Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER
Case No: UI-2025-001480

First-tier Tribunal No: HU/50663/2024

THE IMMIGRATION ACTS

Decision & Reasons Issued:

30th October 2025

Before

UPPER TRIBUNAL JUDGE LODATO

Between

SYEDA ZAKIA YOUSAF
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Ms Selvakumaran, counsel
For the Respondent: Mr Tufan, Senior Presenting Officer

Heard at Field House on 6 October 2025

DECISION AND REASONS

Introduction

1. In a decision dated 22 July 2025, the decision of the First-tier Tribunal to dismiss this appeal on human rights grounds was set aside because it involved a material error of law. No findings of fact were preserved, and it was decided that the appropriate procedural course was to remake the underlying appeal decision after a further hearing. At the remaking hearing, I heard evidence from the appellant and three of her children.

2. The elderly appellant, who has a range of physical and mental health conditions, contends that it would amount to a breach of her Article 8 human rights to return her to Pakistan thereby separating her from her UK-based children who currently care for her. The respondent’s case is that any private life she has acquired in the UK was accumulated while her status was precarious, or after the expiry of her lawful initial stay as a visitor. It is further suggested that neither she nor any members of her family would suffer unjustifiably harsh consequences as a result of her removal such that her removal would be a disproportionate interference with their Article 8 rights.

Background

3. The broad immigration history is not in dispute between the parties. The appellant arrived in the UK, over 9 years ago, on 29 September 2016, using a visit visa which expired in March 2018. She did not return to Pakistan in compliance with the requirements of her visa and has remained in the UK ever since. The centrepiece of her factual case is that soon after she arrived in the UK, her husband, who remained in Pakistan with his second wife and their children, divorced her according to customary Islamic law. He promptly sold the family home he had previously shared with the appellant and his second wife and moved to Islamabad. Since these events, the appellant’s physical and mental health has deteriorated to such an extent that she now requires round-the-clock care which is currently provided by her children in the UK. A factual matter which loomed large during the hearing was the role which could be played by the appellant’s daughter who continues to live in Pakistan with her husband and his wider family. It was argued that she could not provide the necessary support for her mother because the prevailing cultural expectation was that she give herself over completely to her husband’s family. Providing any kind of care to her own mother would not be tolerated.

Appeal to the Upper Tribunal

4. At the remaking hearing, I heard oral evidence from the appellant and three of her children. I was asked to treat the appellant and her son, Mr Shah, as vulnerable for the purposes of the hearing and to take their vulnerability into account when assessing their credibility as witnesses. No objection was taken by Mr Tufan and I acceded to the application. I explained that breaks could be taken during the hearing and that questions were to be narrowly framed and to use simple language. I heard oral submissions from both parties. I address any evidence and submissions of significance in the discussion section below.

5. Ms Selvakumaran confirmed that it was not suggested that the appeal could succeed on Article 3 grounds on the strength of the appellant’s health conditions. The parties agreed that the following principal controversial issues fell to be decided in the appeal:

a. Would the appellant encounter very significant obstacles to integration on return to Pakistan?

b. If there are not very significant obstacles to integration, are there any exceptional features which would otherwise render the appellant’s removal to Pakistan disproportionate under Article 8 of the ECHR?

Legal Framework

6. Article 8 of the ECHR provides:

(1) Everyone has the right to respect for his private and family life, his home and his correspondence.
(2) 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 well-being 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.

7. The question is whether the refusal breaches the appellant’s right to respect for private and family life under Article 8 ECHR. That right is qualified. The appellant must establish on the balance of probabilities the factual circumstances on which they rely and that Article 8 (1) is engaged. If it is, then I have to decide whether the interference with the appellant’s right is justified under Article 8 (2). If an appellant does not meet the immigration rules, the public interest is normally in refusing leave to enter or remain. The exception is where refusal results in unjustifiably harsh consequences for the appellant or a family member such that refusal is not proportionate. I take into account the factors set out in s.117B Nationality Immigration and Asylum Act 2002 and balance the public interest considerations against the factors relied upon by the appellant.

8. The Court of Appeal considered the meaning of integration in Kamara v SSHD [2016] 4 W.L.R. 152. At paragraph 14 of the judgment of Sales LJ (as he then was), the following interpretation was given: 

In my view, the concept of a foreign criminal's “integration” into the country to which it is proposed that he be deported, as set out in section 117C(4)(c) and paragraph 399A, is a broad one. It is not confined to the mere ability to find a job or to sustain life while living in the other country. It is not appropriate to treat the statutory language as subject to some gloss and it will usually be sufficient for a court or tribunal simply to direct itself in the terms that Parliament has chosen to use. The idea of “integration” calls for a broad evaluative judgment to be made as to whether the individual will be enough of an insider in terms of understanding how life in the society in that other country is carried on and a capacity to participate in it, so as to have a reasonable opportunity to be accepted there, to be able to operate on a day-to-day basis in that society and to build up within a reasonable time a variety of human relationships to give substance to the individual's private or family life. 

9. The meaning of very significant obstacles was considered by the Upper Tribunal in Treebhawon [2017] Imm. A.R. 790 where the following guidance was provided at paragraph 37: 

[…] The other limb of the test, " very significant obstacles ", erects a self-evidently elevated threshold, such that mere hardship, mere difficulty, mere hurdles and mere upheaval or inconvenience, even where multiplied, will generally be insufficient in this context. […] 

10. The Court of Appeal, in Parveen v SSHD [2018] EWCA Civ 932, clarified the Treebhawon summary of the threshold. Underhill LJ stated:

I have to say that I do not find that a very useful gloss on the words of the rule. It is fair enough to observe that the words "very significant" connote an "elevated" threshold, and I have no difficulty with the observation that the test will not be met by "mere inconvenience or upheaval". But I am not sure that saying that "mere" hardship or difficulty or hurdles, even if multiplied, will not "generally" suffice adds anything of substance. The task of the Secretary of State, or the Tribunal, in any given case is simply to assess the obstacles to integration relied on, whether characterised as hardship or difficulty or anything else, and to decide whether they regard them as "very significant".

11. In TZ (Pakistan) and PG (India) v SSHD [2018] EWCA Civ 1109, the Senior President of Tribunals provided guidance as to how competing public and private interests should be balanced in a case where the requirements of the Immigration Rules are satisfied. He said this at paragraph 34:

[…] An evaluation of the question whether there are insurmountable obstacles is a relevant factor because considerable weight is to be placed on the Secretary of State's policy as reflected in the Rules of the circumstances in which a foreign national partner should be granted leave to remain. Accordingly, the tribunal should undertake an evaluation of the insurmountable obstacles test within the Rules in order to inform an evaluation outside the Rules because that formulates the strength of the public policy in immigration control 'in the case before it’, which is what the Supreme Court in Hesham Ali (at [50]) held was to be taken into account. That has the benefit that where a person satisfies the Rules, whether or not by reference to an article 8 informed requirement, then this will be positively determinative of that person's article 8 appeal, provided their case engages article 8(1), for the very reason that it would then be disproportionate for that person to be removed.
[Underlining added]

12. The appellant bears the burden of substantiating the primary facts of the appeal. The standard she must meet is on the balance of probabilities.

Discussion

13. In deciding the central issues which fall to be determined in this appeal, the first question I must ask myself is whether the appellant has established on the balance of probabilities the events which she and her children have described as bringing about her current situation. Her case is that she visited the UK in 2016 with every intention of returning to Pakistan with the return ticket she had already purchased, just as she had done in the past when she had previously visited the UK. However, on this occasion, she claimed that her circumstances changed beyond all recognition when her husband contacted her from Pakistan to inform her that he was divorcing her. All of the witnesses described how this could be achieved according to Islamic customary tradition simply by the husband making a repeated verbal declaration to this effect. The appellant explained that her husband could not have been clearer that he no longer intended to remain married to her in favour of his second wife. He was said to have seized the opportunity presented by the appellant’s trip to the UK to sell the family home he had previously shared with both of his wives and to relocate to Islamabad. The appellant and her children have heard little from him in the 9 years which have elapsed since.

14. At the hearing, Mr Tufan probed at the edges of this factual centrepiece of the claim by questioning why there were no documents to support the claimed divorce. This appeared to be a challenge to the reliability and certainty of the appellant’s marital status in law. He did not, however, suggest to any of the witnesses that they were not telling the truth about this sequence of events. I was therefore surprised to hear the oral submission later to the effect that the witnesses had been “economical with the truth”. I queried why this challenge to their honesty as witnesses was not directly put to them to enable them to respond to allegations that they were not being truthful. The response was that it would have been “rude” to do so. At the risk of stating the obvious, procedural fairness demands that a witness who is to be accused of not being truthful should have an opportunity to address such an imputation. I saw no reason to conclude that the witnesses were anything less than truthful. They were all broadly consistent with each other about these distressing family events. They explained in compelling detail the shockwaves which the appellant’s husband had caused by his decision to end the marriage and the immense impact this had on her mental health. They all described how they felt a sense of powerlessness in the face of the cultural imbalance which allowed the appellant’s husband to abandon his wife in this way and leave her with no assets. I had no good reason to doubt the credibility of the coherent and consistent evidence I heard from all four witnesses. I accept the factual backdrop of the circumstances in which the appellant came to be divorced according to Islamic customary law soon after her arrival in the UK in 2016. This was the catalyst for the family deciding to make a series of applications for her to remain in the UK with them.

15. In advance of the remaking hearing, the appellant and her children provided updated witness statements going to her condition and circumstances. The appellant described her significant physical and mental decline and that she struggles to keep up with all the medications she is now required to take to regulate her respiratory function and mental health conditions. Mr Shah vividly described how his mother’s severe arthritis and osteoarthritis meant that she had limited mobility and used a wheelchair when out of the house. Chronic hand tremors made it impossible for her to look after herself or prepare meals in the home. He described how her breathing could become restricted at night, and he or his family members need to be readily available to assist her to regain a regular breathing pattern. The appellant’s daughter, Dr Yousaf, said this in her most recent statement:

I also regularly provide support to my mother by being the only individual who is qualified to take care of her in the near family. Even though she lives with Bilal, I have always been involved in all health decisions that our mother has to take. At her age it is not only about the best way / decision to take care of her. All the support that she needs cannot just be provided. It is the medium of providing that support which is crucial to her. She is definitively more likely to be receptive to her treatment if provided in the supervision of one of her children.

16. None of the above narrative evidence was challenged in any real sense during the remaking hearing.

17. I am satisfied that the appellant has family members remaining in Pakistan but with whom she is likely to enjoy varying degrees of support. Her father was said to be 96 years of age and bedridden. Her brother, who is in his 70’s, has shouldered the responsibility of providing for their father. All of the witnesses gave consistent evidence that they had seen very little of the appellant’s brother over the last decade and that he frequently travelled internationally for business and had shown virtually no interest in his sister. In a witness statement dated 24 September 2025, the appellant’s Pakistan-based daughter, Uzma Sarwat, set out her circumstances. She explained that she had been absorbed into the wider family of her husband in accordance with their culture. Her circumstances meant that she was constrained from providing her mother with the kind of care she would need if she returned. There was simply not enough room in the home she shares with her husband’s family and her mother’s presence would not be tolerated by her husband and his family in any event. While I recognise that the respondent has not had an opportunity to test Mrs Sarwat’s evidence through cross-examination, I had little reason to doubt what she had to say in her statement and it broadly cohered with the evidence of her mother and siblings who were available to be cross-examined and were not meaningfully questioned about Mrs Sarwat’s inability to provide the necessary care and support.

18. The evidence provided in respect of the appellant’s income in Pakistan was not entirely clear. She described having previously worked as a teacher and that she had benefitted from a pension upon retirement. However, there was a lack of clarity as to how much she received, to whom it was paid and how frequently any payments were made. However, I accept the evidence that any pension was more likely than not modest given the brief period she was employed as a teacher, when she was young, before she stopped working to have children. The impact this modest pension is likely to have on her ability to integrate and function in Pakistani society is unlikely to be significant. However, her children in the UK are gainfully employed and I note that Dr Kanwal Yousaf is working as a plastic surgeon in the UK under a skilled visa. While a detailed breakdown was provided of the expenses the appellant would be likely to incur on return to Pakistan, some of these costs appeared to be extravagant and difficult to justify. It was suggested that a total monthly cost of some £7,454 would be required to pay for bills and services including the apparent employment of a security guard, driver, chef, helper, maid, cleaner and nurse. The notion that the appellant would require such a full complement of staff struck me as outlandish. More persuasive was Dr Yousaf’s evidence that she had experience of working in Pakistan’s healthcare sector and was all too aware of what round-the-clock care would look like in the real world as opposed to the sanitised material to be seen on the internet. She explained that the only care homes to speak of were private institutions of the poorest quality. This stemmed from the cultural expectation that families take responsibility to care for their elderly loved ones. The quality of provision was worse in Peshawar than in other big cities because of its proximity to Afghanistan and its rural and underdeveloped conditions.

19. I was directed to a report from Consultant Psychiatrist, Dr Bedi, completed in July 2021. In the context of his review of the appellant’s medical records, it was noted that the appellant spoke to her GP in March 2021 of paranoid delusions that her husband’s second wife was performing black magic. At [3.3] of his report, the expert referred to the appellant’s description of hearing voices daily as well as visual hallucinations. He went on to reach the following conclusions:

There is evidence of impairment of her cognitive functioning with disorientation and reduced concentration. She is unable to manage her activities of daily living such as attending to her personal care, preparing meals and doing house-work.

The history and presentation are consistent with:
• Psychotic disorder
• Moderate Depressive episode
• Cognitive Impairment.

[…]

Mrs Yousaf’s mental health conditions, in combination with her medical conditions, has significantly impacted on her functioning. She is unable to manage her activities of daily living such as personal hygiene, doing house work and preparing meals. In the absence of adequate support, there is a significant risk of self neglect.

[…]

Mrs Yousaf has a significant medical history. The medical records provided state that she suffers from a number of medical conditions including:

• Tremors of both hands;
• Asthma;
• Bilateral knee arthritis; chronic knee pain; given steroid injection in knee joint. She was seen at the Orthopaedics department at Whipps Cross University Hospital.

Mrs Yousaf physical health issues have affected her ability to manage her day to day activities such as personal hygiene, meals and housework. She has a history of falls and her mobility is limited and she is only able to walk short distances in the house and requires a wheelchair outside. Her hand tremors prevent her from doing most things and she cannot even make a hot drink for herself. Mrs Yousaf’s family assists her with all personal care, manages the meals and house work and ensures that she takes her medication regularly. Mrs Yousaf’s fluctuating mood symptoms, erratic behaviour and cognitive difficulties also prevent her from managing her physical conditions safely.

[…]

The history and presentation is consistent with Moderate Depressive episode and Psychotic Disorder. There is also evidence of cognitive impairment likely to be secondary to her mood and psychotic symptoms.

Mrs Yousaf mood and psychotic disorder as well as cognitive deficits in combination with her physical health issues have significantly affected her ability to manage her day to day essential tasks such as meals, personal hygiene and housework. In the absence of adequate support from her family she is at risk of serious self neglect.

The mood and psychotic symptoms have persisted with episodes of agitated and aggressive behaviour and mood fluctuation. She would become angry and tearful at times and the changes in her mood and behavior [sic] are unpredictable. Mrs Yousaf’s daughters are concerned about her erratic behaviour. Mrs Yousaf’s mood and psychotic symptoms have been present for a prolonged period despite being on treatment. I feel she will benefit from support from the local mental health services and review of her medication. She will require regular monitoring for efficacy and for any potential side effects of the medication. She would also benefit from having psychological assessment followed by therapy. The combination of medication and psychological therapy is likely to be more effective in treating her mental health conditions.

[…]

There is likely to be a detrimental effect on Mrs Yousaf’s mental health and physical health if she is forced to leave the UK and is separated from her caring family. Mrs Yousaf is suffering from significant mood and psychotic symptoms complicated by cognitive difficulties and significant medical conditions. The combination of her physical and mental health problems has affected her functioning. She requires assistance with her day to day needs such as meals, personal care, housework and travel. Mrs Yousaf displays unpredictable behaviour. Mrs Yousaf’s family ensures that all her needs are met in a timely manner. She continues to experience significant mood and psychotic symptoms despite being on medication and the care and emotional support provided by her family in the UK.

Mrs Yousaf stated that she has no income of her own and she has to rely on her children for everything. She acknowledged that they are very caring and she loves them dearly. Mrs Yousaf worries about her current situation and what would happen if she is forced to leave UK. She stated that if she is separated from her children it will be the end of her life.

The loss of this environment can potentially lead to further deterioration in her mental state and functioning. Mrs Yousaf’s mental health could get worse if she was separated from her caring family.

The loss of this support is also likely to lead to risk of self neglect and have a detrimental effect on her physical conditions and their overall management.

[Pages 7-12]

20. More recent clinical commentary came in the shape of a letter, dated 19 February 2024, from Mr Murthy, Consultant ENT/Head and Neck Surgeon. He said this:

I saw this 74 years’ old lady who attended with an Urdu interpreter today. She presented with a long history of a multi-nodular goitre which has potentially been present for over forty years. This was small to begin with but has gradually progressed and more recently has started to cause compressive symptoms of airway compromise and a sense of tightening of her neck. She describes occasional dysphagia. She has been investigated in the past for palpitations but reported that there is no cardiac diagnosis for the symptoms which have been extensively investigated.

Examination confirmed a multinodular goitre involving both thyroid lobes with no obvious retrostemal extension. She has had a recent ultrasound and CT scan which has also confirmed the presence of bilateral benign nodules in both thyroid glands for which an FNA was not indicated.

I discussed the option of total thyroidectomy including the risk of bleeding, infection, haematoma, keloid scar, airway compromise and dysphonia secondary to unilateral or bilateral recurrent laryngeal nerve injury as well as the need for lifelong replacement medication with Levothyroxine and/or calcium. I have also intimated these facts to her son who was present. He expressed a wish to discuss the matter with the family and they will then discuss the proposed plan with yourself. If the family are agreeable to proceed with surgery please drop me a line so that I can place her on the waiting list.

21. In a letter dated 2 January 2025, Dr Greaves, writing on behalf of the Croydon Community Mental Health Team after fears were raised about the appellant expressing suicidal ideas in the wake of the refusal of her leave to remain application. Dr Greaves assessed her mental state in the following terms:

Mrs Yousaf is a 72 year old Pakistani lady. She is overweight. She has difficulty with her mobility. She was frequently putting her head down or her hands over her face and needed a lot of reassurance and comfort from her son who was sitting next to her. She was often sighing, shaking her head and seemed to be in a state of agitation. She answered our questions readily.

She said her thoughts were mainly around wanting to end her life, feeling hopeless due to the Home Office refusing her visa application. Her son said he has tried to reassure her that they will reapply again and that it is not unusual for the application to be refused the first-time round, but she cannot be reassured by him. She said that she has no family in Pakistan anymore and so would have no-one to help her or support her and that for this reason she wants to remain in the UK.

She said she hears a voice telling her that she should end her life and she hears it particularly at night time when she is trying to go to sleep. Her sleep she said is very poor. Her appetite however is good. I did not test her formally cognitively today. She appeared grossly intact. Her insight is partial in that she recognises her mood has deteriorated and that she is anxious and upset and she acknowledges the various stressors for this, however she cannot be reassured by her family or anyone else.

Her son said that he is with her all of the time because he is fearful that she will try to end her life. He said it is difficult to give her medication and when I asked her today if she would re start her medication she said "no." However, her son says that he believes she can be persuaded.

Mrs Yousaf is experiencing a relapse of her psychotic depression as a result of multiple stressors which have occurred recently. She is at risk to herself.

22. Adding to the subjective and expert evidence, the appellant relied on country background information in the shape of the CPIN: Pakistan: Women fearing gender-based violence of November 2022. The following relevant points emerge from this source:

5.2.1 – The status of women differs in terms of their class, religion, education, economic independence, region and location (urban or rural), cultural and traditional values, caste, educational profile, marital status and number of children. However, patriarchal attitudes and discriminatory stereotypes about women’s roles and responsibilities in the family and in society, worsened by religious divisions in government, maintain their subordination to men.

5.2.8 - The Australian Government’s Department of Foreign Affairs and Trade (DFAT) January 2022 Country Information Report, informed by DFAT’s on the-ground knowledge and discussions with a range of sources in Pakistan and elsewhere, as well as information from government, non-government and media sources, noted that:
‘Women’s participation in society in Pakistan can be heavily curtailed depending on their social circumstances. Observation of the purdah (literally “curtain”, an Islamic practice of segregating women from unrelated men) restricts many women’s personal, social and economic activities outside the home. While women in cities such as Lahore, Karachi and Islamabad often enjoy relative freedom, conservative rural communities are much stricter. There are reports of widespread sexual harassment of women and girls in public places, schools and universities. Some, mostly wealthy, Pakistani women have attained senior positions in public life, but their experience is not representative of the general population.’

5.3.4 - A study on ‘singlehood’, based on interviews with 20 single women over the age of 35 in Rawalpindi, Punjab, published in March 2021 noted:
‘Marriage has always been central to women’s lives in Pakistan and to remain single is not only considered socially unacceptable but also perceived as non-compliance to the cultural hegemony of the institute of marriage. Pakistan is a country where marriage is considered mandatory and singlehood is viewed as anomalous particularly in the case of women… Regardless of whether the causes for their single status were circumstantial or optional, unmarried women experience criticism, disgrace, loneliness, and feeling of being left out in a patriarchal societal setup where traditional gender role expectations bound women with marriage and motherhood.’

5.3.5 – According to an August 2021 article on the situation for single women, by Lahore-based journalist and writer, Nushmiya Sukhera:
‘There seems to be no space in Pakistani culture for women living alone. The common and expected arc of a woman’s life consists of first living in her parents’ home and moving out only when moving into the home of her husband and his family. Women who seek independence are often thought to be bringing shame upon the family by doing so and are severely criticized by relatives – close and distant alike. But in recent years, the country has seen a change in which more women are choosing to live independently, whether it’s by relocating to a different city for work, leaving abusive domestic situations, or even simply wanting to dip their toes in some form of liberation in a country determined to shackle them in one way or another. However, for most of these women, the decision to live independently brings with it its own set of challenges. They often have to put themselves in potentially dangerous situations in order to live a life devoid of control and confinement.’

5.3.8 – A research study on post-shelter lives of women survivors of violence by Rozan, an Islamabad-based NGO, published November 2018, noted that:
‘Depending upon the trajectory of their post shelter lives, many [women] still face violence or the threat of violence, severe stigma for living without male members or as a divorced woman as well as considerable distress as consequence of years of abuse and loss of support from family members. Many also face financial constraints and practical challenges of living such as safe housing… Many try to dissociate, at least visibly, with the shelter and lie to neighbours and landlords that they have brothers or fathers earning abroad. Single and younger women reported this more, and often shared a heightened sense of insecurity and vulnerability as a lone woman, without male members in their life.’

Issue (a) – very significant obstacles to integration

23. In assessing whether the appellant would have the capacity to participate in Pakistani society on return, there are a number of factors which fall to be considered. Firstly, she spent over 60 years living in Pakistan, worked there when she was younger and raised a family of successful and industrious children. However, it must be recalled that most of this time was spent within the benign cultural conditions of being a married woman. That is no longer the case. She will return to Pakistan as a divorced woman with all of the incumbent difficulties this presents in Pakistani society as is clear from the Home Office CPIN on the serious challenges single or divorced adult women must overcome. In addition to these factors are the constellation of physical and mental health ailments which mean that she cannot forge her own path but must rely on the care of others. While I do not doubt that her Pakistani-based daughter would do all she could, this is most unlikely to extend to offering a place in her home with her husband’s family. The CPIN is tolerably clear that a woman in Mrs Sarwat’s position will be seen to have transferred to her husband’s family which makes it entirely plausible that her new family would simply not tolerate the assumption of what they would see as a burden they should not have to shoulder. Simply put, Mrs Sarwat is in no position to fill the gap which would be left by the round-the-clock care which is currently being provided by her family in the UK.

24. I found some of the evidence relied upon going to the feasibility of arranging private care to be difficult to accept. The notion that the appellant would require a bevy of staff to care for her struck me as having little connection to the reality of the costs of the personal services she would actually require. I also bear in mind that the family in the UK are not without resources. While I find that private care could be paid for, the evidence shows that these arrangements would be likely to have a palpably deleterious effect on the appellant such that she is likely to withdraw from society rather than participate and integrate within it. This is underscored by the expert conclusions reached by Dr Bedi to which I attach some weight. His report is of some age, but the recent medical records tend to reveal a picture which is largely unchanged if not showing a deterioration with credible suicidal ideation now a prominent feature of her psychiatric presentation.

25. When I put all of the pieces together in my analysis of whether the high threshold of very significant obstacles to integration has been reached, I bear in mind that the appellant has a deep understanding of Pakistani culture. However, the combination of her physical and mental health conditions taken together with her changed status as a divorced older adult woman without a home to return to, without any meaningful independent resources or a local support network which could provide her with meaningful assistance all persuade me that she would not be able to participate in Pakistani society without overcoming very significant obstacles. I agree with the appellant’s daughter, Dr Yousaf, that it is overly simplistic to simply look to whether private care is affordable for the family who are based in the UK. In this case, given the appellant’s particular needs, vulnerabilities and changed position within Pakistani society, I am satisfied on the balance of probabilities that private care may regulate her physical and mental health needs but that the overall effect will be that she will withdraw from society, not integrate. The obstacles to her integration are very significant.

26. Applying TZ, the conclusion I have reached, that the appellant will face very significant obstacles to integration, is a complete answer to the appeal. The respondent has not suggested that the appellant’s Article 8 rights are not engaged. The fact that the appellant meets the requirements of paragraph 5.1(b) of Appendix Private Life of the Immigration Rules means that the decision to refuse the application is self-evidently a disproportionate interference with the appellant’s Article 8 human rights and her appeal must therefore succeed.

Notice of Decision

The appeal is allowed on Article 8 human rights grounds.

Paul Lodato

Judge of the Upper Tribunal
Immigration and Asylum Chamber

20 October 2025