Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM
CHAMBER
Case No: UI-2025-000091

First-tier Tribunal No: PA/60612/2023
LP/10765/2024

THE IMMIGRATION ACTS

Decision & Reasons Issued:
On 20 January 2026

Before

UPPER TRIBUNAL JUDGE MANDALIA

Between

AIM
(ANONYMITY DIRECTION MADE)
Appellant
and

Secretary of State for the Home Department
Respondent
Representation
For the Appellant: Mr M Mohzam, Burton and Burton Solicitors
For the Respondent: Ms S Simbi, Senior Home Office Presenting Officer

Heard at Birmingham Civil Justice Centre on 18 November 2025
Decision and Reasons
Anonymity
1. This appeal concerns a claim for international protection and an Article 3 claim. 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.
Introduction
2. The appellant is a national of Egypt. He arrived in the United Kingdom on 3 July 2021 and claimed asylum. There are two strands to the claim for international protection. First, the appellant claimed he will be at risk upon return to Egypt because of his past association with the Muslim Brotherhood. Second the appellant claimed his removal from the United Kingdom will be in breach of Article 3 ECHR as a result of his physical and mental health following injuries he sustained in France, on route to the UK. In summary, he was run over by a train resulting in the amputation of his right leg and four toes on his left foot. The appellant’s claims were refused by the respondent on 27 October 2023.
3. The appellant’s appeal to the First-tier Tribunal (“FtT”) was allowed on Article 3 grounds only by FtT Judge Wyman (“the judge”) for reasons set out in a decision dated 20 November 2024. The respondent was granted permission to appeal to the Upper Tribunal on 8 January 2025 by FtT Judge Boyes. The decision of FtT Judge Wyman to allow the appeal on Article 3 grounds was set aside by Deputy Upper Tribunal Judge Hoshi for reasons set out in a decision issued on 9 April 2025.
4. In summary, the Deputy Upper Tribunal Judge found that FtT Judge Wyman had referred to the decision of the Upper Tribunal in AM (Article 3, health cases) Zimbabwe [2022] UKUT 131 (IAC) but failed to properly apply the test set out. The judge had failed to make any findings on whether the appellant was at real risk of being exposed to a serious, rapid and irreversible decline in his state of health resulting in intense suffering or to a significant reduction in his life expectancy. The Deputy Upper Tribunal Judge also accepted that there was no proper evidential basis for the finding that appropriate treatment would not be available to the appellant in Egypt and said that a full and up-to-date assessment of the appellant’s physical and mental health conditions will be required. The Deputy Upper Tribunal Judge directed that the decision in the appeal will be remade in the Upper Tribunal and issued directions, including directions for the filing and service of further evidence.
The Hearing of the Appeal Before Me
5. In readiness for the hearing of the appeal before me, the appellant’s representatives had filed an ‘Appellant’s Addendum Bundle’ that includes two key documents and comprises of 22 pages. The first document is a statement of the appellant that was electronically signed by the appellant on 13 October 2025.
6. The second document is what purports to be an ‘Expert Report’ that is titled “Country Condition report for presentation to the court in the case of [AIM]”. Mr Mozham indicated at the outset that the report is relied upon by the appellant as evidence of the availability of healthcare in Egypt. He acknowledged that the expert does not appear to have any qualifications and experience relevant to the availability of healthcare in Egypt, but indicated that the expert has drawn upon background material as set out in section 7 of the report. I will return to that report when I refer to the evidence.
7. The appellant attended the hearing and was assisted by an interpreter. I was satisfied that the appellant and interpreter understood each other.
The Evidence of the Appellant
8. The appellant was referred to the witness statement that is dated 13 October 2025, that purports to have been signed electronically by the appellant and an interpreter, and is to be found at pages 2 to 4 of an ‘Addendum bundle’ filed by Burton and Burton Solicitors. The statement includes a ‘statement of truth’ and includes a declaration made by an interpreter in the following terms:
“I, Sherzad Jabary, confirm that the entirety of the above statement of evidence has been read out by me before the Appellant in their own language and it has been confirmed and understood by the Appellant.”
9. The appellant claimed that the statement had been translated to him in ‘Iraqi’ and that he did not understand the interpreter. Unfortunately, the interpreter does not set out the language used for communication. The appellant confirmed that he had signed the statement and claimed that he did so because he was told “it will be put before the court”. Mr Mozham sought, and was granted a short adjournment so that he could take instructions from his instructing solicitors regarding the preparation of the witness statement.
10. Mr Mozham was unable to shed any further light on the preparation of the statement and I permitted him to ask the appellant some questions to draw out his evidence before me. In his evidence in chief, the appellant said that when he was attempting his journey to the UK, he fell from a train causing injuries to his right leg, and four toes on his left foot. He said that he has received treatment for his injuries and also for his mental health, including counselling. He explained that he has a constant pain in his leg and takes regular medication. He said that he has a ‘triple crack’ on his left knee and that it is not straight. Mr Mozham asked the appellant why he cannot return to Egypt. The appellant said that as an ‘Arab’, he feels that he has let his family, including his parents and wife, down. He said that he had left Egypt as someone who was ‘fit and healthy’ but would return as someone in a wheelchair. He claimed that there is no physical and mental health care available in Egypt.
11. In cross-examination the appellant confirmed that, as set out in his witness statement dated 18 May 2024 that was before the FtT, he has two wives, and his parents who remain living in Egypt. He still maintains contact with them. He also has two children that are aged almost 10 and 6 that live in Egypt. He said his wives and children are supported by charities in Egypt. His brothers, who remain in Egypt, are married and have their own families to support. The appellant confirmed his family are aware of his health and disability. He said that he has not spoken to his family about how his life would continue in Egypt because they all hope he will be able to settle in the UK. He hopes that once he is able to settle in the UK, he will be able to work and support his own family. He said that if returned to Egypt he would be unable to support his family because he would be unable to work in the same way as he can in the UK. When asked whether his wives have made any enquiries in Egypt about support that may be available to him, the appellant said that there are no charity organisations that would be able to assist him in Egypt. He said that his wife has approached a few places but they will not listen to her, and that it is not easy to get any support in Egypt. He said that the NGO’s are all fake, and will only help people that are close to them. They are not genuine and do not assist the public. The appellant said that in the UK he is assisted by carers who prepare food for him and assist with cleaning, washing and the arrangement of taxi’s to attend medical appointments. The carers will sometimes attend appointments with him. He said that he tries to attend to his own personal care and hygiene where he can, and that the carers will wait outside the bathroom to help when he finishes.
Medical Evidence
12. In the evidence that was before the FtT, the appellant provided a copy of his GP records for the period between 3 July 2021 and March 2024. Latterly, the appellant received GP services, as an asylum seeker, at “The ASSIST Practice. I note:
a. The appellant was seen on 12 May 2023 by Michelle Collins, a Specialist registrar in Plastic Surgery with regard to his “right below knee amputation stump”. Options were discussed with the appellant who wanted to go away and consider surgical management. The appellant was to be seen in two months time.
b. The appellant was seen by Mr Mathew Smith, a Consultant Plastic Surgeon on 5 September 2023. The letter from Mr Smith confirms the appellant agreed to surgery for refashioning of the stump of his ‘right below knee amputation and excision of neuroma’. The letter states that the involvement of the Prosthetists may be required before the procedure to organise refashioning of the appellant’s prosthetic limb.
c. A letter dated 26 July 2023 from Mr Urjit Chatterji, a Consultant Orthopaedic Surgeon, confirms the appellant failed to attend a clinic appointment. Mr Chatterji confirms he is giving the appellant “one further appointment” and that his care is being transferred to Leicester General Hospital to make attendance easier from. In a further letter dated 15 November 2023, Mr Chatterji, states the appellant “did not attend on two or three occasions” and has therefore been discharged from Mr Chatterji’s clinic.
d. The last recorded entry in the GP records is of a consultation on 3 November 2023 when the appellant is noted to be using paracetamol and ibuprofen but requesting something else to manage on-going pain. The appellant reported that the cold weather was making matters worse, but he did not have a fever, was eating as normal, and did not feel unwell. The appellant was prescribed, co-codamol (for short term use) and mirtazapine.
The Expert Evidence
13. A report has been prepared by Mr Hatem Nasr, who is described as “Appellate Lawyer & Country Expert” on the face of the report. The report is neither dated nor signed by the ‘expert’. In the ‘Executive Summary’, Mr Nasr states he has been instructed to provide “an expert opinion on the availability of healthcare in Egypt” for the appellant. Mr Nasr is the Founder Chief Executive Officer of XSolutions Ltd, which is described as a UK-based legal consultancy established in 2017, “specializing in cross-border legal advisory, expert country reporting, and bilingual contract drafting.” Mr Nasr confirms that he is, inter alia, a registered Foreign Lawyer with the Solicitors Regulation Authority, (SRA) in England and Wales, and an “appellate advocate before the Egyptian Court of Appeal and a member of the Egyptian Bar Association with over thirteen years of litigation experience in civil, criminal, and human rights law. His qualifications and experience are set out in paragraphs [3] to [12] of the report and he outlines his ‘areas of expertise’ at paragraphs section 2 of the report:
“My areas of expertise include providing legal analysis and strategic guidance in politically sensitive and high-risk environments, particularly where concerns arise regarding the integrity of judicial processes or abuse of power. I have extensive experience in examining patterns of judicial misconduct, politically motivated prosecutions, and the misuse of legal systems to suppress dissent.
I have advised on cases involving violations of freedom of expression, with a focus on the persecution of journalists, media bloggers, and civil society activists. My work also covers culturally and legally sensitive matters, including honor-based violence, gender-based discrimination, and sectarian or interfaith conflict.
Additionally, I address complex legal challenges across a range of sectors, including state governance, financial regulation, cross-border trade, and issues arising from religious or ideological diversity. My practice often involves navigating legal systems that blend civil, customary, and religious law traditions.”
14. In section 3 of his report Mr Nasr claims:
“I work UK law firms on asylum and human rights cases involving MENA and GCC nationals. My reports have supported claims involving:
o Gender-based persecution and honour-related harm
o Religious conversion
o Forced marriage and domestic abuse
o LGBTQ+ risk and political dissent
My role is to bridge legal-cultural understanding and support evidentiary clarity in complex asylum proceedings.”
15. Because of concerns raised at the hearing regarding the expertise of Mr Nasr, Ms Jessica Frost, a Solicitor at Burton and Burton Solicitors attended the hearing before me. She confirmed that she has responsibility for the majority of publicly funded work. She confirmed that she had read the extracts from the experts report where the expertise is set out. She said the expert had been provided with an outline of the appellant’s medical background and he had confirmed by email dated 1 August 2025 that he was able to assist with the preparation of a country expert report addressing the availability, accessibility, and adequacy of healthcare services in Egypt, with reference to the medical and psychological needs of the appellant as outlined. She said that the fact that the expert report is unsigned and undated appears to be an oversight and unintentional. She said that a solicitor cannot be expected to go behind the claimed expertise, but acknowledged that the report does not set out any qualifications or experience held by Mr Nasr to support his claimed expertise to address the availability, accessibility, and adequacy of healthcare services in Egypt. She said that the firm will not make any claim to the Legal Aid Agency for the costs associated with the report including the expert’s fees.
16. I have set out the above expertise and qualifications of Mr Nasr because it is obvious that Nr Nasr does not have the required qualifications and experience to provide an expert opinion on the issues that arise in this appeal. That is relevant here because the appeal had been listed for hearing previously on 22 September 2025. That hearing was reluctantly adjourned by Upper Tribunal Mahmood because the expert evidence to be relied upon by the appellant was said not to have been available. In response to directions made by the Upper Tribunal, a statement was filed with the Tribunal by Mr Mohammed Mahruf, a solicitor and Senior Partner at Burton and Burton Solicitors explaining the delays in securing the expert report. In his statement dated 13 October 2025, Mr Mahruf confirmed that the expert report had been received and he states that it was not appropriate or fair for the report to be filed immediately “as the appellant must be given a reasonable opportunity to review the contents and provide instructions..”. It seems that the appellant’s solicitors, having had an opportunity to consider the report, failed to consider whether the experience and qualifications of the expert demonstrate his ability to give expert evidence as to the issues in the appeal.
Submissions
17. Ms Simbhi adopted the respondent’s decision and submits the appellant has failed to establish his Article 3 claim. She submits the expert evidence relied upon by the appellant is unreliable and the source material referred to by the expert does not support the claims made. She submits the expert does not provide impartial evidence regarding the availability of services that the appellant can access. She submits the appellant’s wives, children, parents, and brothers all remain in Egypt, and they will be able to assist the appellant on return, both in the short and longer term. The support received by the appellant at the moment is limited and the evidence does not establish the removal of the appellant will be in breach of his Article 3 rights.
18. On behalf of the appellant, Mr Mozham submits the appellant’s GP records confirm that in November 2023, the appellant continued to experience physical pain and required medication to manage his mental health. Mr Mozham confirmed that he does not rely upon the opinions expressed by the expert. He conceded the qualifications and experience of the expert do not disclose any expertise to provide the opinions expressed. However, Mr Mozham provided a bundle of extracts (191 pages) taken from the expert’s report that provide background material upon which the appellant continues to rely regarding the provision of healthcare in Egypt. The material relied upon includes:
a. A ‘World Health Organisation” assessment for mental health systems in Egypt (2006);
b. A report by Dr Hesham Dinana and others published in July 2024 as part of the Partnership for Health System Sustainability and Resilience (PHSSR) titled ‘Sustainability and Resilience in the Egyptian Health System;
c. ‘Egypt National Health Accounts; Establishing an expenditure baseline to support Egypt’s health care reform 2019/2020 by the World Health Organization;
19. Mr Mozham submits the medical evidence before the Tribunal confirms the appellant has complex physical and mental health needs following his amputation and the background evidence demonstrates a lack of available treatment and facilities in Egypt. The majority of expenditure for healthcare in Egypt is funded by family members of the patient. Public expenditure is limited and the appellant would not have recourse to adequate treatment, in breach of Article 3.
Decision
20. The appellant has appealed under s82(1) of the Nationality, Immigration and Asylum Act 2002 against the decision of the respondent dated 27 October 2023. The issue before me is the appellant’s Article 3 claim on medical grounds. In reaching my decision I have considered all of the evidence presented to me, whether I refer to it specifically in these findings and conclusions or not. I have also had regard to the submissions made by the representatives although I do not consider it necessary to address everything that is said.
21. In AM (Zimbabwe) v SSHD [2020] UKSC 17, Lord Wilson noted the ECtHR set out in Paposhvili v Belgium (41738/10), the requirements (at paras 186 to 191) for the procedure to be followed in relation to applications under Article 3 to resist return by reference to ill-health. It is for the appellant to adduce evidence capable of demonstrating that there are substantial grounds for believing that, if removed, he would be exposed to a real risk of being subjected to treatment contrary to Article 3. The Supreme Court confirmed that that is a demanding threshold for an applicant. His or her evidence must be capable of demonstrating “substantial” grounds for believing that it is a “very exceptional case” because of a “real” risk of subjection to “inhuman” treatment.
22. In AM (Art 3; health cases) Zimbabwe [2022] UKUT 00131 (IAC), the Upper Tribunal found that the initial threshold test involves two questions:
(1) Has the person discharged the burden of establishing that he or she is ‘a seriously ill person’?
(2) Has the person 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 to:
(a) a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering, or
(b) a significant reduction in life expectancy?
23. At paragraph [62], the Upper Tribunal made the following general observation about “health cases”:
“… Whilst this Tribunal is more used to having before it, experts who are academics in their field, the sort of expert evidence which is likely to be more useful to it in “health cases” is from 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, and evidence of expertise at a reasonably contemporary date.”
24. The Upper Tribunal noted that 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.
25. The evidence before me regarding the on-going treatment and medication required by the appellant is limited. The most recent medical evidence before me is set out in the appellant’s medical records. In November 2023 he described to the GP that he was using paracetamol and ibuprofen to manage his pain and in addition, he was prescribed Co-codamol. He was also prescribed Mirtazapine to assist with the management of his mental health. By that time, he had been seen to consider surgical options but had been discharged by Mr Chatterji, the Consultant Orthopaedic Surgeon in November 2023 because he had failed to attend two or three appointments. There is no other evidence before me of any planned on-going treatment.
26. It is for the appellant to adduce evidence capable of demonstrating that there are substantial grounds for believing that, if returned to Egypt, he will be exposed to a real risk of being subjected to treatment contrary to Article 3. I accept the appellant has been left with a significant disability following the amputation of his leg, but there is very limited evidence before me, let alone any strong evidence regarding the seriousness of his ongoing disability, the treatment that he is receiving, and the consequences of the removal of any treatment. I do not therefore accept that the appellant has discharged the burden of establishing that he is ‘a seriously ill’ person by reason of his disability. The evidence is that the appellant was provided with advice in 2023 regarding the options available for surgical intervention, but he has taken no steps to avail himself of the treatment offered. In November 2023 his symptoms appeared to have been managed by routine medication and there is no medical evidence before me regarding any further deterioration in his physical or mental health.
27. In any event, even if I had accepted that the appellant is ‘a seriously ill’ person, I reject the appellant’s claim he ‘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 to: (a) a serious, rapid and irreversible decline in his state of health resulting in intense suffering, or (b) a significant reduction in life expectancy?
28. As Mr Mozham was bound to accept, Hatem Nasr is not a country expert in this area, and I find that he does not have the relevant qualifications or experience to provide the opinions he expresses. I therefore attach very limited weight to his evidence. By way of one example only, Mr Nasr claims, at [7.1], that for individuals such as the appellant, who requires prosthetic services, orthopaedic follow-up, pain management, physiotherapy, and mental health treatment, the reality of healthcare in Egypt is characterised by limited availability, uneven distribution, and significant financial barriers. The source cited is the report by Dr Hesham Dinana and others published in July 2024 as part of the Partnership for Health System Sustainability and Resilience (PHSSR) titled ‘Sustainability and Resilience in the Egyptian Health System. Mr Nasr fails to objectively review the report which refers to the challenges faced by the healthcare system but goes on to say that the approval of the new Constitution in January 2014, which nearly doubled government expenditure on healthcare from 1.5% to 3% of GDP, presents a significant opportunity to improve health system financing toward universal health coverage (UHC) in Egypt.
29. There is no evidence relied upon by the appellant or any analysis of what other treatment or support may be available to the appellant in Egypt, nor any reasons given as to why such treatment or support would not be effective. Equally there is no evidence before me of the costs of the medication that the appellant requires to support his claim and I reject his claim that even if the medication that he requires is available, the cost is prohibitive because his wives and children rely upon charitable support and he would be unable to work. Having heard the appellant give evidence, I find that he has been managing his mental health and that he knows what he must do, and how to secure the help that he requires.
30. I have carefully considered the background material that is relied upon by the appellant. The World Health Organisation assessment for mental health systems in Egypt (2006) is somewhat dated and confirms that there is a disproportionate distribution of mental health facilities and services between urban and rural areas. Services are said to be more prevalent in urban areas (especially in large cities) than in rural areas. The budget of health system represents 3.4% of annual total budget, of which 2% is provided to mental health sector. There were said to be 62 outpatient mental health facilities available in the country, of which 2 are for children and adolescents only.
31. The report by Dr Hesham Dinana and others published in July 2024 that is relied upon by Mr Mozham states, at [2.1.1], that although historically, the Egyptian healthcare system has faced challenges due to limited public investment and high out-of-pocket expenditures, the approval of the new Constitution in January 2014, nearly doubled government expenditure on healthcare from 1.5% to 3% of GDP, presenting a significant opportunity to improve health system financing toward universal health coverage in Egypt. However, overall health financing is said to be largely funded by ‘out-of-pocket’ payments, albeit the report states the implementation of the new universal health insurance (UHI) system will ensure financial protection and health equity for all the population regardless of their ability to pay or other socio economic variations. The report highlights, at [3.1.1], that before 2020, there was an increase in the number of healthcare workers in Egypt, potentially linked to the rise in medical schools (WHO Eastern Mediterranean Region, 2016). However, following the COVID-19 pandemic there has been a reduction in the number of healthcare workers due in part to worker exhaustion (WHO, 2020a).
32. Finally, the report; ‘Egypt National Health Accounts 2019/20’, confirms levels of out-of-pocket payments in Egypt have historically been relatively high. The report confirms “..Egypt’s level of out-of-pocket payments increased between 2017 and 2019 and then fell from 2018/19 to 2019/20, which is an encouraging sign…” That report concludes that structural economic and fiscal reforms are needed and that the recent reform plans, including the presidential public health campaigns and the implementation of the Universal Health Insurance system are expected to positively contribute to increasing the priority of health within government spending and therefore increasing government health spending as a share of GGE and of GDP. The report confirms retail pharmaceutical expenditure has always been one of the largest expenditure categories in the Egyptian health system and a key driver for increased out-of-pocket spending. The report confirms however that the retail pharmaceutical sector, however, tells only part of the story of overall pharmaceutical expenditure in Egypt, since considerable pharmaceutical spending takes place inside health facilities. It is said that this relatively high pharmaceutical expenditure, could be viewed positively as a considerable driver for Egypt’s economy, but it also raises concerns about the equity and future sustainability of the health system. On the evidence relied upon, Mr Mozham has been unable cast doubt on the availability or accessibility of treatment for the appellant in Egypt.
33. The respondent refers to background material set out in ‘Britannica’ concerning Egypt which confirms that the budget of the Ministry of Health has reflected an increasing expenditure on public-health programs, especially since the 1990s. It is said that the numbers of government health centres, beds in public hospitals, doctors, and dentists have increased significantly, and that an important aspect of health-care development in Egypt always has been the expansion of facilities in the rural areas. It is said that well-trained physicians and specialists are available in large numbers in the cities and larger towns.
34. I do not accept that treatment would not be available to the appellant nor that appellant could not afford any medication that he requires. The appellant has had the opportunity of receiving surgical treatment in the UK and has not taken up the opportunity. There is no credible evidence of any on-going treatment being received by the appellant. I accept that he is likely to be prescribed medication on an on-going basis to manage his pain and mental health but there is no evidence before me as to how much the medication would cost in Egypt. The appellant has family living in Egypt and although the appellant claims that they would not assist him if he returns to Egypt, I am not satisfied that it is credible that they would not support him. Furthermore, the appellant does not claim that his health conditions prevent him from working. Indeed his evidence is that he would like to work in the UK. There is no reason to believe that the appellant would be unable to find work for himself on return to Egypt to help him pay for his medical treatment. In reaching that finding, I have taken into account that before coming to the UK, the appellant was an able bodied male with a family of his own. I am not persuaded on the evidence before me that the appellant would be unable to find work for himself on return. That is especially the case when he has a family support network to return to, including his wives, children and siblings.
35. Standing back and considering the evidence before me, I am not satisfied that the appellant has come anywhere close to establishing that he has met the AM (Zimbabwe) test.
36. It follows that in my judgement, the appellant has failed to establish that his removal to Egypt will be in breach of his Article 3 rights and the appeal on Article 3 grounds falls to be dismissed.
Notice of Decision
37. The decision of First-tier Tribunal Judge Wyman to allow the appellant’s appeal on Article 3 grounds is set aside for the reasons set out in the decision of Deputy Upper Tribunal Judge Hoshi issued on 9 April 2025.
38. I remake the decision and dismiss the appeal on Article 3 grounds.

V. Mandalia
Upper Tribunal Judge Mandalia

Judge of the Upper Tribunal
Immigration and Asylum Chamber

9 January 2025