Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER
Case No: UI-2025-001809

First-tier Tribunal No: PA/00001/2021

THE IMMIGRATION ACTS

Decision & Reasons Issued:

On 13th of January 2026

Before

UPPER TRIBUNAL JUDGE CANAVAN
UPPER TRIBUNAL JUDGE KHAN

Between

S K
(ANONYMITY ORDER MADE)
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Mr R. Halim, instructed by Duncan Lewis Solicitors
For the Respondent: Mr W. Irwin, instructed by the Government Legal Department

Heard at Field House on 15 December 2025

Order Regarding Anonymity

Pursuant to rule 14 of the Tribunal Procedure (Upper Tribunal) Rules 2008, the appellant is granted anonymity because the case involves consideration of sensitive medical issues. 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

Summary

1. This is a decision of the Upper Tribunal (Immigration and Asylum Chamber) (‘the Upper Tribunal’). The Upper Tribunal is an independent decision-making body with powers given to it by an Act of Parliament. This decision is made in the context of the Upper Tribunal’s role in considering statutory appeals from decisions made by the First-tier Tribunal (Immigration and Asylum Chamber) (‘the First-tier Tribunal’).

2. The appellant (SK) appealed a decision of the respondent (SSHD) dated 28 October 2020 to refuse a protection and human rights claim. The appellant lodged an appeal to the First-tier Tribunal under section 82 of the Nationality, Immigration and Asylum Act 2002 (‘NIAA 2002’). The appeal could be brought on the ground that removal from the United Kingdom would breach the United Kingdom’s obligations under the Refugee Convention or would be unlawful under section 6 of the Human Rights Act 1998 (‘HRA 1998’).

3. The losing party in an appeal before the First-tier Tribunal can apply for permission to appeal to the Upper Tribunal. If permission is granted, the Upper Tribunal will consider the legal arguments put forward by both sides in the appeal. The Upper Tribunal only has power to set aside a decision of the First-tier Tribunal if it concludes that the arguments put forward by the party that applied to appeal show that the decision involved the making of an error of law: see section 12 of the Tribunals, Courts and Enforcement Act 2007 (‘TCEA 2007’).

4. If the Upper Tribunal finds that a decision of the First-tier Tribunal did not involve the making of an error of law, the First-tier Tribunal decision will stand. If a decision of the First-tier Tribunal is found to involve the making of an error of law the Upper Tribunal has power to set aside the decision. The Upper Tribunal will then decide whether it will remake the decision or whether the appeal might need to be reheard in the First-tier Tribunal.

5. A First-tier Tribunal judge dismissed the appellant’s appeal on Refugee Convention grounds but allowed the appeal on human rights grounds relating to his health. The appellant did not seek to appeal the Refugee Convention decision. The respondent appealed the human rights decision. The Upper Tribunal found that the human rights decision made by the First-tier Tribunal involved the making of an error of law. It set aside that part of the decision and returned the case to the First-tier Tribunal for a fresh decision to be made in relation to the human rights aspect of the appeal.

6. A different panel of the First-tier Tribunal dismissed the human rights appeal in a decision sent on 19 November 2024. The panel was not satisfied that the medical evidence produced in support of the appeal showed that there were substantial grounds for believing that the appellant was a ‘seriously ill person’ or that he would face a real risk of a ‘serious, rapid and irreversible decline in his state of health resulting in intense suffering’ or ‘a significant reduction in life expectancy’ ‘on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment’: see AM (Art.3; health cases) Zimbabwe [2022] UKUT 00131. The panel concluded that the appellant’s removal would not breach Article 3 (inhuman or degrading treatment) or Article 8 (private life) of the European Convention. It is this decision that is the subject of the appeal before the Upper Tribunal.

7. The Upper Tribunal has concluded that the arguments put forward by the appellant fail to show that the First-tier Tribunal decision involved the making of an error of law. The First-tier Tribunal’s findings were within a range of reasonable responses to the evidence.

Decision and reasons

Background

8. The appellant appealed a decision of the respondent dated 28 October 2020 to refuse a protection and human rights claim. The respondent found that the appellant had failed to provide sufficient reliable evidence to establish a credible account. The respondent found that the evidence relating to the appellant’s claim to fear persecution from the Moroccan authorities was internally inconsistent and that the expert medical and country evidence did not support his account.

9. The respondent made a supplementary decision on 06 August 2021 in response to further representations made on behalf of the appellant relating to the claimed reasons for his expulsion from Italy to Morocco in 2015. The respondent maintained the decision to refuse the protection claim and the human rights claim based on the appellant’s health.

10. First-tier Tribunal Judge Haria (‘the first judge’) dismissed the protection appeal in a decision sent on 14 December 2021. The judge also rejected the credibility of the appellant’s claim to fear persecution from the authorities in his country of origin. However, the judge allowed the appeal on human rights grounds relating to the appellant’s health with reference to Article 3 of the European Convention of Human Rights. The Secretary of State applied for permission to appeal to the Upper Tribunal in relation to the human rights aspect of the decision. In a decision sent on 04 August 2022 the Upper Tribunal found that the First-tier Tribunal decision involved the making of an error of law because the judge failed to give adequate consideration to differing opinions relating to the nature and extent of the appellant’s mental health condition. That aspect of the appeal was remitted to the First-tier Tribunal for a fresh decision to be made.

First-tier Tribunal decision (2024)

11. The human rights aspect of the appeal was reheard by a panel of the First-tier Tribunal (‘the panel’) comprising of First-tier Tribunal Judges Easterman and Gibbs. The issues for determination were whether the appellant’s removal would breach Articles 3 or 8 of the European Convention on grounds of his health. In addition to the medical evidence before the first judge, the panel considered up to date evidence. The most significant of which were reports by Dr Jens Wiebe, a Consultant Forensic Psychiatrist, dated 02 July 2024 and 05 July 2024.

12. In light of the decision made by the first judge, the panel found that the starting point was that the appellant was not a reliable witness. They found that this might affect the reliability of the information provided to medical professionals regarding his health. This much was also noted by Dr Wiebe who found that there had been a degree of exaggeration and dishonesty in his account [16]. Dr Wiebe observed that the account given by the appellant to Dr Malomo and Dr Galappathie about the treatment he received when he was removed to Morocco in 2015 was inconsistent. The panel accepted that Dr Wiebe’s willingness to engage with these issues gave weight to his report [17]. They went on to consider other aspects of Dr Wiebe’s report in some detail. The panel concluded that his report was the most reliable of the expert evidence [18]-[20]. Nevertheless, the panel went on to consider what weight could be given to the rest of the medical evidence before them [21]-[30]. The panel concluded that Dr Wiebe’s report was ‘strong medical evidence’ but made clear that his diagnosis must, in part, rely on the evidence of an unreliable witness. This was factored into his report [31]-[32].

13. The panel went on to find that, although Dr Wiebe’s report should be given weight, it was not ‘strong medical evidence of a serious illness’. In coming to this finding the panel placed weight on the fact that the appellant’s GP records from September 2023 to February 2024 indicated that he was not prescribed any medication. Nor had he been in contact with his GP since September 2023 when he failed to attend a meeting with the Community Mental Health Team. When Dr Wiebe was asked about what treatment the appellant might require when he gave oral evidence, he suggested that the appellant might benefit from talking therapies and ‘possibly’ medication [33]. The panel went on to consider paragraphs 5.1.3-5.1.14 of Dr Wiebe’s report and made the following findings:

’35. We find that this is evidence that the appellant does not suffer from disordered thought, have auditory or visual hallucinations, suffer from delusional thought or have a problem with memory or concentration. Further p.6.1.18 – 6.1.19 Dr Wiebe dismisses any diagnosis of depression or PTSD.

36. In reaching our finding that the appellant is not seriously ill we do not seek to minimise Dr Wiebe’s diagnosis and we have taken into account his statement at p.6.1.14 that a personality disorder is a serious mental disorder. However, what we must also take into account is how this affects the appellant day to day and the level of treatment required to manage his condition.

37. In our opinion Dr Wiebe’s oral evidence was very clear in the respect that in reaching his conclusions about the appellant, and particularly the risk that he would face on removal, two factors were of key significance; firstly an acceptance that the appellant had previously tried to commit suicide and secondly an acceptance that he had previously self-harmed.

38. Dr Wiebe’s evidence is that, being aware of the propensity for dishonesty he has sought to ‘triangulate’ the evidence in order to find objective corroborative evidence on these issues [6.6.1 quoted].

39. We are not persuaded however that we can simply follow Dr Wiebe’s findings regarding the credibility of the appellant’s previous suicide attempt or any previous acts of self-harm. We are the fact finders and must take into account the totality of the evidence before us on this issue. In doing so we once again remind ourselves that the appellant is not a reliable witness, and evidence in the view of his own expert has a tendency to exaggerate facts and symptoms to try to benefit himself.’

14. The panel considered the observations about the newspaper article contained in Dr Wiebe’s supplementary report and went on to find:

‘41. We agree with Dr Wiebe’s concerns and find that the article does not assist the appellant in establishing his claim that he has previously attempted to commit suicide. More than that however we find that this is evidence of the lengths that the appellant will go to, to try to establish his claim. We also find that this information is at odds with the appellant’s evidence to Nurse Chigoya in detention (12 August 2020) that he had attempted to commit suicide in Morocco in 2016.

42. We place weight on the fact that neither the appellant nor his wife make any reference in their numerous witness statements to a suicide attempt made in Italy. We also find that it is very significant that the appellant did not raise any attempt with either Dr Malamo, Dr Patel or Dr Galappathie.

43. We therefore find that Dr Wiebe was the first of the appellant’s experts to whom he disclosed a suicide attempt. Dr Wiebe does not, in our view, properly address this issue, which we find is significant, particularly given the importance that his acceptance of the appellant’s suicide attempt plays in Dr Wiebe’s risk assessment for the appellant. We also note that the appellant identified his children as his main protective factor (IRC records 22 September 2020) and we find that Dr Wiebe has not considered this in his assessment of the appellant’s risk.’

15. The panel was not satisfied that the appellant had produced sufficient reliable evidence to show that he was a person who had previously made a serious suicide attempt [44].

16. The panel went on to consider the evidence relating to the appellant’s claim to have self-harmed in the past. Dr Wiebe concluded that the appellant had self-harmed based on his own consideration of a scar that he saw on the appellant’s arm [45]. The panel found that the scar described did not appear to be recorded in Dr Malomo’s report and nothing in the IRC health records indicated that the appellant had self-harmed while in detention in the UK [46]. When he spoke to Dr Malomo the appellant only attributed two scars to self-harm while in prison in Italy [47]. The panel noted that Dr Malomo prepared his report at a time when there was no evidence to show that the appellant might be an unreliable witness. Nor did the assessment of those scars accord with the Istanbul Protocol [47]-[48]. The scarring recorded in the rule 35 report appeared to be attributed to torture [49]. The appellant had mentioned self-harm to Nurse Chigoya on 22 August 2020, but the panel noted that this was in the context of a threat to harm himself if he did not get the drugs that he wanted [50]. The panel also placed weight on the fact that the appellant had given inconsistent evidence as to when and where incidents of self-harm might have occurred. Nor was there any evidence to show that he had self-harmed since he had been in the UK despite a lengthy period of detention [51].

17. The panel accepted Dr Wiebe’s diagnosis of personality disorder with paranoid and unstable features, but did not accept that this was in itself evidence to show that the appellant was ‘seriously ill’ for the purpose of Article 3. At times the appellant had lived without any medical intervention. At its highest, the evidence showed that since he was released from detention in the UK the most treatment he had received was a prescription for Mirtazapine, a standard anti-depressant medication. For the reasons they had already explained, the panel was not satisfied that there was sufficient reliable evidence to show that the appellant had made a serious suicide attempt in the past or that he had self-harmed [52]. The panel noted Dr Wiebe’s opinion that there would be a real risk of serious harm if the appellant had previously made a serious suicide attempt or self-harmed. It seems that Dr Wiebe was asked for his opinion as to risk if those past events were not accepted. The panel recorded his oral evidence was that ‘it would be difficult to predict because of the appellant’s dishonesty.’ [54].

18. The First-tier Tribunal concluded that the appellant had failed to produce sufficient reliable evidence to show on the low standard of proof that he would face a reduction in his life expectancy or a serious, rapid and irreversible decline in his state of mental health [55]. In the alternative, the panel rejected the submission that the appellant would be unable to access required treatment in circumstances where he was receiving minimal, if any, treatment in the UK [56].

19. The panel turned to consider Dr Elliott’s country expert report. The judges were not persuaded that the appellant would not be able to access the medical assistance scheme which was available in Morocco. Dr Wiebe’s report suggested that the appellant did not appear to suffer from any clinical memory impairment that would prevent him from engaging in treatment [57]. The examples of people not renewing their card related solely to women but did not discuss the individual circumstances of this appellant (who has family members in Morocco). Nor did Dr Elliott discuss whether the only treatment that the appellant says he is in receipt of (Mirtazapine) was available in Morocco [58].

20. Finally, the panel considered whether the appellant would face ‘very significant obstacles to integration’ in Morocco as a result of his mental health condition with reference to the private life requirements of the immigration rules. They noted that he had been able to adapt to life in various European countries and continued to have cultural, linguistic and social ties to Morocco [59]. The evidence showed that he only required limited access to medical treatment [60]. They noted what Dr Elliott had said about the stigma associated mental health issues in Morocco ‘affecting their opportunities to establish themselves outside their familial network.’ However, the panel went on to find that the evidence showed that the appellant’s condition was not immediately apparent, and that according to Dr Wiebe’s evidence, ‘he is able to function.’ For this reason, the First-tier Tribunal was not satisfied that the appellant would become so excluded from society that he would be unable to reestablish a private life there [61]. For these reasons, the appeal was dismissed.

Upper Tribunal proceedings

21. The appellant applied for permission to appeal to the Upper Tribunal on the following grounds:

(i) The First-tier Tribunal failed to give adequate consideration to the evidence suggesting that the appellant was treated as an in-patient in Italy in January 2015 when assessing whether the appellant suffered from a ‘serious illness’.

(ii) The First-tier Tribunal ‘misstated’ the evidence relating to whether the appellant had mentioned any previous suicide attempts to medical or mental health professionals before speaking to Dr Wiebe in 2024.

(iii) The First-tier Tribunal failed to give adequate reasons or made ‘illogical’ findings relating to Dr Wiebe’s opinion that the scar shown to him was likely to be evidence of self-harm by cutting.

(iv) The First-tier Tribunal ‘misstated’ the evidence of Dr Wiebe as to whether there was any evidence of memory impairment or concentration. It was submitted that, even a witness who is telling the truth might make mistakes in their recollection of events.

(v) The First-tier Tribunal ‘misstated’ the evidence contained in Dr Wiebe’s report as to whether the appellant is likely to suffer from disordered thought or auditory or visual hallucinations. It was submitted that Dr Wiebe found that the appellant appeared to experience transient paranoid states albeit they did not reach delusional intensity.

(vi) The First-tier Tribunal failed to engage adequately with the country expert reports of Dr Elliott relating to the availability of treatment and the living conditions that the appellant would face in Morocco.

22. Permission to appeal was granted by an Upper Tribunal judge in an order sent on 12 June 2025.

23. We have considered the First-tier Tribunal decision, the documentation that was before the First-tier Tribunal, the grounds of appeal, and the submissions made at the hearing, before coming to a decision in this appeal. It is not necessary to summarise the oral submissions because they are a matter of record, but we will refer to any relevant arguments in the decision.

24. We bear in mind that judicial caution and restraint is required when considering whether to set aside a decision of a specialist tribunal. In particular, judges of a specialist tribunal are best placed to make factual findings: see HA (Iraq) v SSHD [2022] UKSC 22. Appellate courts should not rush to find misdirections simply because they might have reached a different conclusion on the facts or expressed themselves differently: see AH (Sudan) v SSHD [2007] UKHL 49 and KM v SSHD [2021] EWCA Civ 693. Where a relevant point is not expressly mentioned by the tribunal, the court should be slow to infer that it has not been taken into account: see MA (Somalia) v SSHD [2020] UKSC 49. When it comes to the reasons given by the tribunal, the court should exercise judicial restraint and should not assume that the tribunal misdirected itself just because not every step in its reasoning is fully set out: see R (Jones) v FTT (SEC) [2013] UKSC 19.

Dr Wiebe’s reports

25. The appellant’s case before the First-tier Tribunal, and before us, relies heavily on the more up to date reports prepared by Dr Wiebe in July 2024. The first is a detailed report dated 02 July 2024. The second is a supplementary report dated 05 July 2024, which made observations about an online newspaper report that the appellant said related to a suicide attempt while he was living in Italy. Given the significance of these reports it may be helpful to make some overarching observations about Dr Wiebe’s evidence before considering the grounds of appeal in more detail.

26. The First-tier Tribunal and the Upper Tribunal were both impressed by the quality of Dr Wiebe’s reports. There was no dispute as to his qualification to make an assessment in relation to the appellant’s mental health. Dr Wiebe was conscious of his duty as an expert witness throughout the reports. He wrote a careful, well-balanced, and detailed report considering previous opinions given by Dr Oluseyi Malomo (Consultant Psychiatrist), Dr Nuwan Galappathie (Consultant Forensic Psychiatrist), records from the immigration removal centre (IRC) medical team, GP records, and evidence relating to past treatment in Italy in 2015.

27. Where relevant, Dr Wiebe noted divergences between medical professionals as to the appellant’s likely condition and gave reasons for his own opinions. Dr Wiebe saw the appellant after the first judge had already dismissed his appeal at a time when the appellant was waiting for a fresh decision to be made in relation to the human rights appeal based on his health. It is clear from the report that Dr Wiebe bore in mind that the first judge had found aspects of the appellant’s account to be unreliable. In assessing the appellant’s health, Dr Wiebe considered whether there was any evidence to indicate that he might be exaggerating of feigning any of his symptoms [1.18 pg.293].

28. We have no hesitation in accepting that the report prepared by Dr Wiebe is of good quality. However, many of the arguments put forward by the appellant rely on an interpretation of the report taken at its highest. In fact, Dr Wiebe’s opinions were more nuanced and he himself outlined limitations.

29. First, Dr Wiebe is not the appellant’s treating clinician. The report was based on an assessment done over the course of two interviews, lasting around four hours in total. Although he could conduct his own mental state examination in that time, and had the benefit of the opinions of other medical professionals, any assessment is by its nature more limited than an opinion given by a treating clinician who would benefit from a more developed knowledge of their patient’s condition. It is notable that, despite the stated severity of the appellant’s condition, no significant evidence appears to have been produced from a treating clinician in the UK.

30. Second, Dr Wiebe made clear that he was acutely aware of the fact that the assessment was being done in the context of legal proceedings and that ‘it would be naïve to take his account at face value’ [1.16 pg.295]. He made clear that it should not be assumed that he accepted information uncritically [1.17 pg.295]. Nevertheless, he went on to accept various documents said to relate to the appellant’s previous treatment at face value e.g. the letter relating to previous treatment in Italy. Throughout the report he rightly pointed out that matters relating to the credibility of factual aspects of the appellant’s account were not for him to decide and he proceeded to ‘triangulate information’ in the best way he could to assist the Tribunal.

31. Third, when asked whether the appellant could be feigning or exaggerating his symptoms Dr Wiebe considered that ‘a degree exaggeration and dishonesty’ was a feature of the appellant’s account [6.2.12 pg.327]. He also considered that there was some evidence to suggest that the appellant ‘may not be truthful when disclosing details about his history and symptoms’ [6.3.1 pg.327]. He pointed out various inconsistencies in the appellant’s account of his symptoms and his clinical presentation. At different points in the report, Dr Wiebe indicated some doubts about the appellant’s account of ‘hearing voices’. For example, Dr Wiebe considered that the appellant’s account of auditory and visual hallucinations lacked detail and was not accompanied by affective changes [5.1.12–5.1.13 pg.320]. His account was not in keeping with ‘delusional intensity’. He qualified this part of the report by describing the appellant’s reported symptoms, ‘if genuine’, as more in keeping with ‘pseudo-hallucinations’ and or ‘overvalued ideas’. These findings appeared to underpin his conclusion that the appellant was likely to have a personality disorder with paranoid and emotionally unstable features rather than suffering from a psychotic disorder or schizophrenia as suggested by Dr Malomo and Dr Galappathie.

32. Fourth, Dr Wiebe’s opinion regarding the risk of suicide was qualified in a similar way. He emphasised that the past incident of attempted suicide described by the appellant would be of ‘high significance’ to any assessment of the risk of suicide [4.6.5 pg.316]. He reiterated that a confirmed past suicide attempt by jumping from a bridge ‘would be a strong indicator of future suicide risk’. However, this opinion was given taking the appellant’s account at its highest. Dr Wiebe made clear that the past history was a factual matter for the Tribunal to determine [6.4.4, 6.5.4 & 6.6.1]. In other words, his opinion was dependent on the Tribunal accepting that there had been a serious attempt to commit suicide the past.

33. Fifth, Dr Wiebe’s second report indicates that he was only provided with a copy of the newspaper report said to relate to the appellant’s attempt to commit suicide in Italy after he had concluded the first report. In the second report he was even more careful not to express any concluded view as to the factual basis of this aspect of the claim. Dr Wiebe summarised the content of the newspaper report. He then listed a series of observations relating to the report before making clear that it was outside his area of expertise to come to any conclusion on the facts. Nevertheless, the panel of the First-tier Tribunal relied on those observations to come to their own conclusion that the account of a past-suicide attempt was unreliable [40]-[41].

34. Dr Wiebe observed that: (i) the appellant was not named in the article and could not be identified in the blurred photographs; (ii) the incident was said to have taken place in Prato, where the appellant said he lived at the time; (iii) the reported incident took place in 2011, not in 2008 as stated by the appellant; (iv) the report stated that a man was rescued from the water after falling in the river near a bridge, whereas the appellant told him that he fell on hard floor; (v) the article refers to the man being in a ‘confused stated of mind’, which might support the appellant’s account of suffering from a mental health crisis, though other explanations were possible, such as intoxication; (vi) the article did not contain sufficient information to either confirm or dismiss the account of this being a suicide attempt.

35. Sixth, Dr Wiebe’s opinion as to the likelihood of deterioration on return appeared to be premised on an assumption provided to him by the appellant’s solicitor that he would be unable to access healthcare if returned to Morocco [1.8 pg.293]. Given the absence of evidence of any significant or ongoing treatment in the UK, Dr Wiebe did not appear to consider what impact the availability of family support in Morocco might have on his opinion.

36. Seventh, Dr Wiebe’s opinion diverged from those of Dr Malomo, Dr Galappathie, and Dr Patel in the IRC health team. He did not consider that there was any evidence to show that the appellant was likely to suffer from episodes of psychosis, nor that he met the diagnostic criteria for depression or Post-Traumatic Stress Disorder (PTSD), nor was there any clinical evidence of memory impairment.

37. We make these preliminary observations in relation to Dr Wiebe’s report to emphasise that he approached the difficult task of marshalling a large amount of information relating to the appellant’s history and previous medical opinions with some care. He made a diagnosis based on his own mental state examination and with reference to the previous opinions of other mental health professionals. In doing so, he did not necessarily accept that all of the symptoms described by the appellant. He bore in mind that the credibility of the appellant’s account was in issue but proceeded to make his assessment of suicide risk based on his account of a past suicide attempt taken at its highest. Dr Wiebe was well aware of his role as an expert witness and was careful not to express his own opinions as to the credibility of certain aspects of the appellant’s account.

Ground 1 – historic evidence of psychiatric treatment in Italy

38. It is argued that the panel’s finding that there was insufficient reliable evidence to show that the appellant suffered from a serious illness was flawed because the judges failed to give adequate consideration to the medical evidence of previous in-patient treatment in Italy in 2015.

39. The evidence was contained in a photocopy of a document that is said to be a medical record relating to an admission to hospital in Italy on 13 January 2015 [original pg.635 / translation pg.617]. We have not been pointed to any evidence to indicate that his UK solicitor obtained the evidence directly from the relevant hospital in Prato. The photocopy of the original document shows logos for the Health Service of Toscana in Prato at the head and foot of the document. There is no signature or other official stamp or endorsement. The nature of the document is unclear. The document does not appear to be a letter from the hospital to a doctor in general practice. Nor does it appear to form part of printed medical records. Nor does it appear to be a formal medical report for proceedings that might have taken place in Italy. The document appears to be a discharge summary albeit this is not stated on the face of the document.

40. The translation indicates that the appellant was brought to the psychiatric unit in an agitated state by the police. He left the unit but then returned later in the afternoon. He stayed overnight on a voluntary basis. The notes record a diagnosis of ‘personality disorder’. The appellant was reported to be ‘excited and logorrheic tones showing psychosis, loosening associative links, megalomaniac and paranoid ideation.’ It was noted that he had a good rest overnight and that ‘it seems that he had slept little for days’. His condition was reported to have improved overnight and he was able to give a more comprehensible version of the events that triggered his hospitalisation, which was confirmed in a subsequent conversation with his wife. However, the document does not go on to say what event triggered his admission. The notes recorded that the appellant was seen by a doctor from Addiction Treatment Services the next day to consider his 20 year use of THC. The suggestion, but no more, is that the deterioration in the appellant’s mental health on that occasion was likely to be linked to his long term use of cannabis. An appointment was booked with the Addiction Treatment Services later that month. The ‘offered therapeutic program’ was Olanzapine (an anti-psychotic drug) and Valium drops (a sedative) and a follow up appointment with a doctor from the unit a few days later. There is no evidence of ongoing treatment in Italy following this brief overnight admission in January 2015.

41. Having considered this evidence we conclude that the First-tier Tribunal’s failure to specifically refer to it does not disclose a material error of law that would have made any material difference to the outcome of its assessment of whether the appellant suffered from a serious illness.

42. It was open to the panel to consider what weight to place on the evidence relating to the appellant’s health in the context of his overall credibility. The appellant’s account of how long he spent in hospital during 2015 varied between his witness statements, the history he gave to medical experts, and the 2015 discharge summary. We note that the appellant previously produced false medical evidence said to be from a clinic in Morocco to support an application to revoke the expulsion order made by the Italian authorities. His explanation that this evidence was given to his wife by family members in Morocco without his knowledge was weak. The appellant sent a copy of the application to revoke the expulsion order made in Italy in 2019 with his initial asylum application, which referred to him having received treatment in Morocco for a period of 20 months from 2016. It is not plausible that he would have no knowledge of the evidence prepared for such an important application.

43. Even if the discharge summary from Italy is taken at its highest, it indicates a similar diagnosis to Dr Wiebe. The evidence was dated. It did not indicate that the appellant required any significant in-patient treatment on that occasion beyond a night of sleep in hospital. Follow up support was offered with addiction treatment services. However, there appears to be no other evidence to show that the appellant required any significant ongoing treatment or support in Italy after this incident. There is no evidence to show whether he was prescribed and took the medication that was recommended.

44. It is difficult to see how this evidence of a brief admission to hospital in 2015, some nine years before the hearing, was capable of making any material difference to the findings made by the First-tier Tribunal. The panel accepted Dr Wiebe’s diagnosis that the appellant was likely to be suffering from a personality disorder with paranoid and emotionally unstable features. Even if the letter from the hospital in Italy was considered to be reliable, at highest, it showed a brief overnight admission with no meaningful evidence of any ongoing treatment following his discharge. It would have made no material difference to the panel’s assessment of the situation disclosed by the evidence at the date of the hearing. It was within a range of reasonable responses to the evidence for the panel to conclude that there was no evidence of any admissions to hospital nor of any meaningful treatment for a serious illness of the kind required to engage the high threshold required in health cases since the appellant arrived in the UK in 2020.

Ground 2 – previous reference to suicide attempt

45. It is argued that the panel ‘misstated’ the evidence when it observed that the appellant did not mention a previous suicide attempt in Italy until he spoke to Dr Wiebe. We read the assertion about the misstatement of evidence to be arguing that the First-tier Tribunal made an error of fact. Having considered the evidence in more detail, we find that the argument put forward in the second ground is misleading and misconceived.

46. A large number reports have been prepared in this case. Dr Galappathie alone seems to have prepared four reports during the course of 2021 and another two reports in 2024. The reference that Mr Halim relied on was contained in Dr Galappathie’s report dated 27 May 2021 in a summary of the mental state examination [pg.159]. At the end of this paragraph, Dr Galappathie made the following statement: ‘He did not report any thoughts about self-harm or suicide, but showed me scars from previous acts of self-harm and attempted suicide.’ However, this seems to have been an unparticularised comment by Dr Galappathie. When the report is read in full, it does not appear to record any detailed assessment of the scarring nor did the appellant appear to disclose details of any previous attempt to commit suicide. This seems to have been a generalised assumption made by Dr Galappathie based on his consideration of unspecified scarring.

47. When asked to clarify whether the appellant had given the details of a previous suicide attempt to Dr Galappathie at that time, Mr Halim could not refer us to any section in the report of 27 May 2021. Instead, he referred us to a section contained in Dr Galappathie’s report dated 13 February 2024, nearly three years later. Even then, in the section of the report that Mr Halim relied on Dr Galappathie was summarising a letter dated 17 May 2023 from a Community Mental Health Nurse who recorded that the appellant had said that ‘when he was [in] Italy, he tried to jump from a bridge due to hearing voices.’ He said that ‘he broke his leg and had pins in his ankle.’ Beyond that summary of the medical evidence, there is nothing in Dr Galappathie’s report to suggest that the appellant had disclosed the details of a significant suicide attempt during the course of at least three meetings.

48. We conclude that the second ground is inaccurate in suggesting that there was evidence to show that the appellant had disclosed a serious suicide attempt to Dr Galappathie. Nothing in the reports appears to suggest that this was the case. Dr Galappathie only noted that there was a record of the appellant having mentioned an incident in Italy to a community mental health nurse.

49. The first time that the appellant appeared to mention such a significant incident seems to have been to the community mental health nurse on 15 May 2023. This was after the first judge had dismissed the appeal in relation to his protection claim and the appeal was due to be reheard in relation to the human rights claim.

50. Although there is some evidence to show that the incident was reported to the nurse on 15 May 2023, it was not a ‘misstatement’ of the evidence for the panel to conclude that Dr Wiebe was the first of the appellant’s experts to whom he mentioned a suicide attempt in Italy [43]. It was open to the panel to take into account the fact that the appellant had not previously mentioned such a significant incident to any of the previous medical experts who were instructed to write reports. We were not referred to any mention of this incident in any of the interviews, witness statements, the expert reports, or the medical records (save for the note taken by the community mental health nurse).

51. In assessing the reliability of the appellant’s account of this incident, it was open to the panel to take into account his overall credibility as a witness. It was also open to the panel to consider the inconsistencies between the appellant’s own account of this incident and the information contained in the newspaper report. It was within a range of reasonable responses for the panel to find that the evidence did not disclose any clear or consistent history relating to incidents of self-harm or suicide attempts. For these reasons, we conclude that the second ground does not disclose an error of law that would have made any material difference to the outcome of the appeal.

Ground 3 – inadequate findings relating to scarring on arm

52. It is argued on behalf of the appellant that the panel failed to give adequate weight to Dr Wiebe’s opinion relating to scarring on the appellant’s arm. The evidence that was before the panel relating to incidents of scarring was as unclear and varying as the psychiatric evidence.

53. A rule 35 report was prepared on 14 August 2020. Such reports are only intended to assess a person’s fitness to be detained and are not as thorough as a full scarring report that considers the consistency of scars with their stated causes in accordance with the Istanbul Protocol. The report summarised the history given by the appellant. The appellant told the doctor that he had scars from being beaten while in detention in Morocco. He also said that he was ‘admitted to a mental hospital as he self-harmed’. No details were recorded as to when or where this admission took place. It seems unlikely that the appellant was describing the admission that he says took place in Italy in January 2015 because there is no mention of self-harm in the discharge summary. The rule 35 report did not give any further detail beyond that generalised information.

54. The rule 35 report also contained a body map identifying areas of scarring. The GP in the detention centre noted the appellant’s report of scars on his head. The doctor also recorded transverse scar marks on the shins of both legs, scar marks on the appellant’s chest and abdomen, and several scars on his back. The body map also appears to record around nine scars on the appellant’s left arm, which were described as follows: ‘Deep and long vertical scar marks L arm and forearm along with multiple transverse scar marks L forearm. Looks like self-inflicted.’

55. Dr Malomo prepared a report relating to scarring dated 09 September 2020. This report seems to be omitted from the Upper Tribunal bundle but was in the Home Office bundle before the First-tier Tribunal. Dr Malomo is a Consultant Psychiatrist. Beyond having completed medical training, and the possibility that he might have experience of patients having self-harmed, he did not outline any specific training or qualifications to comment on scarring. Nevertheless, the report documented four scars and was prepared with some reference to the relevant criteria contained in the Istanbul Protocol albeit only in relation to two of the scars.

56. The report was prepared at an early stage when the credibility of the appellant’s account of detention in Morocco had not yet been called into question. Dr Malomo recorded several scars that the appellant attributed to ill-treatment while in detention in Morocco. The scars that were attributed to self-harm in the past were (i) a lateral scar on his abdomen; (ii) two lateral scars on his right leg. Both were attributed to self-harm during a period of mental ill-health while he was detained in Italy. Dr Malomo did not consider whether they were consistent with the stated cause nor whether there could be alternative causes. Despite what had already been noted in the rule 35 report, Dr Malomo’s report did not record any scarring on the appellant’s arms or back. The fact that the report did not consider all scarring, and did not apply the Istanbul Protocol to every scar recorded, significantly reduced the weight that could be placed on his expert opinion.

57. Dr Galappathie’s reports also provide a mixed account of scarring. Dr Galappathie did not conduct a formal scarring assessment but noted when the appellant showed him scars on his left arm. He also summarised what was said in the IRC records in his first report dated 26 May 2021. On that occasion the appellant attributed the scarring on his arm and shoulder to self-harm that occurred in Morocco [pg.150]. However, on the same page, Dr Galappathie noted that the IRC records indicated that the appellant attributed the scarring on his arm to torture by the police in Morocco when he spoke to a consultant psychiatrist in the detention centre. Dr Galappathie noted that the appellant also showed Nurse Chigoya scars on his shoulder and leg as evidence of self-harm when he wanted medication to be prescribed to him. However, the records did not indicate when or where the appellant said the scars were caused on that occasion [pg.151][pg.420]. The appellant told Dr Galappathie that he tried to commit suicide in 2016, which was at a time when he was likely to be in Morocco [pg.151]. No details were provided.

58. None of the evidence before the panel appeared to disclose any clear, consistent, or chronological account of the scarring recorded in the body map contained in the rule 35 report. It was not clear on how many occasions the appellant might have self-harmed. Nor was it clear when, where, or why he might have self-harmed. At times he suggested that he self-harmed due to hearing voices, another time he suggested that it was because he was depressed, another time he suggested that he was distressed while in detention in Italy. At least one of the scars on his left arm seems to have been variously attributed to torture or self-harm. The appellant reported that he had in-patient treatment in Italy in 2015 for 2 months and 3 months was not consistent with the single piece of evidence of an overnight stay in a psychiatric unit in January 2015, his wife’s statements, or the history he later gave to Dr Wiebe [4.6.9–4.6.10 pg.317].

59. Dr Wiebe also noted that the history of self-harm given by the appellant ‘varied regarding the triggers.’ [4.6.12 pg.317]. On some occasions the appellant said that he acted on hearing voices even though he did not want to self-harm. Elsewhere in his report, Dr Wiebe explained why the appellant’s reported symptoms did not appear to be consistent with a clinical diagnosis of auditory hallucinations or psychosis. Dr Wiebe noted that on other occasions the appellant suggested that he acted with suicidal intent or during periods of distress.

60. In the same paragraph, Dr Wiebe said that the appellant showed him ‘a scar on his left forearm, which he claimed was self-inflicted while in Morocco.’ Dr Wiebe did not describe the size, nature, or the position of the scar in any detail to know whether it might have been one of the scars recorded in the rule 35 report. We note that the description of it being on the appellant’s left forearm is broadly consistent with the body map in the rule 35 report although it is perhaps surprising that Dr Wiebe did not observe more than one scar if he was looking at the anterior aspect of the forearm.

61. A few paragraphs before this, Dr Wiebe had recorded the appellant’s claim that he cut himself while he was in prison/detention in Italy [4.6.7 pg.316]. Again, no specific account seems to have been given as to which scars were attributed to past self-harm in Italy or in Morocco.

62. Later in the report Dr Wiebe cited the scar that he had seen on the appellant’s arm as one of the pieces of evidence that underpinned his opinion relating to the risk of self-harm or suicide. He said that he considered the scar to be ‘the consequence of self-harm’ but did not give reasons for coming to this conclusion [6.6.1 pg.331]. Dr Wiebe did not consider the scarring in the structured way recommended by the Istanbul Protocol. He did not consider whether the scarring could be consistent with other causes. We do not criticise Dr Wiebe for this omission because he was not instructed to consider scarring.

63. Nevertheless, Dr Wiebe’s opinion relating to the scarring on the appellant’s forearm was consistent with the opinion of the doctor who prepared the rule 35 report. Both doctors considered that at least one of the scars on the appellant’s left forearm had the appearance of a self-inflicted injury. We accept that the existence of several transverse scars on the appellant’s left forearm, but not his right forearm, is broadly consistent with the possibility of self-inflicted injuries. On behalf of the respondent, Mr Irwin said that it was not disputed that the appellant might have self-harmed at some point in the past. However, it was argued before the First-tier Tribunal that the evidence did not show that the risk was sufficiently serious to meet the high threshold required to show a breach of Article 3 on health grounds.

64. It is argued on behalf of the appellant that the panel erred in failing to give sufficient weight to the opinion of Dr Wiebe when they concluded that there was insufficient reliable evidence to show that the appellant was likely to be a seriously ill person who was at risk of self-harm or suicidal behaviour.

65. In relation to the risk of self-harm the first piece of evidence the panel considered was Dr Wiebe’s opinion about the scar seen on the appellant’s left arm [45]. They also considered the evidence contained in Dr Malomo’s report [46]. It was open to the panel to find, for essentially the same reasons we have already observed, that little weight could be given to Dr Malomo’s report [47]. We accept that the panel’s findings at [49] appear to have overlooked the fact that the rule 35 report did record scarring on the appellant’s left forearm that ‘looks like self-inflicted’. The panel went on to note that the appellant had raised the issue of self-harm with Nurse Chigoya on 22 August 2020, but it was open to them to take into account the fact that this appeared to be in the context of the appellant ‘trying to get his own way’ in relation to medication.

66. The panel went on to find that the appellant’s account of self-harm varied as to whether it happened in Italy or Morocco. They took into account the fact that he was a vulnerable witness but also had regard to the fact that Dr Wiebe had found no clinical evidence of memory impairment [51]. Those were findings that were open to the panel to make on the evidence.

67. The reason why we have outlined the evidence in some detail is to illustrate the fact that it did not present a clear history of past self-harm. Although there was some indication that the appellant might have self-harmed at some point, there was no detailed or reliable scarring report itemising the scars in accordance with the Istanbul Protocol. Neither the rule 35 report, Dr Malomo’s report, Dr Galappathie’s generalised observations, nor Dr Wiebe’s opinion relating to a single scar, taken individually or together, presented a coherent picture of the nature and extent of any previous history of self-harm.

68. While we accept that Dr Wiebe is likely to have experience of treating patients who have self-harmed, even if his evidence was taken at its highest, it was limited to an observation about a single scar without any further detail or any reasons to explain his opinion. We bear in mind that self-harm may also be an indicator of distress and is not always indicative of a serious suicide attempt. The exact nature and the extent of the appellant’s history of self-harm was therefore relevant to the assessment of risk.

69. Even on the appellant’s confused and varying account, the broad picture indicates that he may have led a difficult life that could have given rise to any number of injuries over time. His early life in Morocco may have involved physical work with his father in the docks. He made several illegal journeys into Europe with attendant risks. He said that he was also involved in the selling of drugs during his early years in Italy. The evidence also indicates that he may have had a long term issue relating to drug misuse. The buying and selling of drugs might give rise to the risk of injury from criminal elements and/or the risk of injury while using drugs. The appellant has also given an account of difficult periods living on the streets in Europe. We outline this history to illustrate why it would be important for any scarring to be carefully itemised in accordance with the Istanbul Protocol. Despite a number of medical professionals having noted the existence of scarring, the evidence as a whole did not begin to identify how many scars the appellant attributed to self-harm or whether they could be attributed to other forms of injury.

70. For the reasons given above, we conclude that it was within a range of reasonable responses for the panel to conclude that the evidence was not sufficiently clear or reliable to show that the appellant had made serious attempts to self-harm or to commit suicide in the past [53] such that there would be a real risk of serious harm if removed [55]. Although the appellant gave an account of becoming distressed during the process of his removal from Italy there was little reliable evidence to show that this was as a result of a serious mental illness. Such distress could be managed through safeguarding procedures prior to and during removal. The evidence showed that on the previous occasion the appellant was supported by his siblings when he returned to Morocco. They also assisted him to access some limited healthcare. For the reasons given above, we conclude that the third ground amounts to a disagreement with the panel’s findings on the evidence and fails to disclose an error of law.

Ground 4 – ‘misstatement’ of evidence relating to memory impairment
Ground 5 – ‘misstatement’ of evidence relating to disordered thought / hallucinations

71. The fourth and fifth grounds make submissions disagreeing with the panel’s findings without disclosing any errors of law.

72. Mr Halim did not expand on the fourth ground in oral submissions. In light of Dr Wiebe’s report it was open to the panel to conclude that there was no reliable evidence to show that the appellant suffered from any significant memory impairment. The fourth ground merely points out that anyone could be mistaken in their recollection of events, but fails to particularise how or why this broad statement might be relevant. It was within a range of reasonable responses for the panel to take into account numerous inconsistencies in the appellant’s account when assessing the reliability of his evidence, including the history given to the various health professionals who prepared reports in support of the appeal.

73. Similarly, it is not arguable that the panel’s conclusion that there was no reliable evidence to show that the appellant suffered from disordered thought or from auditory or visual hallucinations was not open to them in light of Dr Wiebe’s report. He was careful to explain why he came to a different conclusion to the doctors who had previously given a possible diagnosis of paranoid schizophrenia. Dr Wiebe was careful to explain why he did not consider the symptoms described by the appellant, ‘if genuine’, were of the nature and intensity that would normally be seen in psychotic episodes albeit he described the appellant’s stated symptoms as ‘pseudo-hallucinations’. The fifth ground makes no attempt to identify how or why the possibility that the appellant might suffer pseudo-hallucinations was likely to make any material difference to the overall conclusions of the First-tier Tribunal.

Ground 6 – inadequate engagement with Dr Elliott’s country report

74. The last ground also sets out submissions on the evidence contained in the country expert report of Dr Elliott but fails to identify any material error of law in the First-tier Tribunal decision.

75. Again, it might be helpful to make some overarching observations about Dr Elliott’s reports. There appears to be no dispute that she is qualified to comment on the overall situation in Morocco. Albeit her area of research and expertise does not relate to health services, she outlines a great deal of experience of living and working in Morocco and was able to provide detailed information about identity documents and the systems for access to basic health services.

76. Dr Elliott acknowledged that the credibility of the appellant’s account had been questioned [pg.357][pg.358]. Nevertheless, we observe that her conclusions seem to have been premised on two factual assumptions.

77. First, an assumption that the appellant would be returned to Morocco to live on his own [pg.369]. Although she was aware that the appellant had siblings in Morocco [pg.378] the possibility of assistance and support from relatives does not appear to have been addressed in any detail. Nor did the fact that the appellant had previously worked in Morocco seem to be considered. Nothing in the medical evidence suggested that his condition rendered him unfit to work.

78. Second, an assumption that the appellant’s mental health condition was sufficiently serious and that there was likely to be a significant deterioration in his condition if returned such that he would require assistance with referrals [pg.384-385]. Again, the possibility of assistance and support from his siblings did not appear to be considered. The appellant’s account of how long he spent in Morocco when he was removed from Italy has also been inconsistent. On at least one version of events he spent at least 11 months in Morocco living with members of his family before leaving to travel to Europe again.

79. It is clear from the decision that the panel considered Dr Elliott’s report because they made direct reference to it when coming to their conclusions about the consequences of removal [58]-[59]. The panel found that there was insufficient reliable evidence to show that the appellant suffered from a serious illness. The evidence showed, at its highest, that his condition was treated with ‘minimal medical intervention in the UK’. It was open to the panel to observe that Dr Elliott did not address the availability of the only medication that the appellant was said to receive in the UK, which was a standard anti-depressant. We note that the evidence also showed that, even when the appellant had been referred to secondary mental health services in the UK, he did not attend appointments or engage with the specialist teams. Having considered Dr Wiebe’s report, it was open to the panel to conclude that there was nothing to suggest that the appellant would be unable to function.

80. Mr Halim submitted that the panel failed to give adequate consideration to the possibility of destitution outlined in Dr Elliott’s report. However, this fails to take into account the fact that her report was premised on the assumption that he would be returned with no family support. In fact, the evidence showed that the appellant’s family had provided support to him after he returned to Morocco in 2015. The report also seemed to be based on an assumption that the appellant’s mental health was such that he might be unable to work to support himself, but that was not an assumption born out by the appellant’s own evidence or the medical evidence.

81. In the circumstances, it was open to the panel to conclude that any obstacles to accessing medical services might not be insurmountable given the minimal level of treatment that the appellant was receiving in the UK. They were satisfied that despite his mental health condition he had been able to overcome difficulties to establish himself in Italy and then in other countries in Europe. The panel found that the appellant continued to have cultural, linguistic and social ties to Morocco that would enable him to reintegrate within a reasonable period of time. It was also open to the panel to conclude that the evidence did not show that this mental health condition was sufficiently serious to give rise to ‘very significant obstacles’ to reintegration.

82. Although there was some evidence to indicate that the appellant is a vulnerable person who might have self-harmed in the past, the evidence relating to potential scarring was vague and incomplete. The appellant’s account of events was confused and inconsistent. The evidence relating to the exact nature of the appellant’s mental health condition also varied between different medical professionals. Although the panel accepted Dr Wiebe’s assessment that the appellant had a personality disorder, it was open to them to find that his condition only gave rise to ‘minimal intervention’ since he has lived in the UK. We conclude that the panel gave adequate reasons to explain why there was insufficient reliable evidence to show that the appellant was a ‘seriously ill person’ or that removal was likely to lead to a ‘serious, rapid and irreversible decline’ in his mental health to engage the high threshold required to show a real risk of a breach of either Articles 3 or 8 of the European Convention.

83. For the reasons given above, we conclude that none of the grounds put forward on behalf of the appellant show that the First-tier Tribunal decision involved the making of an error of law. The decision shall stand.

Notice of Decision

The First-tier Tribunal decision did not involve the making of an error on a point of law

The decision shall stand

M. Canavan
Judge of the Upper Tribunal
Immigration and Asylum Chamber

05 January 2026