UI-2025-001252

• Status of case: Unreported
• Hearing date: 23 Dec 2025
• Promulgation date: 25 Mar 2026
• Publication date: 09 Apr 2026
• Last updated on: 09 Apr 2026

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2025-001252
First-tier Tribunal No: PA/53484/2024
LP/04466/2024

THE IMMIGRATION ACTS

Decision & Reasons Issued:
On 25 March 2026

Before

UPPER TRIBUNAL JUDGE OWENS

Between

AM
(ANONYMITY ORDER MADE)
Appellant
and

Secretary of State for the Home Department
Respondent

Representation:
For the Appellant: Mr Gilbert instructed by Londinium Solicitors
For the Respondent: Mr Nappey, Senior Presenting Officer

Heard at Field House on 23 December 2025

Order Regarding Anonymity

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

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


DECISION AND REASONS

1. In an error of law decision dated 20 August 2025 (annexed to this decision at Annex A), a panel of the Upper Tribunal set aside a decision of the First-tier Tribunal dated 14 January 2025, dismissing the appellant’s appeal against the decision to refuse his protection and human rights claim for the reasons given in that decision.

2. The appellant’s appeal now comes before me to be remade pursuant to s.12(2)(b)(ii) of the Tribunals, Courts and Enforcement Act 2007.

3. The issue before the Upper Tribunal in this case is whether due to the appellant’s health conditions, he faces inhuman or degrading treatment on return to Bangladesh in violation of his Article 3 ECHR rights or whether the decision to return him to Bangladesh is a disproportionate breach of Article 8 ECHR. For the reasons which follow, I conclude that it would not.

Background and chronology of appeal

4. The appellant is a national of Bangladesh who entered the UK on 25 January 2010. He has a lengthy immigration history which is outlined in the refusal decision. He last had lawful leave on 5 September 2016. Following a number of unsuccessful claims on human rights and protection grounds the appellant made further submissions to the respondent on 30 November 2021.

5. At his appeal the appellant argued that he would be at risk in Bangladesh as a result of his political opinion. The judge found that there would be no risk to him on account of this and the judge’s findings in this respect were upheld by the panel of the Upper Tribunal. This issue has now fallen away.

6. The remaining issues to be resolved are the Article 3 medical and Article 8 claims.

Documentary evidence

7. The appellant uploaded a PDF bundle of 814 pages which included the bundles before the First-tier Tribunal. He also uploaded a 24 page supplementary bundle with up to date medical evidence. I also had before me the latest CPIN on healthcare in Bangladesh. The latest skeleton argument was uploaded on 15 December 2025 shortly before the hearing.

Oral evidence

8. Mr Gilbert applied for the appellant to be treated as a vulnerable witness in light of the medical evidence. Mr Nappey did not oppose the application. I am satisfied that the sponsor has Brugada Syndrome and anxiety. I agreed to treat the appellant as a vulnerable witness in accordance with the Practice Direction on “Child, vulnerable adult and sensitive witnesses”. It was agreed that the questions put to the sponsor would be straightforward and I informed the sponsor that he was able to take breaks.

9. The sponsor gave his evidence in Bengali through a court appointed interpreter. He confirmed that he understood the interpreter. He was cross examined by Mr Nappey. His evidence is recorded in the record of proceedings, and I will summarise it below and refer to it when making my findings. There were no further witnesses.

10. The appellant’s oral evidence was that he currently lives in London E1 with his friend Sharif. He shares a room with Mr Rahman who pays the rent. He does not have relatives in the UK.

11. He gave detailed evidence about his implantation of an insertable loop recorder (“ILR”) which monitors his heart. If a malignant arrhythmia is detected a message will automatically be sent to the hospital via an app on his mobile phone. If he receives a message from the hospital he has to call an ambulance. He has never received a message telling him that he has a malignant heartbeat. His symptoms include dizziness, palpitations and sometimes an irregular heartbeat. He has to wear the ILR for life.

12. He was discharged from the therapy sessions at Barts Hospital in November 2024. He did not take up the offer of talking therapy at Tower Hamlets because of dizziness. He continues to take sertraline.

13. His parents who are retired public servants now live in their ancestral lands in Sandwip island outside Chittagong, although they previously lived in Chittagong city. In the past the appellant lived with his parents in Chittagong. At that time he was studying.

14. The only way to travel to Chittagong from Sandwip is by small boat which takes an hour. If he were to return to Bangladesh he would not be able to live in Sandwip because of his medical condition. He has never lived in Dhaka, nor does he have any family there. It is too expensive for him to live in Dhaka. He does not have any relatives in the UK. Other people have heart problems in his family but not the same condition as the appellant. He previously worked in a pub in the UK. He stopped work because he no longer had the right to work.

Submissions

15. Both representatives made submissions which are recorded in the record of proceedings and which I refer to when making my findings below.

Legal Framework

16. The question is whether the refusal breaches the appellant’s Article 3 ECHR right not to be “subjected to torture or to inhuman or degrading treatment or punishment”. The appellant must establish that they are a seriously ill person and adduce evidence capable of demonstrating that substantial grounds have been shown for believing that as a seriously ill person they would face a real risk, on account of the absence of appropriate treatment or the lack of access to such treatment, of being exposed to a serious, rapid and irreversible decline in their state of health resulting in intense suffering, or to a significant reduction in life expectancy. The standard of proof is the lower standard.

17. The key test in Paposhvili v Belgium 41738/10 is set out at [183], in AM (Zimbabwe) [2020] UKSC 17 at [23], Savran v Denmark 57467/15 at [130] and helpfully summarised in AM (Art 3; health cases) Zimbabwe [2022] UKUT 00131 as follows:

“In Article 3 health cases two questions in relation to the initial threshold test emerge from the recent authorities of AM (Zimbabwe) v Secretary of State for the Home Department [2020] UKSC 17 and Savran v Denmark (application no. 57467/15):

(1) Has the person (P) discharged the burden of establishing that he or she is “a seriously ill person”?
(2) Has P adduced evidence “capable of demonstrating” that “substantial grounds have been shown for believing” that as “a seriously ill person”, he or she “would face a real risk”:

[i] “on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment,

[ii] of being exposed

[a] to a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering, or
[b] to a significant reduction in life expectancy?”

“It is only after the threshold test has been met and thus Article 3 is applicable, that the returning state’s obligations summarised at [130] of Savran become of relevance – see [135] of Savran”

Findings

Ability to travel

18. Mr Gilbert made much of his submission that the appellant is not able to physically undertake a flight to Bangladesh because of his heart condition. Dr Lo Monaco provided letters dated May 2023 and 28 July 2025. He is an experienced medial professional who has had sight of the appellant’s medical records and has expertise in respect of cardiac issues to give an opinion on this issue. In his letter dated 9 May 2023 he said as follows:

“considering his potentially life threatening arrhythmia he is not currently fit to fly and he may need emergency health care in case he has a malignant arrhythmia.

19. However I find that the letter is expressed in vague terms. I was also provided with the Civil Aviation Authority (CAA) medical guidance which says those with Type 1 Brugada Syndrome with symptoms or history of 1) Documented VF or VT, or 2) syncope suggestive of tachyarrhythmia or 3) nocturnal adonal respiration are unfit to fly. Mr Gilbert submitted that the appellant has Type 1 Brugada syndrome with syncope and collapse and that this demonstrates that the appellant falls under Type 1 note 2, which means is he is unfit to fly. This document is medically technical. Manifestly, some people with Brugada Syndrome wish to travel by air and are able to fly particularly those with Type 1 persistent or intermittent and asymptomatic or Type 2 Brugada syndrome. I am not persuaded that the evidence before me demonstrates that the appellant comes into the category of Type 1 with the symptoms set out at “note 2” and is therefore “unfit” for the purposes of the CAA. My understanding from the medical evidence is that he has Type 2 Brugada syndrome on resting and that no dangerous heart rhythms have been detected. His symptoms are referred to as presyncope. Dr Lo Monoco did not refer to the CAA guidelines or explain how the appellant’s particular Brugada syndrome diagnosis falls into the guidance (Type 2 on resting with presyncope). It is possible to do investigations and ECG tests which can be reviewed by the CAA. I am not persuaded on the balance that evidence demonstrates that the appellant is unfit to undertake a journey by air to Bangladesh. I find that this evidence does not establish that if the appellant were to take a flight to Bangladesh that he would become seriously ill or die. Prior to knowing that he had Brugada syndrome, he flew to the UK in 2010 and returned to Bangladesh for a visit in 2013.

20. In any event whether the appellant is fit to fly or not, is not relevant to my assessment of whether a lack of treatment in Bangladesh would cause the appellant harm reaching the Article 3 threshold of severity. The Article 3 assessment is in relation to the consequences of lack of treatment in the “receiving country”. Removability is an operational matter for the respondent. If there is no risk of treatment contrary to Articles 3 and 8, it is the respondent‘s duty to remove the appellant safely. If at the point of removal, he is unfit to fly it will be for the respondent to consider alternative methods of removal. This is a logistical problem for the Secretary of State when it comes to removing the appellant from the UK.

21. I refer to HH (Somalia) & Ors v SSHD [2010] EWCA Civ 426 at [84] where Lord Justice Sedley says.

“In conclusion, our provisional view is that the Directives read together require that the issues of safety during return (as opposed to technical obstacles to return) should be considered as part of the decision on entitlement. Only technical obstacles of the kind we have sought to identify may legitimately be deferred to the point at which removal directions are being made or considered. We are aware that the entitlements which appear to follow may be considered an unintended consequence of the Directives; but this, as we have said, is an issue for another day”.

Seriously ill person

22. There was ample evidence in respect of the appellant’s cardiac health in the form of letters from Dr Adam Dennis Cardiology Speciality Registrar at the Department of Arrhythmia Services at St Barts Hospital, Professor Peir Lambiase PhD EHRS Professor of Cardiology St Barts Hospital, Cardiologist Dr Francesco Lo Monaco as well as GP records. All of these are consistent with the appellant having Brugada Syndrome. This was diagnosed after the appellant attended A and E on 19 July 2021 after a month of dizzy spells culminating in a loss of consciousness. The electrocardiogram (“ECG”) taken at hospital showed that he had a Type 2 Brugada pattern on resting ECG with provoked Type 1 Brugada pattern following Ajmaline challenge. He was said to have a structurally normal heart on echo. On 20 July 2021 an insertable loop recorder was implanted which showed symptomatic episodes correlating with sinus rhythm and sinus tachycardia.

23. Since then the appellant has had regular follow ups with the cardiology department and more recently on 23 May 2025 had a new device fitted because the previous loop monitor had run out of batteries. The latest letter from Professor Lambiase states that the appellant has Brugada Syndrome and a history of blackouts. “He is currently reporting episodes of light-headedness. We have not documented any dangerous heart conditions from his loop recorder which is very reassuring.”

24. I find from the medical evidence and general information on Brugada Syndrome in the bundle that it is a rare inherited heart condition that can cause potentially life-threatening irregular heartbeats. It is characterised by abnormal ECG findings. The condition increases the risk of sudden cardiac death with affected individuals experiencing symptoms such as syncope (passing out) or fainting spells. There is no cure for Brugada syndrome but there are things that sufferers can take to reduce the risk such as avoiding triggers like high temperatures, drinking alcohol, certain mediation and keeping hydrated. Most people can carry on exercising, driving and functioning as normal.

25. In the case of the appellant he often feels dizzy, lightheaded and occasionally falls or briefly loses consciousness. These are recorded in his GP notes and by the cardiology department. On 12 October 2024 he attended A and E in an ambulance after experiencing dizziness, vomiting and blacking out. He required 30 seconds of CPR. The test showed that he “had a gradual sinus bradycardia and a nine second pause in keeping with a vagal event”. Dr Nikhil Ahluwalia who reviewed the appellant on 30 April 2025 reassured the appellant that this was not related to his Brugada symptoms because there was evidence that his heart was beating at a normal rate and rhythm from the loop monitor. This was also recorded on his discharge sheet.

26. I accept that this the appellant is seriously ill in the sense that Brugada syndrome is a rare heart condition and the respondent does not take issue with this.

27. It is possible to mitigate the risk of sudden death by avoiding triggers and with close monitoring. The appellant has not been prescribed medication and the appellant is said to be too young for a pacemaker. The appellant has regular follow ups with the cardiology department. The loop implantation would pick up any malignant arrhythmia and notify the appellant so that he is able to seek urgent and immediate specialised cardiological treatment which might involve defibrillation or medication. Thus far, since the insertion of the loop monitor in 2021 he has not had malignant arrhythmia. In future he may need the implantation of an implantable cardiac defibrillator. The appellant gave evidence that his current device transmits direct to the hospital via an app on his mobile phone so that the hospital can immediately detect if there is an abnormality.

28. The appellant also has mixed anxiety and depressive disorder. From his GP notes, it is apparent that he has been reporting low mood since before his diagnosis of Brugada Syndrome because of his insecure immigration status and housing situation. I find from his GP records and consultant notes that the diagnosis of Brugada Syndrome has also affected his mental health. He feels low, has anxiety, poor sleep and sometimes experiences suicidal thoughts. He feels unsafe and unsteady when he leaves home so normally only leaves his flat when accompanied. He had approximately 11 sessions of Talking Therapy from Bart’s Hospital which ended in late 2024. He has been prescribed with sertraline, although from the records, I find that he has not taken this medication consistently. In the past he told his GP that he “sometimes” stopped taking it. In October 2022 the GP noted that he had last ordered tablets in August 2022 and in a letter from the GP dated November 2024, it is reported that he last ordered Sertraline in July 2024.

29. On 23 May 2023, Dr Francesco Lo Monaco stated that “the symptoms have caused him a remarkable burden of anxiety, depression and also sleepless nights and also complains of headaches and reduced appetite”. On 18 October 2023 Professor Pier Lambiese (Professor of Cardiology at Barts) confirmed that the appellant “is suffering from significant mental health issues exacerbated by the condition and is receiving counselling from our teams as well as anti-depressant medication. This letter was repeated verbatim by Professor Lambiese in a document dated 18 November 2025 from the Cleveland Clinic Heart Vascular and Thoracic Institute Cardiology headed “new consultation”, although there was no evidence that he was continuing to receive counselling from St Barts in November 2025.

30. The appellant was referred to the Barts Department of Psychology by the clinical psychologist from Tower Hamlets Community Psychology team in 2023. The appellant had a triage call on 2 October 2023 and then a consultation with Dr Abbie Unwin DClin Psych Clinical psychologist Barts on 12 November 2023. She recorded the psychological effect on the appellant of his heart condition including significant anxiety, low mood and worrying he might die. She also describes the uncertainty the appellant is living with because of his immigration status; that the property he lives in is not in a good condition, he can no longer work, he cannot carry out some activities of daily living and fears going out because he does not feel safe travelling on his own in case he becomes dizzy or something happens to him. He reported that the challenges he faces on a daily basis “have left him feeling that life is not worth living at times” and he stays away from the kitchen because of fire and knives. The Department of Psychology accepted the referral and said that they would arrange an initial consultation.

31. Dr Unwin asked the GP to refer him to holistic support. In January 2024 he was invited to a men’s health and wellbeing group. There was no evidence that he attended and his oral evidence was that he did not.

32. The appellant went on to have regular talking therapy sessions with Dr Unwin. On 14 November 2024 she wrote a letter to the GP confirming that the appellant still struggles with intermittent suicidal thoughts. She stated that when he struggles with anxiety he feels like he wants to die and has thoughts to jump from his flat. She suggested that he be offered more therapy. The appellant’s evidence is that he declined further therapy.

33. Although, the covering letter to his further representations dated 2021, states that the appellant has attempted suicide several times, this is not supported by the medical evidence.

34. I find from the medical records that the appellant’s low mood has been caused by a combination of his poor living circumstances, his immigration uncertainty and fears about his heart condition and sudden death. Although he has reported suicidal ideation to both his GP and Dr Unwin, there have been no actual attempts. He told his GP that his family are a protective factor and that he is his parents’ only son which would prevent him from killing himself. The most recent evidence is from Dr Unwin in her discharge letter dated 14 November 2024. There is no further medical evidence. The appellant has never been sectioned nor been an inpatient due to his mental health problems. He is not said to be psychotic. He has been found not to be at risk in Bangladesh for political reasons and any suicidal thoughts are not because of any perceived risk to him in Bangladesh. Although Mr Gilbert sought to persuade me that there is a real risk of suicide were the appellant to be returned to Bangladesh, there was insufficient evidence from the mental health professionals to support this particular assertion. There was no assessment as to the risk of suicide if the appellant were living with his family or with family support in Bangladesh with access to medication. The evidence is insufficient to persuade me that there is a real risk of a completed act of suicide nor of a serious rapid and irreversible decline in his state of mental health resulting in intense suffering short of suicide if he were to be returned to Bangladesh.

35. I am satisfied that the appellant has established that he is a seriously ill person on account of his Brugada syndrome and because of his mental health problems including depression and anxiety.

Has the applicant produced substantial evidence that because of the absence of treatment or a lack of access to treatment the appellant will be exposed to a serious, rapid and irreversible decline in their date of health resulting in intense suffering or to a significant reduction in life expectancy

36. In respect of Brugada Syndrome I remind myself here that appellant does not take any specific heart medication. It is only if he a malignant arrhythmia occurs that he will require treatment. Because of the nature of the syndrome it is impossible to predict if or when a malignant arrhythmia might occur. Thus far no malignant arrhythmias have been recorded. The implantable loop monitor and close monitoring enable him to access specialist cardiac treatment quickly. If the appellant does experience a malignant arrhythmia and is not able to quickly travel to the hospital for specialised cardiac treatment, he may die suddenly. This is the view of the medical professionals who all emphasise the high risk of sudden death without close monitoring or access to treatment.

37. In respect of the lack of treatment, the appellant originally produced a handwritten letter from Dr SK Md Murtuza Khan MBBS (page 573) Ex-Assistant registrar (Indoor Department) Senior Medical Officer and Incharge (Outdoor Department) Bohdharhat Branch, Chattogram Diabetic General Hospital dated 4 November 2021. He commented on the fact that the appellant is receiving developed and specialist care and treatment. He has been fitted with a loop recorder to monitor his heart and a specialist team at the hospital has been constantly monitoring his heart. Any sudden change would need to be treated without delay which is extremely important. Dr Khan says that heavy treatment makes access to immediate care difficult.

38. He then says: “Unfortunately our hospitals in Bangladesh we do not have monitoring facility through the loop recorder system. Brugada is a very rare disease and life threatening which required constant/ regular monitoring and specialised treatment. Here in Bangladesh we have hardly any patient suffering from this syndrome (sic)”.

39. I have some concerns about this evidence. Firstly it is written by a doctor from a diabetic hospital not from a cardiologist and the expert does not set out his credentials or source of knowledge and secondly the letter is now 4 years out of date and technological improvements move fast. The evidence is not that there is no patient with Brugada Syndrome in Bangladesh but that that the Syndrome is rare. The evidence is that the loop recorder system is not available but not that other cardiac treatments are not available.

40. The latest evidence produced on the availability of treatment in Bangladesh is a letter from Dr Hossain Ahmed who is said to be an Associate Professor (Cardiology) Southern Medical College Hospital Medicine and Cardiologist.

41. He says:

“As a cardiologist, I can confirm that cardiac patients with Brugada Syndrome are found very rarely and we do not have sufficient treatment process for them.

[The appellant] has further informed me that he has been fitted with a loop recorder to monitor his heart.

To meet his enquiries, I take a view that it is not possible to provide medical treatment for a patient having Brugada syndrome”.

42. This letter is lacking in detail and does not really explain why there is insufficient treatment, given that there is specialist cardiac treatment available in Bangladesh. Nor does the letter explain what other less sophisticated monitoring is available.

43. Mr Nappey’s position is that there is evidence that there is treatment available for Brugada syndrome in Bangladesh. He referred me to the CPIN Bangladesh medical treatment dated July 2022 section 5. Cardiovascular care is available. The National Institute of Cardiac Disease in Dhaka provides ECG, Exercise Stress testing, Pacemakers and ICD (Implantable Cardioverter Defibrillator) and as well as critical cardiac surgery including for arrhythmia management and cardiac electrophysiology and therapeutic ablation of arrhythmias. I therefore find that specialist treatment for cardiac problems and arrhythmia management are available in Dhaka.

44. I am not satisfied that the appellant has met the high burden of establishing that there is an absence of appropriate treatment. The standard of treatment for Brugada Syndrome in terms of monitoring in Bangladesh is not as sophisticated as in the UK but there is specialist treatment for arrythmia and specialist cardiac treatment does exist at least in Dhaka.

45. The appellant has not adduced evidence of a lack of mental health treatment in Bangladesh, indeed his focus is on the lack of cardiac treatment. The background evidence before me is that mental health treatment in Bangladesh is substandard. Nevertheless, the appellant’s mental health treatment currently only consists of taking sertraline. He is not currently receiving talking therapy. Although there is a lack of inpatient treatment and treatment for those with very severe psychiatric problems, according to the CPIN at 10.1.6 sertraline is available in Bangladesh. I am not therefore satisfied that the appellant has met the burden of demonstrating that the mental health treatment he requires is not available nor accessible. He also has also come nowhere near demonstrating on the evidence that if this treatment were not available there would be a significant shortening of his life expectancy or that he will be exposed to a serious, rapid and irreversible decline in the state of his mental health resulting in intense suffering.

Is there a lack of access to such treatment

46. In respect of cardiac treatment, the appellant’s evidence was that if he were returned to Bangladesh he would not be able to live with his parents in Sandwip because the trawler and speedboat services to Chittagong operate only during the day when the weather permits. At night there is no transportation. Emergency patients cannot travel to the mainland. There is no proper clinic or hospital in Sandwip.

47. When asked why he could not relocate to Dhaka to be near the hospital that offers specialist cardiac treatment, the appellant said that this is too expensive. This is a bare assertion unsupported by evidence. The appellant has not said that his family would not help him or that there are financial constraints. I agree that the onus is on the appellant to produce evidence that treatment is not accessible. He has not been forthcoming about his family situation or provided evidence of the cost of living in Dhaka/ the cost of medical treatment or why this would be unaffordable to his family. He has managed to live in the UK on his own in a much more expensive country without working or having an income. It is not explained why the appellant cannot relocate to Dhaka with the assistance of his parents. He speaks the language. He is educated and is familiar with the culture.

48. I find that the appellant has not adduced evidence capable of demonstrating that substantial grounds have been shown for believing that as a seriously ill person he would face a real risk on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment of being exposed to a serious rapid and irreversible decline in his state of health resulting in intense suffering or a significant reduction in life expectancy. I find that it would not be a breach of Article 3 ECHR on medical grounds to remove the appellant to Bangladesh.

Article 8 ECHR

49. Article 8 ECHR states as follows:

Everyone has the right to respect for his private and family life, his home and his correspondence.

There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic wellbeing of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

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

51. It is agreed that the appellant has private life in the UK because he has lived in the UK for 16 years, previously studied here and receives medical treatment. His evidence is that he does not have immediate family in the UK. He also claims not to have wider family. His private life in the UK is of a poor quality. He has a few close friends only. He does not work. He rarely leaves home and he feels isolated. His living conditions are poor. Nevertheless Article 8 has a low threshold of engagement.

52. It is agreed that the respondent’s decision to refuse his human rights claim causes an interference in the appellant’s enjoyment of his private life to the extent that he will not be able to access medical treatment. The likely consequences of the interference are sufficiently serious to engage Article 8(1).

53. There is no dispute that the decision was made in accordance with the law or in pursuit of a legitimate aim.

Proportionality

54. The immigration rules reflect where the Secretary of State considers the balance of proportionality to lie. If the appellant can demonstrate that he meets the immigration rules this will be determinative of the appeal.

55. The appellant arrived in the UK in 2010. He has been living in the UK for 16 years. He has not been living in the UK for a continuous period of 20 years. He cannot meet the immigration rules in respect of long residence.

56. I turn to whether there are very significant obstacles to the appellant reintegrating in Bangladesh. He has been absent from Bangladesh for 16 year but his evidence is that he is still in touch with his parents who are retired civil servants. He also has a sister and brother in law and a wider family in Bangladesh. His parents have their own home and the appellant has not made full disclosure about their financial situation. They previously lived in Chittagong. He speaks the language and he is familiar with the culture and society in Bangladesh. His friends in the UK are from the Bangladeshi diaspora. He does have some qualifications in accountancy after studying in the UK and he reported to Dr Unwin in 2023 that he previously worked as an accountant. He also said he worked in pizza hut and in a pub. He stopped work initially because he no longer had the right to work. The appellant has not explained why his parents would not be able to support him.

57. He has been signed off sick in the UK because of his mental health problems and dizziness. He is described as being lonely and needing support. He has also not produced any evidence from a professional assessing the likelihood of his mental health improving if he were to be reconnected with his family in Bangladesh and was taking appropriate medication. He has managed to support himself in the UK where he has no income from employment nor access to benefits. Prior to receiving his diagnosis, the appellant did obtain English language and accountancy qualifications from ACCA in the UK in 2012. He also worked. I accept that the appellant will feel anxiety about his heart condition but I am not satisfied that this is a very significant obstacle in itself. I find that the appellant would within a short period of return be enough of an insider to participate in life in Bangladeshi. I am not satisfied that there are very significant obstacles to his integration.

58. I turn to the final limb of the test in R (Razgar) v SSHD [2002] UKHL 27. I consider the factors weighing in favour of the public interest and in favour of the appellant’s private life holistically in the round.

59. In cases where the claimant resists removal to another state on health grounds failure under Article 3 does not necessarily entail failure under Article 8.

60. In GS India in GS (India) & Ors (Article 3 and Article 8 ) [2015] EWCA Civ 40. it was held that the absence or inadequacy of medical treatment even life preserving treatment in the country of return cannot be relied on at all as a factor engaging article 8. It that is all there is the claim must fail. Secondly where article 8 is engaged by other factors, the fact that the appellant is receiving medical treatment in this country which may not be available in the country for return may be a factor in the proportionality exercise but that factor cannot be treated as by itself giving rise to a breach since that would contravene the no obligation to treat principle [801].

61. The immigration rules reflect the Secretary of State’s view of where the balance of proportionality lies. The appellant has failed to satisfy the immigration rules in any category. I give this factor weight.

62. The appellant has lived unlawfully in the UK since 2016 for a period of ten years. Little weight should be given to private life when it was built up when the appellant’s immigration status was precarious or unlawful. The appellant’s private life was established during a period when his status was first precarious as a student and then unlawful. He failed to return to Bangladesh after his student visa expired choosing to remain unlawfully instead even prior to his diagnosis. His asylum claim has also been found to lack credibility. I therefore give his private life little weight in accordance with 117B of the Nationality, Immigration and Asylum Act 2002.

63. The appellant speaks some English, but this is a neutral factor. The appellant is currently financially independent in that his friend supports him. This is a neutral factor. He is reliant on NHS treatment and currently not fit to work and his presence in the UK entails the use of public resources, which is not in the public interest.

64. I set against these factors the appellant’s length of residence in the UK for 16 years, however I have found that the quality of his private life is poor and that he does not have strong ties to the UK.

65. I take into account that the appellant suffers from a serious heart condition and mental health problems and that the treatment he is likely to receive in Bangladesh will not be as good. However I have found that there is some treatment available for his conditions and I am not satisfied that he does not have access to any treatment. I have found that his removal to Bangladesh will not cause him serious, rapid and irreversible decline in his state of health resulting in intense suffering, or to a significant reduction in life expectancy.

66. Having considered all of the factors holistically in the round, I find that the removal from the appellant from the UK would not result in unjustifiably harsh circumstances such that there is a disproportionate interference in the appellant’s right to respect of private life.

67. The appeal is dismissed on human rights grounds.


Signed R J Owens Date 24 March 2026
Upper Tribunal Judge Owens


Appendix 1



IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2025-001252
First-tier Tribunal No: PA/53484/2024

THE IMMIGRATION ACTS

Decision & Reasons Issued:

…………………………………

Before

UPPER TRIBUNAL JUDGE LOUGHRAN
DEPUTY UPPER TRIBUNAL JUDGE WILLIAMS

Between

AM
(ANONYMITY ORDER MADE)
Appellant
and

THE SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Mr P Jorro of Counsel, instructed by Londonium Solicitors
For the Respondent: Mr K Ojo, Senior Home Office Presenting Officer

Heard at Field House on 30 July 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 appeals with the permission of Upper Tribunal Judge O’Brien against the decision of First-tier Tribunal Judge Verghis (‘the Judge’) promulgated on 14th January 2025.

2. By her decision, the Judge dismissed the appellant’s appeal against the refusal of his protection and human rights claims.
Background

3. The appellant is a national of Bangladesh who entered the United Kingdom on 25th January 2010. The appellant has a lengthy immigration history outlined in the refusal decision. Following a number of unsuccessful claims on human rights and protection grounds, the appellant made further submissions to the respondent on 30th November 2021.

4. The appellant claimed that he would be at risk upon return to Bangladesh because of his political opinion, i.e. he is a member of the Bangladesh Nationalist Party (‘the BNP’), involved in sur place activity in the United Kingdom. He further asserted his removal to Bangladesh would be a disproportionate interference with his right to private life, and that his removal would result in a breach of his Article 3 rights because of a number of health conditions he suffers with.

5. In the refusal decision, the respondent considered the appellant’s protection claim in light of the findings made in previous appeals. She deemed the appellant to be a ‘low level’ member of the BNP who would not be at risk from the Awami League. The refusal also considered the appellant’s claims on Article 8 grounds, and concluded the appellant’s familiarity with Bangladesh, his precarious position in the United Kingdom, and the absence of any very significant obstacles would not render his removal disproportionate.

6. As far as his Article 3 claim was concerned, the respondent noted the appellant suffered from a heart condition and from depressive disorder. The respondent referred to objective evidence pertaining to the availability of treatment in Bangladesh, and concluded the test outlined in AM (Zimbabwe) v SSHD [2020] UKSC 17 was not met.

The appeal to the First-tier Tribunal

7. The appeal came before the Judge sitting at Hatton Cross on 10th December 2024 (despite the decision indicating it took place on 22nd July 2024). Both parties were represented. The Judge heard evidence from the appellant with the assistance of a Bengali interpreter. No issues with interpretation were raised at the hearing. The Judge records her decision to treat the appellant as a vulnerable witness. She heard evidence from the appellant and three witnesses.

8. By her reserved decision, the Judge dismissed the appellant’s appeal on asylum, humanitarian protection and human rights grounds.

9. The Judge accepted the appellant had health issues (specified as Brugada syndrome, anxiety and depression), and that he had reported suicidal ideation to his GP as recently as January 2024. The Judge further noted the appellant’s admission to hospital following a loss of consciousness in October 2024, which the evidence indicated was unrelated to his Brugada syndrome. The Judge found in summary that the only evidence from the appellant pertaining to his ability to fly originated with the appellant himself, and that he had exaggerated the effects of his Brugada syndrome. In closing, the Judge found there was no evidence to counter the respondent’s CPIN, and that medical treatment would be available to the appellant upon return to Bangladesh.

The appeal to the Upper Tribunal

10. The appellant sought permission to appeal which was refused by First-tier Tribunal Judge Chinweze. His renewed application for permission to appeal was granted in part by Upper Tribunal Judge O’Brien. That renewed application was advanced on three grounds;

i. The Judge had failed to take into account the evidence before her relating to the regime change in Bangladesh.
ii. The Judge had not taken into account the evidence of medical professionals regarding the appellant’s ability to fly and wrongly found he had ‘exaggerated his condition’.
iii. The Judge had failed to give anxious scrutiny to the medical evidence provided by the appellant from medical professionals in Bangladesh.

11. Permission was granted in respect of grounds two and three, and it is on this basis the appeal comes before us to determine. All parties attended the hearing in person. We were provided with a composite bundle of 814 pages, as well as a skeleton argument dated 22nd July 2025 from Mr Jorro. On the morning of the hearing, we were also provided with an email from the appellant’s solicitors with an application pursuant to Rule 15(2A) to admit new evidence. Mr Jorro agreed with the Tribunal’s preliminary view that such an application was not necessary at this stage, the issue for us to determine being whether the Judge made a material error of law.

The appellant’s submissions

12. Mr Jorro relied on his skeleton argument. He drew our attention to [4] of his skeleton argument which helpfully outlined the medical evidence which was before the Judge. That evidence, taken together, established the nature of the condition (Brugada syndrome), as well as the fact it is incurable and would, without treatment, shorten one’s life expectancy. There were two letters in evidence before the Judge, one from Dr Lo Monaco, a specialist in Cardiology dated 9th May 2023. This letter confirmed the appellant was not currently fit to fly due to his ‘potentially life threatening arrythmia’.

13. A second letter from Professor Lambiase, Professor of Cardiology dated 19th October 2023 highlighted the monitoring regime in place for the appellant. It was further confirmed the appellant suffered from mental health issues exacerbated by his Brugada syndrome, and that he needed ‘close medical follow up’ to minimise the risk of sudden cardiac death. It was submitted both letters indicated the appellant was not fit to fly, and as removal to Bangladesh could only be by air, this was a factor the Judge needed to consider but failed to.

14. The Judge was, in light of this evidence, wrong to say at [47] of her decision ‘whilst the Appellant states that he is not fit to fly…’, as it was not just the appellant who said this, it was also the opinion of two medical experts in the field of Cardiology. Further, the Judge’s finding at [48], i.e. that there was no evidence before her to ‘counter’ the respondent’s CPIN was incorrect, as there were in fact two letters from medical professionals in Bangladesh. Both of these letters pointed out that there was no available treatment for Brugada syndrome in Bangladesh, and in any event, the CPIN did not mention Brugada syndrome and there was therefore nothing the appellant needed to ‘counter’.

15. In summary, it was said the Judge had failed to take into account material evidence and had therefore fallen into error.

The respondent’s submissions

16. For the respondent, Mr Ojo invited us to find there was no error of law in the decision. At [21] of her decision, the Judge pointed out that not every document needed to be referred to, and the absence of mention of a document did not mean it had not been considered. The Judge had considered specifically the evidence of the discharge note of 23rd October 2024 which made clear the appellant’s admission to hospital was not connected to Brugada syndrome.

17. This was the most recent evidence before the Judge at the time of the hearing in December 2024. The evidence referred to by Mr Jorro was some time before the hearing, with the letter of Dr Lo Monaco being over eighteen months old, and the letter of Professor Lambiase predated the hearing by over a year. The letter of Dr Khan was even older, dated November 2021. The Judge, taking the medical evidence in the round, had regard to the only evidence which said the appellant was not ‘currently’ fit to fly (the letter of Dr Lo Monaco), and this evidence was dated eighteen months before the hearing.

18. The Judge was entitled to expect further evidence from the appellant on this point, especially to show what his medical status was at the date of the hearing. The Judge accepted the appellant had an implantable loop recorder, and it was clear from the evidence he did not require specialised treatment beyond monitoring. The letter of Dr Lo Monaco clarified the appellant had not yet needed an implantable cardiac defibrillator, and that he had not developed any malignant arrhythmia. The only treatment the appellant was receiving was medication outlined in the discharge note, and all of this medication was available in Bangladesh.

19. In summary, it was said the Judge had considered the most recent evidence before her and found that this was insufficient to show the appellant would satisfy the Article 3 test, or that treatment would be unavailable to him in Bangladesh. Whilst it was accepted there were elements of the decision which could have been better expressed, it was clear what the Judge was ‘trying to say’.

20. Mr Jorro responded briefly drawing together his earlier submissions. It was clear the Judge had failed to consider the medical evidence supporting the appellant’s position. This was not a case where the Judge had simply failed to mention evidence, but the Judge had reached conclusions and referred to a lack of evidence when it fact it had been provided. The Judge was wrong to consider the discharge note as determinative of the appellant’s health, as it did not obviate the reality that he had been diagnosed with Brugada syndrome.

Analysis and Findings

21. In our consideration of whether the Judge erred, we remind ourselves that where a point is not expressly mentioned by the First-tier Tribunal, we should be slow to infer that it has not been taken into account (MA (Somalia) v Secretary of State for the Home Department [2010] UKSC 49 at [45]). We also take into account the Judge’s self-direction at [21] referred to by Mr Ojo, i.e. that the absence of a document being mentioned does not mean it has not been considered.

22. In our view however, it is clear the Judge failed to have regard to the entire evidential landscape for the reasons below. First, as Mr Jorro submitted, the Judge has made findings which were contrary to the evidence before her. At [47] of the decision, the Judge stated:

Whilst the Appellant states that he is not fit to fly and may need emergency treatment for his heart condition, the medical evidence of his condition on 21 October 2024 conflicts with this assertion. The discharge notice confirms that his Brugada syndrome appeared to play no part in his collapse on that day and that the fitted recording device indicates that since being fitted in 2021, there was at no time any arrhythmia attributable to the Brugada syndrome. The Appellant has put forward that his heart condition is of such a degree that he is at risk at any time a fatal collapse. I find therefore, that whilst the Appellant has a heart condition, he has exaggerated the effects on a day-to-day basis. The Appellant in cross examination declined to answer when asked if he had investigated medical treatment and medical facilities in Bangladesh and that failure in my view, weighs against him and his credibility.

23. As Mr Jorro submitted, it was not only the appellant who stated he was not fit to fly, but there was also the evidence of Dr Lo Monaco before the Judge who stated, ‘for this pleasant gentleman, considering his potentially life-threatening arrhythmia he is not currently fit to fly’. Whilst we note the submissions made by Mr Ojo about the age of the evidence in proximity to the hearing, the Judge does not express any view as to the weight she places upon the evidence of Dr Lo Monaco, and her finding that ‘the appellant’ states that he is not fit to fly gives the impression she had not taken the evidence of Dr Lo Monaco into account.

24. Secondly, the Judge found the appellant had exaggerated the effects of his heart condition, however the evidence provided supported his claim, i.e. that he was at risk of a ‘fatal collapse’. The letter of Dr Lo Monaco referred to Brugada syndrome as being ‘often responsible for episodes of sudden death in young individuals’, and that ‘it can manifest with sudden malignant rhythm disturbances which are known to be causing sudden death’. The letter of Professor Lambiase dated 18th October 2023 stated the appellant ‘requires close medical follow-up to minimise his risk of sudden cardiac death’. The Judge’s failure to give any reasons as to why she found, notwithstanding this evidence, that the appellant was exaggerating the effects of his heart condition indicates she had not considered the evidence.

25. Whilst it is said the appellant ‘declined to answer’ questions about whether he had investigated medical treatment and facilities in Bangladesh, there was evidence before the Judge which showed he had made steps to investigate. There were two letters in evidence provided from physicians in Bangladesh which both referred to a lack of treatment for Brugada syndrome in Bangladesh. The letter of Dr Khan dated 4th November 2021 stated the monitoring system currently used by the appellant is not available in Bangladesh, and that those suffering from Brugada syndrome are advised to seek treatment for it outside of Bangladesh.

26. A letter expressing a similar view about the absence of treatment in Bangladesh was provided by Dr Ahmed dated 8th September 2024. Even taking into account Mr Ojo’s submissions about the age of the medical evidence provided, the letter of Dr Ahmed was written just over two months before the hearing. The Judge does not express any view about this evidence, and again her finding that the appellant had not ‘countered’ the evidence within the respondent’s CPIN gives some force to Mr Jorro’s submission that the Judge had simply failed to take this evidence into account.

27. Taking these points together, we find the Judge failed to give adequate reasons for her findings pertaining to the appellant’s health condition. Having accepted that he did suffer with Brugada syndrome, the Judge failed to give reasons for her rejection of the evidence provided which at least on its face corroborated the appellant’s claim that the illness could result in sudden death, and that there was no available treatment for Brugada syndrome in Bangladesh.

28. The Judge’s failure to give reasons pertaining to this evidence means we are unclear as to whether it was considered at all. The Judge’s conclusions which run contrary to the evidence provided by the appellant indicate that it was not considered. This error was clearly material as it resulted in the rejection of the appellant’s Article 3 claim and the finding that the appellant had exaggerated the effects of his illness. Further, the appellant failing to make any reasonable enquiries about treatment in Bangladesh was a factor weighing against him in the proportionality exercise at [70e] of the decision.

Disposal

29. Both representatives agreed that were we to find the appellant’s challenge made out, the appeal should be retained in the Upper Tribunal for remaking. Taking into account what is said in paragraph 7 of the Senior President’s Practice Statement, AEB v Secretary of State for the Home Department [2022] EWCA Civ 1512 and Begum (Remaking or remittal) [2023] UKUT 00046 (IAC), we agree.


Notice of Decision and Directions

1. The decision of the First-tier Tribunal is vitiated by a material error of law and is set aside.

2. The extent of the fact finding is limited to the issue of the appellant’s health conditions. There being no challenge to the Judge’s findings relating to the protection claim, those findings are preserved.

3. The appeal will be retained in the Upper Tribunal for remaking.

4. Prior to the remaking hearing it will be listed for a case management hearing.


CJ Williams

Deputy Judge of the Upper Tribunal
Immigration and Asylum Chamber

20th August 2025