Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2025-000249
(PA/51568/2022; IA/04260/2022)

THE IMMIGRATION ACTS

Decision & Reasons Issued:
On 3 September 2026

Before

UPPER TRIBUNAL JUDGE BRUCE
DEPUTY UPPER TRIBUNAL JUDGE CONNAL

Between

JR (IRAQ)
Appellant
AND

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:

For the Appellant: Mr Winter, Counsel instructed by Latta & Co
For the Respondent: Mr Mullen, Senior Home Office Presenting Officer

Heard in Edinburgh on 25 June 2026

Anonymity

Unless and until a tribunal or court directs otherwise, the Appellant is granted anonymity. No report of these proceedings shall directly or indirectly identify him, any of his witnesses or any member of his family. This direction applies to, amongst others, both the Appellant and the Respondent. Failure to comply with this direction could lead to contempt of court proceedings

DECISION AND REASONS

1. The Appellant is a national of Iraq born in 1995. He seeks leave to remain in the United Kingdom on protection and human rights grounds.

2. This appeal comes before us as a ‘re-making’, pursuant to our decision of 10 April 2025 to set aside a decision of the First-tier Tribunal dismissing the Appellant’s appeal. We have decided to allow the appeal. Our written decision falls into four sections:

i) Background and the decision of the First-tier Tribunal

ii) The appeal to the Upper Tribunal and our reasons for finding error of law in the decision below

iii) The evidence before us, and our findings on it

iv) Our assessment of risk

3. We record at the outset that we have treated the Appellant throughout these proceedings as a vulnerable witness, because of the uncontested evidence that he suffers from a serious mental illness.

Background and Decision of the First-tier Tribunal

4. The Appellant arrived in the UK on 20 November 2015 and claimed asylum shortly thereafter. The basis of his claim was that his home area of Tuz Khurmato had been taken over by ISIS who were committing large scale human rights abuses. His claim was refused and he appealed to the First-tier Tribunal. When the matter came before the First-tier Tribunal (Judge Henderson) it was accepted that the Appellant was from a village near Tuz Khurmato and that he was therefore at risk as a civilian returning to a “contested area”. The appeal was however dismissed on the grounds that as a Kurd, he could avail himself of internal flight and “return to IKR”. The Tribunal accepted that the Appellant had some mental health issues, and that having been born a Muslim he was now an atheist, but since he had not suffered any harm as a result before he left Iraq, these matters did not establish a real risk of harm going forward.

5. On 20 September 2021 the Appellant made further submissions to the Home Office, based on the changing circumstances in Iraq, and a deterioration in his own mental health. Those submissions were rejected by the Respondent on 19 January 2022. She was nevertheless prepared to treat them as a ‘fresh claim’ for asylum, giving rise to a further right of appeal for the Appellant.

6. The Appellant’s consequent appeal came before First-tier Tribunal Judge McGrade. Judge McGrade properly begins, in accordance with the Devaseelan guidelines, with his consideration of the determination of First-tier Tribunal Judge Henderson. Judge McGrade then considers some contemporary country background information, which can broadly be summarised to say that atheists in Iraq tend to keep their views secret for fear of consequences ranging from familial rejection to extremist violence. He then concludes as follows:

15. I am prepared to accept the lower standard of proof that the Appellant indicated to those around him, including friends and his mother, that he was an atheist, before leaving Iraq. I am also prepared to accept that he has made comments on Facebook which are critical of Islam, which have resulted in threats being made to him. However, I am not satisfied the Appellant is at real risk of persecution on account of his atheism. On the Appellant’s own account, he did not face any serious difficulties while living in Iraq and openly expressing those views for a year. I consider his past experience is a good indicator of how he is likely to be treated upon his return to Iraq. I am also prepared to accept that he has taken part in some debates on social media. However, I have no reason to believe that taking part in debates on social media platforms prior to or following his return to Iraq will raise the Appellant’s profile to such an extent that he will face treatment of sufficient severity to amount to persecution, on account of professing atheist views. I therefore reject his appeal on asylum grounds.

7. Turning to address the Appellant’s mental health issues, Judge McGrade considers the evidence of Dr Kearns, a consultant psychiatrist. It was his view that it is likely that the Appellant suffers from paranoid schizophrenia. The condition was being managed with the prescription of medication, including the antidepressant Mirtazapine, and an antipsychotic, Olanzapine. At its paragraph 19, the Tribunal notes the evidence before it that “Olanzapine is available in the IKR, and not very expensive. Mirtazapine also appears to be available, although I have no specific information as to likely cost. It would appear that drug prices in general are high in the IKR”. Dr Kearns anticipated that in addition to the medication, the Appellant would see him on a three-monthly basis, and would have support from the community psychiatric group. The Appellant had further relied on expert evidence produced by Dr Rebwar Fatah. Dr Fatah reported that such psychiatric care is very limited in Iraq, and that difficulties faced by patients are often compounded by the social stigma attached to mental illness. Having considered all of these matters, the Tribunal concluded as follows:

“21. The Appellant will return to Iraq with a reasonably clear diagnosis and an understanding of the medication that he should take, should he wish to substantially reduce the risk of further psychotic episodes. He is therefore better placed than many others, who are unwilling to seek a diagnosis. I am satisfied that he will have support from family members and that this support is likely to enable him to continue to access medication. Ultimately, it will be a matter for the Appellant whether he continues to take the appropriate medication, whether he is in the United Kingdom or Iraq”.

8. The decision goes on: “I also consider being in a place and culture that is familiar to him, where he can speak his first language and where he will have the support of his family is likely to be of significant benefit to his psychological health and may result in better adherence to any treatment regime, and in particular persevering with medication”. The appeal was thereby dismissed, Judge McGrade having found no real risk of harm, or any violation of the Appellant’s human rights.

Grounds of Appeal: Discussion and Findings

9. The Appellant was granted permission to appeal to the Upper Tribunal on 16 January 2025. Appearing before us on 9 April 2025, Mr Winter helpfully distilled the grounds of appeal as follows.

10. The First-tier Tribunal had correctly noted that the starting point for its analysis of risk arising from atheism was the decision of Judge Henderson. The decision of Judge Henderson was promulgated on 18 January 2017. It summarises the Appellant’s evidence that he stopped practising Islam from 2013, and that he managed to remain living with his family without significant difficulty arising from this, until he left Iraq in 2014. Mr Winter submitted that what Judge McGrade has done in his decision is to simply adopt Judge Henderson’s reasoning without further enquiry. This further enquiry was necessary, not only because of the passage of time, but because of the significant changes that that time has brought, to both the country background situation in Iraq, and to the Appellant himself. It was this alleged failure to address the submissions made, the very submissions that had formed the basis of the Appellant’s fresh claim, which formed the basis of Mr Winter’s ground (i).

11. We are satisfied that this ground is made out. Having reminded himself of the findings of Judge Henderson, the risk arising from the Appellant’s atheism is discounted by Judge McGrade on the same basis: that he was not persecuted for that reason in the past. Whilst it was correct that the decision of Judge Henderson was a starting point, and whilst it is quite understandable that the Tribunal looked to the past for an indicator of risk, we agree with Mr Winter that this was not the end of the risk assessment.

12. First of all, the Appellant’s account must be viewed in context. The period in which the Appellant was living with his family between 2013-2014, upon which both Tribunals below have premised their risk assessment, cannot be characterised as reflecting ‘normal’ life in Iraq. The evidence, apparently accepted by Judge Henderson at his paragraph 39, was that the village from which the Appellant came was at the centre of what is described in the then extant country guidance as a ‘contested area’: AA (Article 15(c)) Iraq CG [2015] UKUT 00544 (IAC). In the relevant period the area was violently attacked by ISIS, and the family were forced to flee into the mountains; it was not even safe for this Kurdish family when ISIS were routed, because they were replaced by the hostile Shi’a militia Hashd al-Shaabi. Whilst the appeal before us is not an appeal against the decision of Judge Henderson, we would observe that in the circumstances it is perhaps unsurprising that the Appellant’s beliefs - one way or the other - were not the focus of his family’s attention between 2013 and 2014. That is to say, how he and they behaved in this period of crisis and extreme danger is not necessarily a good indication of how they might behave under more ‘normal’ conditions.

13. Second, there was more up to date material before Judge McGrade. In respect of the Appellant himself, the evidence had developed substantially since he had appeared before Judge Henderson. At that time he was being treated for anxiety and depression, whereas now he is being treated for the altogether more serious condition of a ‘recurrent psychotic illness with a working diagnosis of paranoid schizophrenia’. We are unable to see anywhere in the decision where the Tribunal considers whether that fact might be relevant to the risk assessment. We note, for instance, the evidence that when the Appellant was in Iraq his family sought ‘treatment’ from Islamic religious leaders for his mental illness which included being beaten: nowhere does the decision consider how such a situation might develop should it reoccur. Further the Appellant has significantly developed his understanding of, and advocacy for, atheist beliefs. The Tribunal does have regard to that matter, but only in the context of whether it has raised his ‘profile’, rather than asking itself whether he would continue to behave in that way in Iraq, and if he did, what the consequences might be.

14. Mr Winter further submitted that there was a failure to address new country background material concerning treatment of atheists in Iraq. We do not accept that the decision overlooks that extensive evidence, which included the report of Dr Fatah. It sets out that evidence in some detail. What we would accept is that it is hard to see where that evidence is factored into the risk assessment that it ultimately makes.

15. This brings us to a further, central, difficulty with the decision below. This was a case concerning fundamental, protected beliefs. In those circumstances it was appropriate that the risk assessment followed the structured approach taken in HJ (Iran)(FC) v Secretary of State for the Home Department [2010] UKSC 31 [at 82]:

“When an applicant applies for asylum on the ground of a well-founded fear of persecution because he is gay, the tribunal must first ask itself whether it is satisfied on the evidence that he is gay or that he would be treated as gay by potential persecutors in his country of nationality.

If so, the tribunal must then ask itself whether it is satisfied on the available evidence that gay people who lived openly would be liable to persecution in the applicant’s country of nationality.

If so, the tribunal must go on to consider what the individual applicant would do if he were returned to that country. If the applicant would in fact live openly and thereby be exposed to a real risk of persecution, then he has a well-founded fear of persecution - even if he could avoid the risk by living “discreetly”. If, on the other hand, the tribunal concludes that the applicant would in fact live discreetly and so avoid persecution, it must go on to ask itself why he would do so…”

16. Swapping the word ‘gay’ for the word ‘atheist’, we see the first question has already been answered in the affirmative: the Appellant is an atheist. The second question is whether, on the evidence, atheists who live openly in Iraq would be liable to persecution. Bearing in mind that we are here concerned with ‘government controlled’ Iraq, which is where the Appellant is from, the evidence at least arguably points in that direction, with the sources referred to in the First-tier Tribunal decision concurring that atheists face discrimination and serious violence at the hands of various actors, including arrest for ‘blasphemy’. Finally, the Tribunal was required to stand back and consider how the Appellant would in fact behave; if he would keep his beliefs quiet it was obliged to consider why. The decision does not answer those questions, and for that reason alone falls to be set aside.

17. That being our finding, we need only address Mr Winter’s second ground of appeal very briefly. Ground two is concerned with the approach taken to the Appellant’s mental illness. We accept that this too contains errors. First, in its analysis of whether drugs would be available, the Tribunal seems to have been under the mistaken impression that the Appellant is from the IKR, since it refers to the availability of Olanzapine there. As we note above, his home area is in fact within government-controlled Iraq. We think it likely that this misunderstanding arose from the Tribunal’s reading of Dr Fatah’s report, since he too refers to the availability of Olanzapine in the IKR; this was however relevant only to a consideration of internal relocation. Second, the Tribunal has not sufficiently analysed the process and means by which the Appellant might access his required medication. It was not enough to know that Olanzapine could theoretically be purchased in Iraq; AM (Article 3, health cases) Zimbabwe [2022] UKUT 131 (IAC) tells us that we also need to consider how accessible that would be to this Appellant, and that this would include analysis of his likely compliance absent the specialist support that he receives now. In this regard we would add that Tribunals should exercise caution before basing decisions on their own prognosis. It may be common sense that an individual would, in general terms, find comfort in being reunited with his country and family, but in the context of a paranoid schizophrenic who fled that country at a time of terror and war, any prognosis about how he would be likely to react is better left to experts.

The Evidence

18. It is unfortunate that neither party saw fit to comply with the directions that we made, on 10 April 2025, regarding the production of further evidence and a timely review of the case. It was not until we issued further directions, on 15 June 2026, that either party took any action in this matter. This inaction caused a regrettable delay in having this appeal listed and being ready to proceed. Nevertheless, by the date of the hearing the Appellant’s representatives had filed a supplementary bundle containing a new statement from the Appellant, and copies of his updated medical records.

The Appellant

19. The Appellant’s evidence is set out in his witness statement dated 17 April 2026, which he adopted before us. The Appellant was then asked some additional questions. His evidence is as follows.

20. The Appellant is a committed atheist. His experiences have led him to strongly oppose Islam, and in particular Islamic extremism. He regularly posts online about his beliefs, and has taken part in livestreaming events on Tiktok and Facebook, for instance those hosted by Halmat, a Zoroastrian living in Germany, and Dr Pshtiwan Abdullah, who lives in Australia. In these live broadcasts non-believers and Muslims alike debate aspects of the faith; although these debates often cross into politics the Appellant does not contribute to that aspect of the discussion since he is not interested in politics. It is however important to him to discuss atheism and to hear from others who share his perspective. In some of these livestreams he and other atheists taking part have been threatened by Muslim participants. When the Appellant asked whether the Prophet Muhammad was a paedophile, one man threatened to “cut off his ears”. In his oral evidence the Appellant explained that this was a form of “cultural humiliation” in Kurdistan. He has received many threats – including from someone in the UK who claimed to have recorded his comments. He said that his most recent participation in one of these debates had been a TikTok livestream the week before the hearing in which he had discussed a current scandal involving an Islamic preacher in Kurdistan.

21. The Appellant’s supplementary bundle contains a series of letters from his Consultant Psychiatrist Dr Conail Kearns, or one of his team, written to the Appellant’s GP in Glasgow. These start in December 2023 and the most recent is dated 28 October 2025. These letters demonstrate that the Appellant is under the long-term care of Dr Kearns, and the Community Mental Health Team in which he works. In the earlier letters Dr Kearns offers diagnoses of ‘recurrent psychosis’, paranoia, anxiety and depression. In these quarterly reports the Appellant is described as suffering from a variety of symptoms including intrusive and persistent auditory hallucinations, with voices instructing him to do things like walking into traffic. By August 2025 these diagnoses have coalesced into paranoid schizophrenia with complex trauma. The Appellant is being treated with Olanzapine and Mirtazapine, and has been referred to the psychology department to investigate whether any other therapies might address the persistence of his auditory hallucinations, which Dr Kearns notes are normally silenced by the dose of Olanzapine that the Appellant is prescribed. In respect of adherence to his medication regime Dr Kearns records the Appellant’s admission that he sometimes deliberately omits to take his Olanzapine, if he wants to stay up late or drink alcohol. He does this even though he understands that it raises the risk of relapse and a worsening of his condition.

22. Dr Kearns notes that the Appellant does have some insight into his illness, and understands that the voices are not real. In his letter of 1 August 2025 he does however note: “at last review he told me about having significant auditory hallucinations which sounded worse than usual, in the context of having been told his mother had died”. We note that this issue also arose in the evidence before us, with the Appellant explaining that someone he knew from Iraq had told him that his mother had passed away, before later retracting this and saying it was a “joke” to see how the Appellant would react. The Appellant maintained before us that he has no reason to believe that his mother is actually dead.

23. The notes of the Appellant’s GP, with which we were provided, demonstrate that he has been receiving treatment for psychotic and trauma-related symptoms in Glasgow since at least 2020. The notes disclose disturbing reports by the Appellant relating to his family members over a number of years. He told his GP in 2021 that he was raped by a family member when he was 4, and on another occasion that he had been forced to have sex with a cousin; there is reference to him being repeatedly distressed when discussing his family. On one admission to hospital he told doctors that he was from a family of prostitutes, and on another that his mother was a prostitute. It may be these incidents that are referred to subsequently in the notes as “bizarre delusional ideas about his family”. We note that the records of a community mental health worker from around this time records these remarks as being inconsistent with the Appellant’s usual description of his family life as being normal, and being fond of his mother; in August 2020 the GP recorded an incident described by the Appellant where a group of men came to his asylum hostel claiming to have his mother on the phone as “probably psychosis”. The Appellant reported being afraid and hiding from these men. During 2021 the Appellant repeatedly refused hospital admission because he believed that his family would be watching him through the lights and that they would be laughing at him. He also believed that his cousin would hang him.

24. The GP notes record the Appellant as having told his doctor that he has had no contact with his family since 2016, although we note that the Appellant subsequently claims to have contacted an uncle by telephone. The bundle contains correspondence with the Red Cross family tracing service who were unable to locate the Appellant’s family.

Atheism in Iraq

25. The expert report of Dr Rebwar Fatah which addresses the question of atheism is dated 20 March 2023. The section on atheism notes that whilst the Iraqi constitution purports to protect people’s beliefs, it does not recognise atheism as a belief, and apostasy and blasphemy remain crimes under the penal code. He notes that there “has been a marked shift away from religion across the middle east. This is evidenced by a Wire report which identifies that in previous years, 91 percent of Iraqis said “not praying” would be an obstacle to accepting a child or sibling’s marriage partner whereas in 2018, only 62 per cent viewed this as an obstacle…. However, atheism remains a huge taboo. It should be noted that atheists in Iraq often have to hide their beliefs due to societal, familial, and legal risks”. Dr Fatah emphasises that there is a marked difference between being an atheist in the comfort of your own home, and publicly declaring such a position in the outside world. The deeply religious elements of society – such as the followers of Muqtadr al-Sadr – believe that society and government should be actively Islamic and those who oppose religion online – or who are perceived to do so, receive a volley of abusive responses and threats. Another prominent Shia leader, Hadi al-Amiri, has proclaimed the biggest threats to Iraqi society to be “the phenomenon of atheism and manifestations of homosexuality and the spread of deviant ideas such as Wahhabism”.

26. The Appellant’s more recent bundle contained several articles covering the murder of an artist in 2023, allegedly by Islamists angered by his public pronouncements of atheism, and another article concerning the arrest, severe torture and trial of a 15 year old boy from Erbil who told his father he no longer believed in god. In its January 2024 guidelines on Iraq the UNHCR agency reported:

Although overt atheism is extremely rare in Iraq, the number of atheists is reported to be on the rise, primarily in reaction to extremist-inspired violence by Da’esh and abuse of power by religious parties. Although there are no laws prohibiting atheism, in some instances, atheists have been prosecuted for “desecration of religions” and related charges.

By law, atheists are required to remain affiliated with one of the recognized religions when applying for a national identity card. Societal tolerance vis-à-vis individuals not believing in God is reported to be very limited, as evidenced also by the public rhetoric of influential politicians and religious leaders. For fear of violence at the hands of their families, vigilantes and conservative/hardline religious groups, atheists are reported to often keep their views secret and comply outwardly with religious norms and traditions.

Some engage in online activities but fear surveillance. Given society’s conflation of atheism with secularism, communism, feminism, immorality and anti-Islamic attitudes, atheists, even if they are not open about their views, may be targeted on account of their political/secular views (e.g., as participants in the Tishreen protests, which advocated for a secular State and rejected influence of religion in politics), their “westernized” appearance and/or liberal lifestyle (e.g., refusal to wear the hijab).

UNHCR considers that, depending on the particular circumstances of the case, atheists may be in need of international refugee protection on the ground of religion.

27. The Home Office Country Policy and Information Note Iraq: Religious Minorities (September 2024) report the EU Asylum Agency to agree that there has in recent years been a rise in secularism in Iraq, particularly amongst the young, and particularly in response to extreme Islamist violence. That said, it remains rare and [at 13.1.1]:

“membership lists are kept secret for fear of persecution by extremist religious groups or the surrounding society. In October 2021, a judicial order enabled the monitoring of social media sites, included [sic] those who promote atheism”

28. The CPIN continues:

13.2.1 The January 2022 EUAA report stated:

‘According to a May 2021 report published in the Review of Nationalities, politicians and the clergy publicly labelled atheists as enemies of the state and traitors to God who threaten to destroy tradition and destabilise society, calling for their punishment.

‘… Whilst atheism is not prohibited by law, Humanists International noted that atheists have been prosecuted for blasphemy and other related charges. An article published in the Review of Nationalities stated that non-believers can fall into the category of Article 372 [part of the penal code about ‘offences that violate religious sensibilities’] because of the lack of precise legal provisions and the freedom of interpretation amongst the judiciary. Freedom House noted in their annual report for 2020 that although blasphemy laws are rarely enforced, the judiciary is influenced by corruption, political pressure, tribal forces, and religious interests.

‘According to a February 2021 report by the UK All-Party Parliamentary Group for International Freedom of Religion or Belief, humanists, atheists and secularists are considered apostasisers and blasphemers and, as a result, face repression across Iraq, in a climate of impunity or collusion in violence by state actors.’

29. The report goes on to give a number of examples of people being prosecuted for not believing in god. In March 2018, arrest warrants were issued in Dhi Qar against four Iraqis on charges of atheism. In May 2020, in Al-Qadissiyah province, a doctor was sentenced to two years imprisonment for promoting atheism and insulting the prophet of Islam online. The situation is reportedly somewhat better in the Kurdish region. Although atheism is in general not well perceived in the IKR, criticism of Islam on social media, particularly on Facebook, has become something of a social trend.

Medical Treatment

30. Dr Fatah identifies several general, but serious, problems facing the universal healthcare system in Iraq: decades of war and insecurity, underfunding, brain drain of qualified staff, corruption and counterfeit medication. Primary healthcare services are hindered by poor organisation, staff shortages, and shortages of medications; around half of these facilities are not staffed by doctors. The lack of adequate healthcare in Iraq, including the acute shortage of medical tools, medication and overcrowding of hospitals, has led patients to seek medical care in India or Iran. Lebanon has also become a destination for Iraqi patients to receive treatment. It is possible to pay for healthcare within Iraq itself, but this is not a viable option for many: 96.4 percent of Iraqis are without health insurance. Iraqis also face obstacles in accessing effective medication. As of 2020, more than 85% of drugs on the country's essential medicines list were either completely unavailable or in short supply, according to the former health minister Alaa Alwan. There is a huge problem with low quality drugs, smuggled into the country over land borders. These can be genuine medicines that have been labelled with false expiry dates, a practice that has caused “several health disasters”. Street vendors selling expired and counterfeit medicine have become widespread across Iraq. This phenomenon has become known as ‘sidewalk pharmacies’. Patients turn to these outlets as they fail to find medicines in pharmacies and healthcare centres. Patients cannot tell the difference between these medicines, as often these counterfeit medicines are re-packed to look like legitimate goods. At the time of writing his report Dr Fatah consulted a psychiatrist in the IKR, who reported that Olanzapine is available, and not very expensive, but that counterfeit versions remain a problem.

31. Dr Fatah writes that despite mental illness being widespread in Iraq, due in part to decades of conflict in Iraq, it remains a deeply stigmatised condition. Dr Fatah cites Iraqi psychiatrist, Dr Wissam al-Zanoon, as stating that most mental health sufferers exacerbate their own mental health issues because they believe they have been subjected to magic or have been possessed by the jinn (demons). They therefore choose to ignore the advice of doctors and turn to the elders. Al-Zanoon states that where people do consult a psychiatrist they will do so in an “out of sight” clinic, “because of the well-known social stigma that haunts individuals who visit a psychiatrist in Iraq”. Dr Fatah cites an article in Al-Araby which reports that the mentally unwell end up living “on the streets…subjected to ridicule by children and sometimes to harassment by adults. A number of them have decided to seek in mosques that provide them with mattresses and food, where no one will harm them”. In other cases families will not allow their mentally unwell relatives to leave their homes, trying to treat them themselves, without result. A 2010 survey of public opinion regarding mental health conducted jointly by the Iraqi Ministry of Health and International Medical Corporation found out that approximately 65 percent of respondents declared that psychological problems were borne of “personal weakness”, and 80 percent affirmed that people with mental health problems are largely to blame for their condition.

32. The stigma surrounding mental illness prevents patients from seeking help, but also inhibits doctors from training in the specialty. As of 2022 there were only 168 psychiatrists working in the country, with no new graduates and a reluctance of medical students to enrol. WHO put the figure at 3 psychiatrists for every one million people in the country, compared with 209 psychiatrists for the same number of people in France, for example. Only 2% of the overall health budget is spent on mental health. This lack of capacity means that practitioners must rely heavily on drug treatments, as they are not able to provide more time-intensive treatments. That in turn exposes patients to the risks associated with counterfeit medication. Dr Fatah did find some evidence of NGOs providing mental healthcare, but this was limited to IDPs, and was only short-term. There is one dedicated specialist hospital providing long term care, known locally as the “crazy hospital”: the Al-Rashad Training Hospital for Psychiatric and Mental Illnesses (Al-Shamaa) in Baghdad. At the time that Dr Fatah wrote his report the latest information available was that it was full, and was no longer able to accommodate new patients.

33. In conclusion, Dr Fatah writes that “there is little reason to believe that [the Appellant] will have access to appropriate mental health care in Iraq”.

34. Section 20 of the Country Information Note Iraq: Healthcare and medical treatment (Version 3.0, August 2024) addresses mental healthcare. It is largely consonant with Dr Fatah’s evidence. See for instance its summary of a 2023 DFAT report:

“Mental health services are inadequate. There are two dedicated psychiatric hospitals in the country, Al-Rashad Psychiatric Hospital and Ibn Rushd Hospital, both located in Baghdad. There are psychiatric wards in some general hospitals, as well as some out-patient clinics, often run by international non-government organisations (NGOs) such as Medicins sans Frontieres. The absence of community-based mental health care means that often the only care available is family-based or in psychiatric institutions, which have been linked to inhumane treatment and degrading conditions.”

35. The CPIN provides a list of medications found to be available at pharmacies in Iraq in a 2020 EUAA enquiry. This includes some generic anti-psychotics, but not Olanzapine. Anti-depressants including Mirtazapine are available.

Our Findings

36. Our starting point must be the decision of Judge Henderson. It stands as an authoritative assessment of the Appellant’s case at the time that it was determined in 2017. Insofar as is relevant today, Judge Henderson found that the Appellant is from a village near Tuz Khurmato; he suffered mental ill health before he left Iraq, for which his family sought the intervention of a ‘healer’ to cleanse him of ‘evil’; he has been an atheist since 2013; he told his family about that and did not suffer any harm as a result; he has been in touch with his family since his arrival in the UK. All of those findings stand.

37. Applying the risk assessment framework set out in HJ we find as follows.

38. The Appellant is an atheist. The evidence accepted by Judge Henderson was that the Appellant considers himself to have left Islam in 2013. Having heard from the Appellant ourselves, we are satisfied that atheism is an important part of his identity, and that it is strongly associated in his mind with his rejection of, and hostility towards, Islam. We accept the Appellant's evidence that he regularly participates in online debates, researches and thinks about religion, and his lack of it.

39. There are two consistent themes to emerge from the country background material. The first is that atheism, secularism and associated ideas, are on the rise in Iraq, particularly amongst the younger generation which has been exposed to many years of violence and disorder at the hands of religious extremists. The second is that this group, although growing, remains small in number, and operating almost exclusively within the confines of private spaces. The evidence consistently reports that people do not openly identify as atheists, because to do so would be to invite harms up to and including murder: see for instance the summary by UNHCR that “for fear of violence at the hands of their families, vigilantes and conservative/hardline religious groups, atheists are reported to often keep their views secret and comply outwardly with religious norms and traditions”. The case of the child imprisoned and tortured by Kurdish police after his own father reported him for blasphemy is a particularly troubling example. In his submissions Mr Mullen accepted that “in some circumstances atheists would be at risk” in Iraq. On the basis of the country background evidence which we have been shown, we find those circumstances to be when they seek to express their views openly. The second HJ question is therefore answered in the Appellant’s favour.

40. Next we consider how the Appellant would in fact behave if returned to Iraq. The answer to that question has, to a large extent, already been provided by First-tier Tribunal Judge Henderson, who accepted that the Appellant had been open with family members about his loss of faith whilst still in Iraq. In the nine years since that appeal was heard the Appellant’s mode of expression has expanded considerably. No longer content with discussing matters of faith (or the lack of it) within the confines of his own home, today the Appellant is a regular participant in online discussion fora, and as we say above, we accept that this is an important part of his identity. It is not possible to say whether any of that is driven by his illness, but it does arguably bear the hallmarks of a preoccupation. In his submissions Mr Mullen agreed that a good indication of how the Appellant would behave in Iraq would be how he behaves here. Having heard from the Appellant himself, we are satisfied that there is a real risk that he would continue to take part in such public events if returned to Iraq. When his appeal was heard by Judge Henderson back in 2017 the Appellant’s expression of his atheist identity had been limited to talking to his mum and dad about it. That is very different from announcing it to the world at large via social media platforms such as TikTok. The finding of Judge Henderson also answers the alternative question, which is if the Appellant were to act with discretion, why would he do so? Judge Henderson found that the Appellant already disclosed his atheism to his family, so any new found reluctance could not be put down to familial or societal pressure to stay quiet. If he was to remain discreet about his atheist beliefs, we find it reasonably likely to be in response to the threat of persecution that those who do speak openly in Iraq, and indeed the IKR, undoubtedly face.

41. It follows that the appeal must be allowed, and we need not address in detail any discrete or related risk arising from the Appellant’s illness. We would simply add this. It is clear on the face of the considerable quantities of medical evidence before us that the Appellant is a seriously unwell man. Even under the regular monitoring of Dr Kearns and his team the Appellant continues to experience distressing symptoms including delusions and auditory hallucinations. We have set out above some of the most extreme and upsetting examples of these symptoms in order to mark the extent of his illness when in full psychosis. Although it has not been necessary to determine the appeal on the basis of the Appellant’s illness, we do have real concerns about the ability of the Appellant to maintain his current drug regime, and so maintain stasis in his condition, should he be returned to Iraq. Whilst we do have some reservations about his own ability to comply absent the oversight of the community mental health team, the country background evidence, and in particular the problems it highlights with fake or out of date medication, is of greater concern. It seems to us that there is a real risk that counterfeit or otherwise ineffective medication could find its way into his supply, thus interrupting his treatment and leading to the deterioration and further psychosis feared by Dr Kearns. This would in turn expose the Appellant to even greater and more immediate danger as a result of his atheism, assuming that psychosis would bring with it increased disinhibition.

Decisions

42. The decision of the First-tier Tribunal is set aside.

43. We re-make the decision in the appeal as follows: the appeal is allowed on protection grounds.

44. There is an anonymity order in this protection appeal.

Upper Tribunal Judge Bruce
Immigration and Asylum Chamber
16th August 2026