Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2025-002652
First-tier Tribunal No: PA/00092/2022

THE IMMIGRATION ACTS

Decision & Reasons Issued:

On 7th of May 2026

Before

UPPER TRIBUNAL JUDGE MAHMOOD

Between

UH
(ANONYMITY ORDER CONTINUED)
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Mr G Brown of Counsel (attended remotely) instructed by Parker Rhodes Hickmotts Solicitors
For the Respondent: Mr Dwyncz, a Senior Home Office Presenting Officer

Heard at Phoenix House (Bradford) on 9 March 2026

Order Regarding Anonymity
Pursuant to rule 14 of the Tribunal Procedure (Upper Tribunal) Rules 2008, the Appellant is granted anonymity. No-one shall publish or reveal any information, including the name or address of the Appellant, likely to lead members of the public to identify the Appellant. Failure to comply with this order could amount to a contempt of court. The parties may apply on notice to vary this order.

DECISION AND REASONS
Introduction
1. The Appellant, a national of Albania, appeals against the decision of First-tier Tribunal Judge M Smith (“the Judge”) promulgated on 23 April 2025 refusing her human rights appeal based on Articles 3 and 8 of the European Convention on Human Rights (ECHR).
2. My task is to consider whether or not there is a material error of law in the Judge’s decision. If there is no material error of law then the Judge’s decision which had dismissed the Appellant’s appeal will stand. If I conclude that there is a material error of law in the Judge’s decision then I shall either remake the decision or I shall remit the matter for rehearing to the First-tier Tribunal.
The Grant of Permission to Appeal
3. Permission to appeal was refused by the First-tier Tribunal and was later granted on 1 December 2025 by Upper Tribunal Judge Neville. The learned Judge observed when granting permission that:
“Judge M Smith observed at [36] that the “real focus of this case is the availability of the drug Rituximab in Albania”, with the caveat at [43] that the consequences of its non-availability would not necessarily reach the Article 3 threshold. The rejection of the Article 3 claim then rested on a finding that the appellant’s son would earn significantly more than the minimum wage in Albania and therefore be able to pay for the drug privately while supporting himself and his mother.

3… the grounds’ challenge to the above finding narrowly crosses the threshold of arguability such to merit substantive consideration. As the other issues in the appeal were framed according to that finding, all grounds may be argued.”
The Hearing Before Me
4. At the hearing before me, Mr Brown relied on the grounds of appeal drafted by his instructing solicitor and he submitted that I ought to allow the appeal. A summary of the written and oral submissions on behalf of the Appellant being.
5. The Respondent had originally relied on a Rule 24 response dated 9 December 2025. Upper Tribunal Judge Reed had ordered that there be a more specific Rule 24 Response which was later provided.
6. Unfortunately, the Respondent had not attended the hearing before the First-tier Tribunal. It is obviously imperative that the Respondent attend hearings, especially when appeals are resisted by the Respondent.
The Judge’s decision
7. At paragraph 3 the Judge identified the issues which the Appellant invited him to consider:
“She asserts a right to remain on Article 3 and Article 8 grounds on the basis that upon return to Albania:
(a) She would face real risk of treatment contrary to her article 3 rights.
(b) She would face “very significant obstacles” to her integration into Albanian society and that, in the alternative, removal to Albania would result in unjustifiably harsh consequences for her and/or her son, amongst others.”
8. Then, after having identified some of the medical and other evidence, the Judge said at paragraph 21 that he would be treating the Appellant as a vulnerable witness.
9. At paragraphs 23 to 26 the Judge identified the law in respect of Article 3 ECHR and then at paragraphs 27 to 57 he made findings in respect of the Article 3 ECHR claim. This included with reference to the expert evidence relied upon by the Appellant.
10. Then at paragraph 58 to 66 the Judge identified the law in respect of Article 8 ECHR. At paragraph 67 (a) to (i) the Judge considered the “very significant difficulties” which were said to arise. At paragraph 69 to 73 the Judge then considered the balancing exercise for the purposes of Article 8 ECHR.

The Appellant’s Written/Grounds and Oral Submissions Summarised
11. The Appellant’s written grounds of appeal are diffuse and I summarise them as follows.
12. Ground 1 contends that the Judge erred in his conclusions in respect of Article 3 ECHR because he had made conflicting and unclear findings in the section headed “availability of required treatment”. It is also said that the Judge failed to adequately address the relevant evidence leading to his decision being infected with errors of law. This ground refers to paragraph 45 of the decision and in respect of the availability of Rituximab infusions. It is said that “the Appellant does not have her life threatened by critical thrombocytopenia.” Dr Patel’s evidence is relied upon the grounds leading to the conclusion that the Judge’s conclusions that alternative therapies (steroids) could be used was at odds with Dr Patel’s evidence. In addition, the side effects of steroids including significant increased mortality. The grounds contend that at paragraph 47 of his decision the Judge wrongly concluded that Albania might run out of stock of Rituximab because Dr Patel had said that a flare up of the disease “could occur within weeks”. It is said that the Judge made irrational findings at paragraph 50 of his decision in respect of the ability of the Appellant’s adult son to assist.
13. In the renewed grounds dated 7 June 2025 the Appellant’s solicitors stated that the original grounds were relied upon and the Judge had made irrational findings about the Appellant’s son’s ability to fund the Appellant’s treatment and that the Judge’s findings were not adequately reasoned. It is also said that the Judge did not make any specific reference to Professor Sen’s report, other than briefly.
14. Ground 2, in respect of Article 8 ECHR contends in summary that the Judge’s conclusion in relation to “very significant obstacles to integration” were legally flawed. It is said that the Judge failed to consider the psychiatric report of Professor Sen. There is reference to part of the report in the grounds and the Judge had failed to consider this in his assessment of Article 8 ECHR. It is said that the Judge had grossly underestimated the extremely serious issues that the Appellant would face on return.
15. In his submissions, Mr Brown said in summary that the Appellant’s solicitor’s grounds were lengthy but were based on adequacy of reasons and how the Article 3 and Article 8 issues were decided. He said that there was no dispute between the parties that the Appellant has been diagnosed with Lupus and life long problems will arise. He said that the evidence before the Judge was voluminous. He said that the Judge properly directed himself at paragraph 24 of the decision but arguably thereafter minimised the treatment required at para 41 to 43 and 45 of his decision. Mr Brown said that the real issue was whether the withdrawal of the treatment would expose the Appellant to intense suffering or a potential reduction in life expectancy. He referred me to various paragraphs of the Judge’s decision such as paragraphs 52 to 56 and to pages 105 to 107 and page 175 of the 233 paged bundle. He said page 103 had the latest letter dated 25 April 2024 in respect of the Rituximab.
16. Mr Brown said that in respect of Article 8, the claim was the combined effect of the Appellant’s physical condition with her psychiatric condition. He said that there was an important report from Professor Sen: at pages 68 to 103. Page 97 at paragraph 5.7 had referred to the very significant obstacles. It said that the Appellant “would perceive a removal to Albania as a severe psychosocial stressor and a re-traumatization experience, as that is where most of her traumatic experiences took place.”
17. Mr Brown says that therefore there was important evidence. He said that although the Judge did direct himself correctly at paragraph 58 of his decision, when one considered that the Appellant’s case rested on the psychiatric evidence nowhere, when dealing with Article 8, did the Judge engage with the medical evidence of Professor Sen. Mr Brown said that it was incumbent on the Judge to engage with this but he had not do so and therefore in the alternative, Article 8 was infected by a material error of law.
18. Mr Dwynch was brief in his submissions. He said there was very little for him to add in view of the additional Rule 24 response from the Home Office. He said that the medication required by the Appellant was available in Albania. At this point, Mr Brown assisted by referring to an undated report of Alban Ylli with answers to questions at page 120. That report had said in summary as follows:
(a) The healthcare system in Albania represents a mix of private and public healthcare influenced by the previous Soviet heritage;
(b) There are regional hospitals and municipal hospitals. Only in Tirana there is a university medical centre which covers most of the country’s needs in terms of specialised health care;
(c) Rituximab infusions are reimbursed and can be administered only in Tirana University Hospital. It is prescribed only in circumstances when life is threatened by critical thrombocytopenia. Methotrexate is available across the country. Hydroxychloroquine is available in regional hospitals and drug stores. Naproxen is available across the country. Lansoprazole is available in selected drug stores. “Belimumab is not available in Albania. Doctors may recommend in very care cases and only in special cases when there is serious renal involvement. Patients may order it abroad. “
(d) In terms of the supply of the listed medication:
“Rituximab is usually available at Tirana University Hospital but there may periods of stock out. It can happen every year and can last 1-2 months”. In terms of payment: “1. Rituximab infusions: It is reimbursed for hospitalized patients. It is available only in hospital and under the monitoring of a haematologists (or oncologists). 2. Methotrexate (10mg per week); It is reimbursed. 3. Hydroxychloroquine (200mg 3 x per week); It is not reimbursed. 4. Occasional steroid pulses. Reimbursed. 79120 5. Naproxen. Within the reimbursement list of medicaments. 6. Lansoprazole (antacid); Not reimbursed”. Further that, “Patients who get a partial reimbursable medication through their family doctor prescription (often verified by the specialist doctor) pay 10% or 25% (as I clarified above) at the drug store. The pharmacy is then reimbursed by the Insurance Fund upon presentation of the prescriptions”.
It is also said by the expert:
“I also estimate Rituximab won’t be part of her routine treatment regime in Albania and it will be substituted by a cheaper medication. In cases when she would absolutely need it, she will get it in Tirana University Hospital.”
19. Mr Brown said that to expose the Appellant to a risk on return would mean a breach of Article 3 ECHR. Mr Brown submitted that it would be far too speculative to expect the Appellant’s son to be able to get a job to pay for the Appellant’s medicine.
20. Mr Dwynch continued with his submissions and referred to the Country Information and Policy Note at section 6.2.4 which referred to Medical and Health Care Provision dated May 2023. He said that there was a tension because the report states that the medicine is available privately, but it is “fully reimbursed”. The medicine is available within the public health system and also available at the cost stated he said. He also submitted that the Judge did what he could with the evidence. He also said that the cost would not be prohibitive.
21. In reply Mr Brown said that there had been an “opaque” grant of permission by the Upper Tribunal. Mr Brown said that in view of the Appellant’s son’s age, it was too fanciful and speculative to expect him to earn money and to provide for his mother.
22. Mr Brown submitted that if there was a material error of law in the Judge’s decision then the matter ought to return to the First-tier Tribunal for evidence to be provided and for a rehearing.
The Correct Approach to Appeals from the First-tier Tribunal
23. I remind myself that the expertise of the First-tier Tribunal has been impressed upon the Upper Tribunal for very many years, including more recently in the decision of the Court of Appeal in MH (Bangladesh) v Secretary of State for the Home Department [2025] EWCA Civ 688 9 June 2025. In particular the judgment of Arnold LJ, with whom Singh and King LJJ agreed. Paragraph 29 makes clear:
“There have been many recent authorities in both the Supreme Court and this Court on the need for appellate courts and tribunals to be cautious before interfering with findings of fact and evaluative assessments by lower courts and tribunals, and in particular specialist tribunals such as the FTT. For present purposes it is sufficient to cite Lord Hamblen’s summary in HA (Iraq) v Secretary of State for the Home Department [2022] UKSC 22, [2022] 1 WLR 3784 at [72]:
‘It is well established that judicial caution and restraint is required when considering whether to set aside a decision of a specialist fact finding tribunal. In particular:
(i) They alone are the judges of the facts. Their decisions should be respected unless it is quite clear that they have misdirected themselves in law. It is probable that in understanding and applying the law in their specialised field the tribunal will have got it right. 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 Secretary of State for the Home Department [2007] UKHL 49; [2008] AC 678 per Baroness Hale of Richmond at para 30.
(ii) 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 Secretary of State for the Home Department [2010] UKSC 49; [2011] 2 All ER 65 at para 45 per Sir John Dyson.
(iii) 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 First-tier Tribunal (Social Entitlement Chamber) [2013] UKSC 19; [2013] 2 AC 48 at para 25 per Lord Hope of Craighead.”
24. The legal test to be met by the Appellant to show a material error of law is to be found in the Court of Appeal’s decision in R(Iran) and others v Secretary of State for the Home Department [2005] EWCA Civ 982; [2005] Imm. A.R. 535.
Analysis and Consideration
25. The Appellant has autoimmune disease comprising moderate to severe systemic lupus erythematous and shingles. It also means active arthritis. She requires life long immunotherapy and monitoring. Professor Sen referred to the Appellant’s mental health conditions. The Appellant’s son, Z, has depression and panic attacks. Although he since his arrival in the UK, he has become an adult, he remains dependent his mother’s claim. This case required a careful assessment of the Appellant’s physical and mental health and indeed that of her son Z.
26. I consider Ground 1. That relates to Article 3 ECHR. As I have stated above, the Appellant’s grounds have been drafted and presented in a diffuse way with numerous branches.
27. In my judgment, the Judge correctly referred to the law, including at paragraphs 23 to 24 of his decision, including reference to the reported decision of the Upper Tribunal in AM (Article 3, health cases) Zimbabwe) [2022] UKUT 131 (IAC). The Judge then considered the issues in the case, including assessing whether the Appellant was a ‘seriously ill person’ and whether evidence had been adduced to demonstrate that substantial grounds had been shown to believe she would face a real risk on return because there would be an absence of appropriate treatment or because of the lack of treatment of being exposed to a serious, rapid and irreversible decline in her state of health resulting in intense suffering or to a significant reduction in life expectancy. The Respondent and thereby the Judge had accepted that the Appellant was a ‘seriously ill person’.
28. The Judge referred to the Appellant’s current medical circumstances, including with reference to Dr Patel’s report following an assessment in April 2024. As the Judge noted, the ‘real focus’ of the case was the availability of Rituximab in Albania. The Judge considered the implications of withdrawal of treatment with detailed reference to Dr Patel’s report at paragraph 39 and 40 of his decision.
29. The Judge referred at paragraph 27 of his decision to having considered all of the evidence and in round and there is no discernible reason to consider that was not the case, especially in this lengthy decision by the Judge.
30. In my judgment, the Judge made clear at paragraph 42 the effect that the withdrawal of treatment would have. The Judge also lawfully and reasonably concluded that whilst the Appellant would be ill, it would not meet the test to meet Article 3 ECHR. In my judgment, it is important to focus too on the test of serious, rapid and irreversible decline in her health resulting in intense suffering or a significant reduction in life expectancy.
31. As the Judge made clear at paragraph 41, whilst there would likely be a flare up of the Appellant’s lupus without Rituximab, he also made clear at paragraph 42 that the effects of the withdrawal of the treatment would not meet the Article 3 threshold. The focus included on the ‘rapid’ decline. The Judge considered in detail the evidence of Alban Ylli (I agree with the Judge that report was not provided in the ‘usual format’).
32. The Judge provided detailed, lawful and lengthy reasons when concluding at paragraphs 45 to 47 that the treatment would be available. At paragraph 47 the Judge was entitled to conclude that even if there was a shortage of the treatment for a month or two, in view of the annual infusions, this was not a real issue. Indeed, anyone who accesses even common medications from pharmacies in the UK will be well aware that supply is not always as good as we would wish.
33. Importantly, in reality, the Judge considered the case in the alternative that if the Appellant really could not access her required medication for free in Albania, then she could do so privately. The Judge considered this at some length at paragraph 50 with its sub paragraphs. This included that the Appellant undertake charity work in the UK and so is fit for some work. The Judge was entitled to come to such a view. The Judge also considered throughout his reasoning the Appellant’s mental health issues. The Appellant’s grounds are wrong if it is being suggested that Professor Sen’s report was not considered because it was. It is referred to at paragraph 13 of the decision and then the mental health issues considered thereafter. Including in detail at paragraph 50 (b) of the decision.
34. The Judge noted at paragraphs 52 and 53 (d) and other sub-paragraphs that the Appellant’s previous claims were disbelieved by a different judge. The Judge was entitled to conclude that Appellant will not have support from family members in Albania. The Appellants son, now an adult, could indeed arguably support the Appellant. These were findings open to the Judge on the evidence. The Judge gave detailed reasons for coming to this view at paragraphs 53 (f) (i) to (vii). The reasons are entirely lawful and reasonable. Paragraph 55 provided further reasoning in any event.
35. The Appellant’s grounds of appeal although lengthy in respect of Article 3 are no more than a disagreement with the Judge’s decision.
36. Ground 2 raises matters in respect of Article 8 ECHR. The Judge cited the correct law at paragraph 58 to 66. The Judge then applied the law to the facts at paragraph 67 (a) to (i) and he lawfully concluded that the Appellant’s appeal could not succeed. The Judge considered the balancing exercise thereafter in clear detail.
37. Again, in my judgment, although the Appellant’s grounds are lengthy, the dismissal of the Appellant’s appeal on the basis of Article 8 ECHR was inevitable. The Appellant’s grounds are wrong when stating that the Judge did not consider Professor Sen’s report because it is clearly referred to and then analysed thereafter in the findings in respect of Article 8 ECHR. I have referred to the detailed paragraphs of the decision above.
38. The Judge had the benefit of seeing and hearing from the Appellant. The Judge heard the detailed submissions from the Appellant’s solicitor at the hearing. The Judge had also considered the written submissions.
39. Having considered the Appellant’s detailed submissions and grounds, it is clear to me that there is no material error of law in the Judge’s decision.
40. The Appellant is seriously unwell. She has mental health problems. Her son, an adult, has his own mental health issues. Whilst one can be sympathetic to them both, the Judge had to apply the law. The Judge did just that. Whilst the Appellant had wished for a different result and seeks to reargue her case, such an approach is impermissible in law.
41. Therefore, despite Mr Brown’s detailed submissions, I have not been able to discern any material error of law in the Judge’s decision.
42. Therefore, the decision of the Judge which had dismissed the Appellant’s and her dependent’s son’s appeal remains dismissed on all grounds.

Notice of Decision
The decision of the First-tier Tribunal does not contains a material error of law.
The decision of the First-tier Tribunal which had dismissed the Appellant’s appeal remains dismissed on all grounds.

Abid Mahmood
Judge of the Upper Tribunal
Immigration and Asylum Chamber

6 April 2026