that they are also not overvalued or seen as a replacement for specialist opinion’
34. It is also submitted there is no arguable basis on which the Appellant’s husband FK could fund any psychiatric treatment in Morocco from the UK as he has lost his previous paid employment and is in receipt of Universal Credit which will be paid at subsistence level for a single Claimant which will prevent him being able to offer any support to the Appellant were she returned.
35. The Secretary of State’s position in relation to section 104 is disputed which I discuss in further detail below.
Discussion and analysis
36. As with many cases in this jurisdiction a considerable volume of evidence has been generated during with the relevant issues in dispute. It is accepted that the Appellant has specific needs associated with her past experiences of mental health and it has been agreed with the parties that every effort will be made to avoid re-traumatising her in this determination. For that reason, there may not be specific reference to certain incidents that may otherwise have been mentioned. It has also been agreed that if the Appellant’s representative believes disclosing a full copy of this decision to her would result in re-traumatising her, they will provide the necessary extract to enable the Appellant to understand the decision and the reasons for it. I support such an approach being taken as a full copy of the decision will always be available to the Appellant to ask for if she felt able to do so at a later date.
37. I begin by considering the Secretary of State’s submission in relation to section 104 as that is important to establish whether this tribunal has jurisdiction to consider the Article 3 ECHR claim on the basis of the Appellant’s health needs.
38. So far as those health needs are concerned, I have seen a report from Dr Thomas dated 29 September 2023. In her opinion section at [106] – [123] Dr Thomas writes:
Opinion
106. Whether the self-perceived risks to HM on return to Morocco are considered objectively true and/or likely to materialise or not, the factor of psychiatric significance is not whether they are objectively accurate, but whether HM believes them to be so. If HM considers that she would not cope mentally on return to Morocco and that she would be considerably re-traumatised there, this will most likely precipitate a further psychiatric deterioration whether this view is considered objectively realistic or not. It is often misunderstood by the SSHD that in matters of psychiatric deterioration in the event of return, objective risk is less important than subjective risk perception on the part of the appellant. Psychiatric illness can also alter perception of risk and cause individuals to exhibit excessive fear even if objectively the risks to them may be considered to be small.
107. Given how mentally unwell GHM already is, I consider that further deterioration could mean deterioration sufficient to cause an augmented risk of suicidality and/or psychiatric breakdown requiring hospitalisation, as detailed further below. It is a well-researched psychological phenomenon that for traumatised individuals, placing them back in a re-traumatising situation causes significant psychiatric deterioration, sometimes to the point of psychiatric breakdown and/or suicide (e.g., Green et al, 1985; MacFarlane, 2000).
108. Given the high levels of post-traumatic avoidance that HM currently manifests, as described above, this is especially concerning in her case because, if this rigid defensive structure is forcibly and rapidly broken down, which I consider it is likely to be given the re-traumatisation HM will experience in the event of return, then she is likely to be flooded by traumatic affect and Cluster B PTSD symptoms which could cause rapid psychiatric deterioration and functional incapacity. I note that Dr Latif had also previously determined that HM’s psychiatric condition would deteriorate in the event of enforced return to Morocco when she assessed HM in 2021.
109. Whilst HM has a number of protective factors against suicide in play whilst in the UK including her felt safety in this country and her close attachment to her UKbased second husband, I consider that her current suicide risk will undoubtedly be increased markedly by the prospect of imminent removal to Morocco where she will lose this current support system and felt safety.
110. In her current state of mental ill health and vulnerability I also do not consider that, if forcibly removed to Morocco, HM will be able to ‘take stock’ of the situation, i.e., to review it objectively, with the help of doctors and/or lawyers, such that she would not self-harm or attempt suicide.
111. I consider that the risk of suicide will increase in all of the following circumstances: a. If HM is told that her immigration case has been refused. b. If she is detained under UK immigration powers, pending removal. c. On the plane to Morocco. d. On arrival in Morocco. e. When released in Morocco.
112. I consider that her suicide risk will augment considerably upon any period of detention in the UK due to the fear of imminent removal that this situation will produce, because it will enforce separation from her husband and because the situation of detention in itself can be directly re-traumatising.
113. I am not an expert on the provision of psychological therapy or medical intervention in Morocco. I consider, however, that even if appropriate psychological, psychiatric and medical provision and support services are available in Morocco, that HM is likely to be far too psychiatrically unwell by this time and too re-traumatised to readily access them.
114. It has been well documented that significantly depressed individuals do not readily ask for help or attend appointments, even those relating to their mental health, due to depressive withdrawal and lethargy, even in situations of perceived external safety with supports in place. This will inevitably be augmented further in a situation felt to be externally unsafe. HM instructs that she would also not be accepted in her culture as a lone woman, even by professionals. Again, it is HM’s personal belief about such matters that is relevant to her psychiatric condition on return, whatever the assessed, objective, reality.
115. I consider that, in her current psychiatric condition which would inevitably worsen in a situation of enforced return, that, even if she were to be removed to Morocco without incident, there is also a real likelihood that HM would not be psychiatrically well enough to readily find and maintain paid work and accommodation and to be self-supporting in Morocco in her current psychiatric condition. Even if she was to find work, it is unclear how she would manage this in her current mental state in the absence of any state or family support which she instructs will be the case in Morocco.
116. I also consider that HM would be at augmented risk of further exploitation in Morocco. She reports having been exploited and trafficked historically and this has been confirmed by the NRM. I consider that she will be at significant risk of further trafficking/exploitation if returned to Morocco, as I anticipate that her psychiatric condition will deteriorate further in Morocco as described and that her vulnerability to further abuse/exploitation/trafficking will thus be much heightened.
117. I note the SSHD’s comment in the refusal documentation that HM will not be at risk of re-trafficking in Morocco if returned, as she was not originally trafficked there. In terms of the psychological profile of trafficking victims, however, this is to take too simplistic a view, as the risk/process of re-trafficking is not merely an external but also a psychological one and, if HM’s mental state deteriorates further in Morocco which I consider it will and she has a pre-existing vulnerability to trafficking and other forms of exploitation, then it follows that her psychological risk of re-trafficking in the event of return to Morocco will be increased because she will be more psychiatrically vulnerable there.
118. In my clinical opinion, based on nearly 20 years working in this field, HM does indeed classify as a ‘seriously ill person’ based on this examination in terms of her psychiatric health, with an overall serious and chronic mental health condition. I therefore consider both that the prolongation of her external situation of perceived instability and lack of safety (the importance of safety and stability needs being met for psychiatric recovery is addressed below) and the absence of appropriate treatment could lead to ‘a serious, rapid and irreversible decline’ in HMs state of mental health in the event of enforced return to Morocco, ‘resulting in intense suffering’.
119. If unable to access appropriate treatment in Morocco and with the inevitable psychiatric deterioration that I consider removing HM to Morocco would produce, I consider that deportation from the UK could thus indeed result in a ‘significant reduction in HM’s ‘life expectancy’ due to augmented suicide risk (and also potentially increased risk of destitution and homelessness again if she cannot be self-supporting in Morocco). Any further periods of homelessness could also be highly re-traumatising for HM given her reported past traumatic experiences of the same.
120. I also consider that, in her current psychiatric condition, it would be extremely difficult for HM to successfully relocate to another part of Morocco which she does not know and where she has no social support and where she would have to find work, accommodation, make new friendships and re-start her life there without her husband to support her. As noted above, HM instructs that her husband would not be able to give up his life in the UK in order to relocate to Morocco with her.
121. If able to remain in the UK, without fearing the additional re-traumatisation of return to Morocco, HM will then be able to receive the further medical and psychological support and treatment (described below) that she requires as a vulnerable adult with a significant psychiatric illness. She will be able to remain in a situation of external safety with her current husband in a stable environment. These will be significant protective factors in her psychiatric recovery.
122. If able to remain in the UK now, HM reported in this assessment that she will finally feel safer and that her felt anxiety will reduce due to the removal of the risk of arrest, detention and deportation due to her immigration status. She said that she would also hope to see her older daughter in person again and to attempt reconciliation with her and said that this would mean a great deal to her.
123. HM reports receiving support in the UK from her husband, legal representatives, GP and other professionals. She reports no meaningful family or social support any longer in Morocco (the situation with her daughters is described above). Whilst she reports limited social relationships in the UK currently, I consider this to be due to her current mental health problems and that this situation would improve as her psychiatric condition ameliorates. Leading psychological research has demonstrated the vital importance of good social support networks in the psychological recovery of individuals with psychiatric disorders. Similarly, the research notes the poor prognostic indicators for individuals in the absence of such supports (e.g. Brown & Harris, 1986).
39. There is also a further medical report from Dr Saima Latif detailing psychological difficulties experienced by the Appellant, dated 1 October 2021, diagnosing post-traumatic stress disorder (PTSD), Depressive Disorder (recurrent and moderate) and anxiety.
40. I have also seen correspondence from the Snowdrop Project dated 30 June 2022 confirming the Appellant was referred to them for counselling on 4 October 2021 when she joined their waiting list, that she was assessed for counselling on 4 July 2022 and at the date of the letter was awaiting counselling slots to commence therapy.
41. The Appellant’s medical notes have been provided at pages 106 – 326 of the Appellant’s bundle.
42. I have also seen a more up-to-date report from Dr Thomas dated 11 April 2025 addressed to the Appellant’s solicitors as a result of the husband recording concerns regarding the Appellant’s mental health in his witness statement, which Dr Thomas states that on a prima facie basis having reviewed the evidence appears to be clinically significant and gives rise to clinical grounds for further mental state assessment; although that assessment could not be undertaken by Dr Thomas as a result of continually changing dates by which such a report would have been available and the interests of justice not being served by such a delay.
43. A point in relation to the medical as well as the country evidence is that although it is challenged in submissions there was no cross-examination by the Secretary of State in relation to any of the evidence relied upon by the Appellant.
44. I find considerable weight can be given to the medical reports and do not accept the opinion of Dr Thomas can be ignored despite what may be said in the GP notes. Dr Thomas’ concerns are supported by, and in accordance with, the medical evidence considered as a whole.
45. To determine the Secretary of State’s point in relation to section 104 of the 2002 Act it is important to look at the specific wording of that section which reads:
104 Pending appeal
(1) An appeal under section 82(1) is pending during the period—
(a) beginning when it is instituted, and
(b) ending when it is finally determined, withdrawn or abandoned (or when it lapses under section 99).
(2) An appeal under section 82(1) is not finally determined for the purpose of subsection (1)(b) while—
(a) an application for permission to appeal under section 11 or 13 of the Tribunals, Courts and Enforcement Act 2007 could be made or is awaiting determination,
(b) permission to appeal under either of those sections has been granted and the appeal is awaiting determination, or
(c) an appeal has been remitted under section 12 or 14 of that Act and is awaiting determination.
(4A) An appeal under section 82(1) brought by a person while he is in the United Kingdom shall be treated as abandoned if the appellant is granted leave to enter or remain in the United Kingdom (subject to subsection (4B)]).
(4B) Subsection (4A) shall not apply to an appeal in so far as it is brought on ground specified in section 84(1)(a) or (b) or 84(3) (asylum or humanitarian protection)] where the appellant—
(b) gives notice, in accordance with Tribunal Procedure Rules], that he wishes to pursue the appeal in so far as it is brought on that ground.
46. It is a settled principle that the starting point when a question of statutory interpretation arises is to look at the ordinary meaning of the words. Section 104 deals with the question of statutory abandonment but specifically refers to its application relating to a pending appeal. Section 104 (1) defines when an appeal is pending which clearly shows that it begins when an appeal is lodged, i.e. when it is instituted (which must be a valid appeal), and ends when it is finally determined, withdrawn, or abandoned.
47. Section 104 (4A) relied upon by the Secretary of State specifically refers to an appeal under section 82 (1) brought by a person who is in the United Kingdom being treated as abandoned if leave is granted to enter or remain, subject to the condition found in section (4B) which is not applicable for the purposes of this appeal.
48. It is therefore a requirement for the provision to bite that an individual is granted leave to remain after the lodging of the appeal.
49. The chronology in this case shows the Appellant was granted 30 months discretionary leave on 19 August 2022 in the reasons for refusal letter of that date, which was prior to the Appellant lodging her appeal to the First-tier Tribunal against the refusal of the other aspects of the claim.
50. The point made by Mr Draycott is simply that the Appellant’s appeals facts fall outside the scenario envisaged by the drafters of section 104 (4A) and that there is no merit in the Secretary of State’s argument that the relevant provision should somehow extend to cover the Appellant’s appeal.
51. Section 104 is clearly drafted to prevent unnecessary litigation and continuation of an appeal if a person has secured the remedy they were seeking, namely leave to remain in the United Kingdom, subject to the qualification relating to protection appeals. Although it may seem counterintuitive to find that although the Appellant has been granted leave to remain the provisions in section 104 do not apply, I find that is the only interpretation that can be given to the wording of section 104 in light of the specific facts of this case. Had the Secretary of State waited for the Appellant to lodge an appeal against refusal letter and at a point thereafter granted her discretionary leave then, subject to section 104 (4B), there would be merit in the Secretary of State’s argument that the appeal had been statutorily abandoned. But she did not. The Discretionary leave was granted prior to the Appellant lodging her appeal against the refusal. On that basis I find section 104 cannot bite to prevent the Appellant from proceeding with her appeal on Article 3 ECHR grounds.
52. Mr Draycott also submits that the point in relation to section 104 is of no significance as (i) the Appellant’s grant of discretionary leave expired on 19 February 2025 with her in time further application remaining undetermined by the Secretary of State, and (ii) the Appellant’s appeal to the Upper Tribunal had not been bought under section 82 of the 2002 Act but pursuant to section 11 of the Tribunal Courts and Enforcement Act 2007 such as section 104 (4) of the 2002 Act is irrelevant.
53. In relation to this submission whilst it is correct that the error of law challenge was brought pursuant to section 11 of the 2007 Act, once material legal error was found and the matter listed for a Resumed hearing before the Upper Tribunal, the appeal continues as an appeal lodged pursuant to section 82 of the 2002 Act which would have made section 104 relevant had it had any application.
54. The leading case in domestic law in relation to Article 3 medical claims is AM (Zimbabwe) [2020] UKSC 17 which considered the application of the test in Paposhvili v Belgium (Application No. 41738/10) to this area of law.
55. In Paposhvili the Grand Chamber found that the appropriate test required a claimant to establish 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 or her state of health resulting in intense suffering or to a significant reduction in their life expectancy.
56. In Savran v Denmark GC (App. No. 57467/15 it was further found that the Paposhvili threshold test can (and should) be applied in the same way for mentally ill people as for ill people with other medical conditions and only after this threshold test is met, and thus Article 3 is applicable, the returning State’s obligations listed in paragraphs 187 – 191 of the Paposhvili judgement concerning the examination of whether the necessary care is available and accessible, comes into play.
57. The Upper Tribunal reviewed the two judgements of the European Courts in its decision handed down with reference AM (Article 3, health cases) [2022] UKUT 00131 in which it was found ‘In Article 3 health cases two questions in relation to the initial threshold test emerge from the recent authorities of AM (Zimbabwe) and Savran v Denmark:
(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”?’
58. The first of these questions, whether the Appellant has discharged the burden upon her to establish she is “a seriously ill person” has been discharged on the basis of the medical evidence - including the report from Dr Thomas dated 29 September 2023.
59. In addition to the mental health issues identified by Dr Latif and Dr Thomas there is also a clear reference to the Appellant’s risk of suicide.
60. In relation to the question of whether the Appellant’s establish faces a real risk as a result of being a seriously ill person medical evidence, including from Dr Thomas, clearly shows that without appropriate treatment the Appellant will deteriorate in terms of her diagnosed mental health conditions but also, more concern, that there is a credible real risk of suicide.
61. It is important that the context of this question is properly considered. As Dr Thomas says, even if the Appellant’s subjective fears are not objectively well-founded the reality is that the Appellant believes these things will happen to her if she is returned to Morocco. That means that she has a fear of being re-trafficked, killed, harmed by family, being destitute, and persecuted/harmed by the authorities, which to her is real, with the resultant impact upon her mental health.
62. The evidence shows, when considers a whole, that there are concerns which the Appellant has in relation to how her family may treat her. Although there is merit in the observation in the Secretary of State’s skeleton argument that the extent of that fear may not be as claimed, as illustrated by the fact the Appellant was able to return Morocco when she was working for the family she was with in the UK, and stay with her own family members, without suffering harm from those she now claims she does fear. What needs to happen at this stage, however, is to assess the position at the date of this hearing.
63. The Appellant’s current husband will not be able to return to Morocco with her as he is not a Moroccan citizen and it was not made out on the evidence that he will be permitted to enter to live with the Appellant.
64. The Appellant will require appropriate documentation to enable her to access services in Morocco and that will require an approach to the authorities. The Appellant will be approaching them with the profile she has, although her children are all adults and she is not a single mother with minor children born outside wedlock who may face discrimination and difficulties when interacting with some officials in Morocco. The Appellant is married, albeit to an individual in the United Kingdom. It is not made out on the evidence that any difficulties or discrimination the Appellant may experience is of a sufficient level to enable her to succeed under Article 3 ECHR, but it will add to the difficulties that she is likely to face on return.
65. There is merit in the submission by Mr Draycott that without appropriate support on return the Appellant is unlikely to be able to establish herself and will run a real risk of becoming destitute and even more vulnerable, as that is a submission based upon the accepted medical evidence.
66. In relation to the risk of re-trafficking, I accept the Appellant was trafficked from Libya and within the United Kingdom as that is the finding of the Competent Authority. She was not trafficked from Morocco but left there in circumstances which she considered left her with no choice. Antagonism from the family as a result of not marrying and having children outside marriage is credible in relation to the country evidence in the male dominated society within Morocco.
67. The question of whether the Appellant would be recognised as a trafficked person by the Moroccan authorities was not properly answered in the evidence. It has been known for some time there is a question mark around the issue of whether a person trafficked in Libya or from the United Kingdom will be recognised as a victim of trafficking by the Moroccan authorities when she had not been trafficked from that country, and I am not satisfied the Appellant has established that she will not. The available evidence to show that that although there are concerns about the support given to victims of trafficking within Morocco, considerable steps have been taken to try and improve protection and services available to those affected have been identified as victims of trafficking.
68. Previous experiences of being trafficked from Libya, combined with the Appellant’s current presentation, establishes clear evidence of a credible risk to the Appellant as a potential victim of trafficking were she to be returned to Libya, in that respect paragraph 339K of the Immigration Rules would apply.
69. I also find there are credible concerns that as it is highly likely that if returned the Appellant’s mental health will seriously deteriorate it is highly unlikely that she will be able to seek assistance from those who support trafficking victims to obtain advice and assistance. There is also a real risk that exposing the Appellant to the type of environment where she is being preyed upon by potential traffickers will have a clear detrimental effect upon her mental health, causing further deterioration.
70. There is a clear diagnosis of depression and post-traumatic stress disorder and recommendations for treatment within the expert medical evidence.
71. In relation to the next element of the test:
(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”?’
72. Reference is made by Mr Draycott to the expert report of Dr Elliot dated 25 October 2023 at [65-71] where it is written:
Access to medical services
64. Because this report is focused on HM’s risks of return to Morocco and her mental health situation, I would like to provide some comment on, and experience of, low-income persons accessing medical treatment generally, to shed additional light to issues related to accessing the current medical scheme AMO Tadamon. HM has experienced psychological/psychiatric issues in the UK (and quite possibly already while in Morocco in Libya), which would not go away if she returned to Morocco but would quite certainly exacerbate, as concluded by Dr Rachel Thomas in her Psychological expert report.
65. The Moroccan health system is in the process of reform. The implementation of Basic Compulsory Health Insurance for poorer strata of the population or AMO Tadamon (AMO is its French acronym, and Tadamon means solidarity – more on this in continuation) is in progress, with a gradual abolition of Ramed, for people who have not previously benefited from Ramed and who cannot pay social security contributions. Were HM to return to Morocco, she would need to begin the registration process for AMO as soon as possible after her arrival in order to be able to continue with her treatment. That will require her to register for AMO with a CIN (a national identity card) or with the support of two family members in her place of residence, and registration can take around 2 months or more (I give that timeframe from my experience of the former Ramed system, however the new AMO system is still being rolled out so average timescales for AMO registration are still unclear). Only once she has subscribed to and is in receipt of an AMO affiliation code would HM have access to all public healthcare services available in Morocco.
66. As the new health care scheme is still in the process of implementation, I would like to offer an overview of the previous health care scheme to be able to understand the potential difficulties citizens have in accessing the current health care scheme.
67. The Moroccan government introduced a Medical Assistance Scheme or ‘Ramed’ in 2002 to help low-income people access public health services. However, many women I talked to in the Listening Centre, as well as my most recent interviewees in 2022, confirmed that they either have not applied for the Ramed card or have not renewed it. Cards were only valid for three years, after which individuals had to resupply all of the required documents. This necessitated knowledge of what these documents were, photos of oneself and their family members, and a number of certificates issued by different administrative offices. To obtain these certificates, people had to know or be able to ask about the procedure, they needed money to travel from their homes to the municipalities and once there, between different administrative buildings, time to do that but also official documents, such as their national identity card – CIN and a Family Booklet. None of this is readily available to people who are functionally and otherwise non-literate. The infrastructure is not customer-friendly, public officials are frequently absent and have haphazard working hours.
68. In addition, when Ramed was still in place, the official poverty rate in Morocco was approximately 4.8 %, while 12.9 % were vulnerable to poverty. Ramed requirements, however, stated that only poor people or those living on less than 3767 MAD (about £300) a year (in urban areas) were eligible for a Ramed coverage free of charge, while those vulnerable to poverty (whose income was between 3767 MAD and 5650 MAD (about £300 to £450)) had to pay a yearly contribution between 120 MAD and 600 MAD (about £10 to £48)58 in order to access the crumbling, inefficient, and inhospitable public health care system. All of my interviewees also complained that with a Ramed card in public hospitals the medical staff would not admit them or give them information about the services they provide unless they paid an unofficial ‘fee’, i.e. give them a bribe. Many people, even those from low-income backgrounds, thus pay for medical services out of pocket – if they have the money – and go to private clinics and hospitals. However, there too people from such socio-economic backgrounds report that they were treated with much disdain. Unless they pay for all services upfront and bring medication, sheets, pads, etc. with them, the medical staff will not treat them. This is also confirmed by the Morocco’s National Human Rights Council (CNDH) Mental Health and Human Rights: Urgent Need for New Policy Report on the state of psychiatric care in the country, which reported that one of the main features of the mental health provision is “[t]he poor quality of the medical and non-medical services offered to those receiving psychiatric care and the living conditions to which they are subjected during hospitalization.” In other words, the problem is not that Morocco would not have an insurance scheme, the problem is in the weak implementation and in people's (medical staff's and public officials') exploitative and harmful attitudes towards those most vulnerable and in need.
69. Despite the fact that the current insurance scheme covers psychiatric services, good mental care remains generally inaccessible for most people, which I will address in more detail in the section on The State of Psychiatric Care in Morocco. Dr Charlotte Hajer, who carried out extensive fieldwork at a psychiatric teaching hospital, rightfully argues that “quality mental health and healthcare in Morocco generally remains difficult to obtain for any but those who belong to the country’s upper socio-economic classes. (…) In other words, quality mental health and healthcare have become economic commodities that some can afford, and others cannot.” Consultation with a specialist such as a psychiatrist working in a private clinic costs between 300 MAD and 500 MAD (about £24 to £40), which is approximately what a cheap room costs per month in one of Morocco’s biggest cities, as I will discuss in paragraph.
70. Dr Hajer continues, that [t]his commoditization is especially problematic because a person’s mental health is directly linked to his or her quality of life and ability to access other resources. To begin with, individuals who belong to lower socio-economic strata are more likely than others to encounter mental health problems because they are more likely to be exposed to risk factors for illness, such as the stress of loss, abuse, economic hardship, existential insecurity, and so on – a disadvantage that is only compounded by their relative lack of access to quality care. In turn, a mental health problem tends to further worsen a person’s socio-economic disadvantage: someone with a psychiatric disorder is less likely to find stable employment, complete an education, find a partner, or maintain other supportive relationships. In other words, low socio-economic status can put a person at risk of developing mental health problems, while bad mental health is likely to further disadvantage a person’s socio-economic status.”
71. In addition, during my ten-year long residence in Morocco, I have experienced sporadic shortage and longer term unavailability of even more mainstream prescription medication (e.g. Levothyroxine), as well as the government not carrying medication for certain illnesses (e.g. for ADHD), which makes treatment extremely precarious and in some cases even deleterious to one's health. Those with means get such medication from their family or friends who live in Europe. When this is not possible because Moroccan prescriptions are not accepted in Europe, they buy medication on the black market, usually smuggled into the country from Europe.
73. I have also considered that in MY (Suicide risk after Paposhvili) [2021] UKUT 00232 (IAC) the Upper Tribunal was considering an Appellant who claimed to be from the OPA but who the Respondent stated was from Morocco, to where he was to be returned. There is a similarity in the factual elements of these appeals. The Upper Tribunal found:
140. The medication he receives here and visits to his GP have no doubt prevented the Appellant from making any recent attempts on his own life. Having accommodation is a feature that has helped him engage with mental health services. In respect of availability of medical treatment in Morocco, we attach weight to Professor Joffé’s clarification of the background evidence relied on by the Respondent. There was no meaningful challenge to this. While we accept that there are some medical facilities in Morocco which if accessed are capable of offering some treatment, we attach weight to the evidence of Professor Joffé that mental health facilities are likely to be inadequate. We find that private facilities would not be affordable to the Appellant. We find that the medical evidence establishes that the Appellant is at risk of self-harm or suicide which we find would materialise as soon as he arrives in Morocco because there will be no support to enable him to access the limited facilities available (though there is no requirement for imminent death properly applying the Paposhvili test).
141. The evidence does not establish that medical facilities and treatment in Morocco will alleviate the immediate and high risk of self-harm or suicide that the Appellant presents. To the extent that treatment might be available, it would certainly not be accessible to this Appellant. We take into account that destitution and poverty are factors that have exacerbated the Appellant’s mental health problems in the past and have also hindered his ability to access medical help in the United Kingdom. His engagement with health services here has been haphazard. It is reasonably likely that he will face destitution and poverty in Morocco. At present the Appellant has accommodation here and there is some engagement with health services. Without any kind of support network, family or accommodation, it is unlikely that he will be able to access any kind of health care, state provision of private.
74. Dr Elliott refers to the problems in the provision of psychiatric treatment in Morocco at [72] – [78] of his report which highlights real issues for the Appellant in being able to accesses suitable services to meet her specific needs.
75. I find the Appellant has adduced evidence capable of demonstrating a prima facie case that there are substantial grounds for believing that, if she was returned to Morocco, she will be exposed to a real risk of being subjected to treatment contrary to Article 3 taking into account her particular characteristics as identified in the medical evidence, and the fact that even though certain concerns relating to protection or return, risk of re-trafficking, or actual harm rather than threats of harm from family members may not be objectively established on the evidence, the Appellant clearly has a very strong subjective fear that these events will befall her. I find considerable weight can be put upon the expertise and the report of Dr Thomas in this respect. The evidence shows that if the Appellant is to be returned to Morocco there will be a serious deterioration in her mental health and suicidal ideation once she knows that is to occur. Whilst that can be managed in the United Kingdom, the first point where risk arises, and possibly during transit, on arrival in Morocco it is not made out that the required support services will be available to her. The Appellant is therefore likely to suffer a very severe and immediate deterioration in her mental health bearing in mind she is already ‘seriously ill’. There is a real risk that as her mental health deteriorates risk of suicide will increase exponentially leading to a very high degree of likelihood that the deep state of depression that she will fall into will mean that she will have no incentive for foresight in terms of the future and is more likely than not to commit suicide which she will see will be the only way out from her subjective fears.
76. The Secretary of State relied upon the section 104 argument to oppose the Appellant’s case in relation to her Article 3 medical claim. That argument did not succeed. The Respondent is required to ‘dispel any serious doubts’ as the Appellant has proved her case. I find on the basis of the medical and country evidence which was not challenged by cross-examination or questions to the experts, on the facts of this case, that the Respondent is unable to do.
77. On that basis the appeal is allowed on Article 3 ECHR medical grounds.
Notice of Decision
78. Appeal allowed.
C J Hanson

Judge of the Upper Tribunal
Immigration and Asylum Chamber

3 July 2025