Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER Case No: UI-2026-001454
First-tier Tribunal No: HU/52001/2024

THE IMMIGRATION ACTS

Decision & Reasons Issued:

On 30th of September 2026

Before

UPPER TRIBUNAL JUDGE RASTOGI

Between

SUMIT KUMAR DHIMAN
(ANONYMITY ORDER NOT MADE)
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Mr A. Swain, Counsel instructed by Legit Solicitors
For the Respondent: Ms S. Lacointe, Senior Home Office Presenting Officer

Heard at Field House on 30 July 2026

DECISION AND REASONS

Introduction

1. By way of a Rule 34 decision sealed on 22 April 2026, Upper Tribunal Judge O’Callaghan allowed the appellant’s appeal against the decision of the First-tier Tribunal (“the FTT”) dated 23 January 2026 in which the FTT has dismissed the appellant’s appeal against the respondent’s refusal of his Article 8 claim. He set aside the FTT decision.

2. He did so because the respondent had conceded that the FTT had made a material error of law in its decision by failing to deal with the appellant’s Article 8 claim distinctly from his Article 3 claim. The respondent did not accept there was a material error in the Article 3 part of the decision and contended those findings should be preserved.

3. In his decision, UTJ O’Callaghan noted that the applicant had not appealed the FTT’s dismissal of his Article 3 claim and that those findings are to be preserved. However, at [10] of his decision, he stated that the appellant’s medical conditions may be revisited given that the relevant date will be the date of the remaking hearing. He retained the appeal in the Upper Tribunal and gave directions regarding the submission of updating evidence.

4. The appeal came before me for remaking. In the bundle filed for use at the hearing, the appellant had included some additional medical evidence. Suffice to say at this stage, the appellant who is 30 years of age, came here as a student, and in 2022 was diagnosed with end stage kidney disease (“ESKD”) which came on suddenly, for no obvious reason.

5. My consideration of the relevant issues in this case has necessarily involved making some difficult decisions about the appellant’s treatment options and his quality of life within the relevant legal frameworks which apply to such cases, and about which there has been considerable litigation. At all stages, the thresholds are relatively high ones for an appellant to reach, and generally cogent evidence is required in order to reach those thresholds. For the reasons I give below, I have not found the appellant able to meet those thresholds.

The hearing

6. At the beginning of the hearing, I clarified the issues with the parties in light of Judge O’Callaghan‘s observations. Mr Swain confirmed that he was not proceeding with the appeal on Article 3 grounds, but entirely through the lens of Article 8, both ‘very significant obstacles’ and whether the respondent’s decision results in unjustifiably harsh consequences for the appellant such that his removal would be a disproportionate interference with his Article 8 rights.

7. I heard evidence from the appellant in English. I checked with the appellant and his representative about what, if anything, was required to ensure the appellant felt well enough to give evidence comfortably. In the event, the appellant needed a break mid-way through his evidence when he felt uncomfortable but otherwise appeared able to give his evidence without difficulty and no complaint was raised to the contrary.

8. I heard submissions on behalf of both parties and at the end of the hearing I reserved my decision which I now give with my reasons for the same. I may not refer to all of the evidence and submissions in this decision, only to what I need to explain my decision. I have considered them all with care.

The Preserved Findings

9. It is useful to set out a little of what evidence was before the FTT and what the FTT made of that together with the FTT’s reasons for dismissing the appellant’s Article 3 claim. That is because those findings continue to be relevant for the purposes of re-making the Article 8 decision, unless they are superseded by updating medical evidence.

10. The appellant’s medical situation then was that he was having dialysis three times per week which took four hours per session. He also had to follow a careful diet, including restrictions about the amount of fluid he takes in. At that time (and still) he lived alone (save for his landlord), and he was able to work for 2.5 hours at a time as a chef. He was awaiting a transplant (and he was on the live transplant list) but there were complications because the cause of his disease was unclear and because he was a B negative blood type. None of his family members are B negative. He is doing well on dialysis which is keeping the worst of his symptoms at bay.

11. The FTT noted that there was a lack of recent medical evidence (i.e. from 2025) and no evidence dealing with how the appellant could manage to travel to India at all and, if so, what arrangements would need to be put in place or how that would work alongside his need for dialysis at frequent intervals and the impact upon him if he were not able to receive dialysis immediately upon arrival. Accordingly, the FTT decided there was an insufficient evidential basis to find that the high Article 3 threshold was met.

The updating evidence about the appellant’s medical condition

12. The appellant’s GP wrote a letter on 3 June 2026 confirming the appellant’s current diagnoses, medication and care [HB27]. The appellant remains under the care of the nephrology team, is receiving dialysis and requires close medical supervision. He is awaiting renal transplant and is on the transplant pathway. That letter was corroborated by a series of letters from the appellant’s treating physicians at Imperial College who had carried out genome and other investigations to try to establish the cause of the ESKD but to no avail. He is aware of the transplant protocol and that he needs to be near a phone.

13. Notwithstanding the comments of the FTT as to the lack of evidence about the appellant’s ability (or lack thereof) to fly or the impact of travel and relocation, if any, on his treatment there was no updating evidence on these issues.

14. Regrettably the appellant has not submitted an updating witness statement. However, in his oral evidence he gave the following updating evidence of note. He continues to have dialysis three times per week for four hours per session. However, the time he is there is nearer to 4.5 hours because it takes some time to set up and then disconnect from the machine. On occasions, there is a delay because the previous patient’s time has run over. His sessions are in the evening each Monday, Wednesday and Friday. He suffers with post-dialysis fatigue so the following morning he needs to rest. For that reason, he has an arrangement in place with his employer that he works in the afternoons only. He works 20 hours a week as a chef. He has had to curtail his Masters’ degree which he was completing at Leicester University. He completed the first semester but the travel to university was too onerous in light of his dialysis schedule (the appellant lives in London). He is awaiting a kidney transplant. He has been approved for a transplant, ideally a living donor, and he needs to remain available at short notice in case a donor is found. Given that the medics are still unsure why he has ESKD, it is not guaranteed that a transplant will succeed because his body may reject the kidney. Accordingly, he will need careful monitoring afterwards and will need to take immunosuppressants which render him vulnerable to infection.

15. The treatment regime has other consequences. Firstly, he has a line in his chest which he needs to keep dry, and he needs to avoid crowds. Secondly, he needs to follow a modified diet. For example, he cannot eat potassium rich foods such as potatoes as that impacts his heart. Thirdly he also has to watch what he eats as he passes very little urine, so all the salts remain in his body. Fourthly, he has to manage his fluid intake. Too much fluid leads to swelling. This was problematic when he became ill and needed antibiotics which he had to take with water. That had the effect of reducing the platelets in his blood. Fifthly, he is also on a strict medication routine. Sixthly, the fatigue impacts his ability to participate in activities, such as sport. Although there is reference in the papers to him playing football, that is at the lowest possible level. If he sees a group playing football in the park, he may ask to join them but he cannot sustain any longevity of play and would have to stop once his body feels tired which is after about 5-10 minutes.

16. As for his ability to receive his treatment in India, the appellant confirmed that his father made some enquiries and there is a letter from one of the doctors with whom he spoke, although the appellant understands he spoke to others. The main problem is the affordability of the necessary treatment there. Whilst he accepts there is a government program of assistance, that represents 5 Lakh Indian Rupees (“INR”) per family per year, that is nothing compared to the cost of dialysis; transplant; the medication he needs etc. Furthermore, even if he were able to get a transplant, the average kidney life is 12 years so he will need to go through the process again. Once the government aid runs out, he would have to pay privately and neither he nor his family could afford it. In any event, he would have a very long journey to access any treatment because it is only available in urban areas and he lives in a village so he would also need to fund his transport.

The Submissions

17. Ms Lacointe made it clear that she was not making any concessions in the appeal, but in light of the evidence, including that the appellant was not fit to fly, she would leave the outcome of the appeal to the Tribunal. She noted that the situation had moved on since the last appeal because the appellant is now on the waiting list for a transplant and, whereas he was found physically fit and active last time, that is no longer the case. Nevertheless, there is treatment in India so the question is whether the appellant can get there, whether he can access it and the application of the legal test, namely whether there would be a serious, rapid and irreversible decline in his health.

18. In light of Ms Lacointe’s submissions, I indicated to Mr Swain that I would be prepared to hear from him on Article 3 grounds, notwithstanding what he had said earlier. He maintained that the appellant’s case was limited to Article 8. He took me to the supporting medical evidence in the bundle which I refer to later in my decision. He submitted that the evidence overwhelmingly shows that the appellant would be unable to reintegrate in India in the Kamara1 sense as reflected in paragraph 5.1(b) of Appendix Private Life in the Rules. There is no effective donor availability there so he would be reliant on dialysis in the long term with all that entails. Even if he could return to India, get to a treatment centre and afford it, his regime there would be as it is here which leaves precious little opportunity to work, meet people and live life in a fully integrated way. On top of that, his case is a complex one given the unknown cause and the uncertainty about the success of any transplant. However, the reality is that the appellant would be unable to return to India, or access or afford the treatment. Mr Swain took me to the background country evidence about availability and cost. He submitted that even if I did not find the ‘very significant obstacles’ threshold met, he submitted that the decision is disproportionate. Mr Swain initially submitted there was no public interest in the appellant’s removal. When I probed this with him, he accepted that there is an impact on the public purse arising from his medical treatment but submitted that otherwise there is no negative impact to the appellant’s presence here. The appellant was here lawfully when he got suddenly ill. Despite all his difficulties he has continued to work and no doubt will continue to do that and pay taxes. Aside from medical treatment, he is self-sufficient and speaks English to a high standard. Whilst Mr Swain realised that the appellant applied for indefinite leave to remain (“ILR”) on compassionate and compelling grounds, he recognised that he could not realistically ask me to find that anything short of that was disproportionate, but if I were minded to find that ILR was required, I could give an indication to that effect.

The Legal Framework

19. The appellant made an application for leave to be granted on an exceptional basis outside of the Rules. He could only appeal a refusal of that to the First-tier Tribunal on the ground that the refusal breaches his human rights. In this appeal, the appellant only pursues his appeal on the basis of the interference with the right to respect for his private life as protected by Article 8 of the European Convention of Human Rights (“the ECHR”).

20. The correct approach to such an appeal was set out in R v SSHD ex parte Razgar (FC) [2004] UKHL 27 and involves answering the following five questions:

1. Will the proposed removal interfere with the exercise of the appellant's right to respect for his private or (as the case may be) family life?
2. If so, will such interference have consequences of such gravity as potentially to engage the operation of article 8?
3. If so, is such interference in accordance with the law?
4. If so, is such interference 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?
5. If so, is such interference proportionate to the legitimate public end sought to be achieved?

21. If someone can meet the requirements of the Immigration Rules, in full, and, providing Article 8(1) is engaged, the public interest may not require their removal (TZ (Pakistan) v SSHD [2018] EWCA Civ 1109).

22. In the appellant’s case, the relevant private life considerations within the Immigration Rules are found at Appendix Private Life (PL) which says that, for someone in the appellant’s position, leave would only be granted on private life grounds if:

“PL 5.1. Where the applicant is aged 18 or over on the date of application: (a) the applicant must have been continuously resident in the UK for more than 20 years; or (b) where the applicant has not been continuously resident in the UK for more than 20 years, the decision maker must be satisfied there would be very significant obstacles to the applicant’s integration into the country where they would have to live if required to leave the UK.”

23. In SSHD v Kamara [2016] EWCA Civ 813, at [14] the Court of Appeal set out how the concept of ‘integration’ should be approached. It said as follows:

“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.”

24. If the appellant is unable to meet the requirements of the Rules, and if Article 8 is engaged, he is only able to succeed if he demonstrates that the implementation of the respondent’s decision would have unjustifiably harsh consequences for him or another person.

25. That requires a proportionality assessment to be varied out balancing the factors on the respondent’s side of the balance sheet against those on the appellant’s and having regard to the factors contained within section 117B of the Nationality, Immigration and Asylum Act 2002 (“the 2002 Act”).

26. In light of the fact that the appellant’s Article 8 case arises from his medical condition and was originally pursued on the basis of a mixed Article 3 and Article 8 claim, it is necessary to apply the guidance set out at [40]-[41] of AA (Morocco) v SSHD [2025] EWCA Civ 144 (confirming GS (India) and Ors v SSHD [2015] EWCA Civ 40) which said:

“40. If such a claim fails under Art.3, it does not follow that an appellant cannot succeed under Art.8. But Art.8 does not provide an easier route for resisting removal on health grounds than Art.3. If an Art.3 claim fails, the appellant cannot succeed under Art.8 without some separate or additional factual element which brings the case within the relevant paradigm for that provision, namely the capacity to form and enjoy relationships, or a state of affairs having some affinity with that paradigm. The only cases where the absence of adequate medical treatment in the country to which a person is to be removed will be relevant to Art.8 are where it is an additional factor to be weighed in the balance with other factors which by themselves are sufficient to engage Art.8. The rigour of the principles applicable to the consideration of ill health cases under Art.3 applies with no less force when a claim is brought under Art.8. Save in the exceptional circumstances recognised in the case law, the UK is under no ECHR obligation to provide medical treatment here because it is not available in the country to which an appellant is to be removed (Laws LJ at [85] to [87]).

41. At [111] of GS (India) Underhill LJ said to the same effect:

"Secondly, where article 8 is engaged by other factors, the fact that the claimant is receiving treatment in this country which may not be available in the country of return may be a factor in the proportionality exercise; but that factor cannot be treated as by itself giving rise to a breach since that would contravene the 'no obligation to treat' principle."

In SL (St. Lucia) v Secretary of State for the Home Department [2018] EWCA Civ 1894 the Court of Appeal held that, subsequent to the Supreme Court's decision in AM (Zimbabwe), those principles in GS (India) still remain good law.”

27. It is for the appellant to satisfy me that the facts on which he relies are more likely than not to be true. The relevant date is the date of the hearing.

Discussion and Findings of Fact

28. There was no challenge to the appellant’s credibility and of course he was found to be a credible witness by the FTT (see [19]).

29. The appellant continues to rely on the material which was previously before the FTT plus some additional medical evidence. As I mentioned at the hearing, it is regrettable that notwithstanding the various observations of the FTT in its decision, the appellant has not provided a comprehensive medical report dealing with the process of the appellant returning to India, how that would (or whether it could) work alongside his medical treatment, what he would need upon arrival and what would happen if his treatment was interrupted. Furthermore, there is no medical evidence as to the impact or consequences of the appellant having to remain on dialysis for life if a donor could not be found. Finally, neither has the appellant provided a medical or country expert report to give an overview of the cost, availability and accessibility of the necessary treatment in India.

30. I have evaluated the evidence that there is on these issues in the round.

31. As to the previous and updating specialist letters, they are generally quite technical in nature. I have not made any assumptions on their meaning but arrived at my findings from what is clear in the narrative parts of the letters. From that I am satisfied there has been some marginal progression on the medical front in terms of the treatment pathway rather than an evidenced deterioration in the appellant’s symptoms or condition. The appellant is now actively awaiting a transplant and is on the transplant pathway. This was not quite the case previously because, although he had been identified as a potential candidate for a transplant, some further investigations were required. The appellant had to await the outcome of the genome sequencing and needed the all clear from cardiology which was given on 12 June 2024. The letter dated 27 June 2024 from the transplant surgeon confirmed that a living donor is the best option for him given his age. In that letter, it is noted that the appellant would discuss this with his family in the UK and India. The next letter of 31 January 2025 also noted that the appellant would “discuss options and come back to us” and he was provided with further clinical information to assist. Both these letters were before the FTT. However, by 3 June 2026 the appellant’s GP confirmed that he is now on the transplant pathway. There is also reference to this in the specialist’s correspondence dated 12 January 2026. There is regular reference in the specialist’s letters to there being minimal urine output, and the need to reduce salt and avoiding potassium.

32. In terms of available treatment in India, the appellant continues to rely on a letter from Dr Vikrant which, whilst not dated, appeared to be before the FTT (as shown by [23] in the FTT decision). Dr Vikrant explained that he has been consulting with the appellant and has reviewed some of the reports although does not say which ones. After addressing the background, and the appellant’s treatment and symptoms, Dr Vikrant says the appellant is “unfit to travel” although provides no further explanation. Moving on to transplant, Dr Vikrant highlights the potential complications given the complexities in the appellant’s case. Dr Vikrant highlights the potential difficulties the appellant will have accessing suitable treatment in India including the post-transplant rehabilitation and monitoring. He notes there may be a lack of continuous treatment there. He talks of rehabilitation services being of a higher standard in the UK than India. He also talks of the costs of treatment: INR 10,000 to INR 30,000 per dialysis and INR 1,000 per month for medicine. As the FTT noted, there is a real lack of detail in this letter on certain key issues such as the reference to the appellant’s lack of fitness for travel and the type of treatment he could get in India and difficulties with the same.

33. The ‘CPIN; medical and healthcare provision, India, April 2023’ (“the CPIN”) has a discrete section about kidney disease, transplants and the availability of dialysis in India. It states that treatment costs vary from state to state and it cites one example from Chandigarh in the state of Punjab which offers free in and outpatient treatment, kidney function testing and haemodialysis three times per week. Some nephrology medicine is also free of charge and when compared with the list of medication the appellant is prescribed, it is noted that ‘Sevelamer’ is available free of charge, but the remaining medication is not listed. However, the appellant’s list of medication includes medication which are not purely nephrology medicines.

34. The CPIN also notes the limited number of transplant donors. That increases the demand for dialysis but there is also an increased supply, and it is described as “easy availability” (Express Healthcare report 8 May 2020) [13.1.3]. However, by 2022 the same source reported that there is limited availability in rural areas where two thirds of the population live and 60% of dialysis patients have to travel over 50km to access treatment and there is a chronic shortage of nephrology personnel [13.1.5]. That chimes with the general rural/urban divide in the provision of healthcare in India as discussed at sections [1.5] and [1.11] of the CPIN. Of the treatment centres there are, most are managed by the private sector although it also noted the existence of a 2016 programme to provide free dialysis to the poor. Nothing more is said about the reach or efficacy of that service [13.1.5] and the source document does not do so either save to say it is a public-private partnership. The CPIN refers to the Apollo Hospitals in India as offering cost-effective renal transplant packages [13.1.4]. However, it noted the 2022 Express Healthcare report which says that organ donation is 0.01% “which makes renal replacement therapy beyond the reach of most people and dialysis remains the only way to prolong life” [13.1.5]. The source document also says “high costs of dialysis topple the finances of most families with such patients”.

35. The respondent relied on the above in the refusal letter, commenting that:

“dialysis and treatment for Kidney Disease is available and it is further noted that hospital treatment and medication is also available for the other conditions that your GP has listed in his letter dated 6 October 2023.

36. In the refusal letter, the respondent noted that the standard of treatment in India versus the United Kingdom is likely to be different and less favourable to the appellant and that he may not be able to afford the treatment. However, the respondent said “these circumstances do not, in themselves, make your circumstances exceptional and do not entitle you to remain in the United Kingdom”. Furthermore, the respondent noted the appellant’s father works and can support him and that his educational background puts him at an advantage in the employment market in India. However, the respondent decided that the difference in the quality of his life here compared to India is not a reason to grant him settlement.

37. In his witness statement, the appellant said that his father earns INR 15,000 per month and there is nothing left after payment of the household expenses. He does not believe he will be able to secure part-time employment in India as such jobs are generally not available and he is not fit enough to work full time. Any part-time job is unlikely to pay more that INR 10,000-15,000 per month. In the witness statement he prepared for his original appeal hearing, the appellant set out a table of medication costs which he calculated as INR 5,618.70 per month and his haemodialysis at INR 49,776 per month, plus travel costs three times per week. Furthermore, he requires frequent blood tests which are not free of charge (they are distinct from the kidney function tests referenced by the respondent as being free of charge).

38. The appellant corroborated these figures by reference to an article on the ‘Karetrip’ website entitled “The costs of End Stage Kidney Disease in India” dated 9 July 2024. That says that the average cost per session of dialysis is INR 1,000-3,000 or INR 8,000-30,000 per month for dialysis three times per week and the cost median of a transplant being INR 392,920 Lakh although it is offered free in state-run hospitals with immunosuppression costs of INR 2,400 per month. There is a government funded healthcare programme (the Ayushman Bharat) which provides INR 5 Lakh (INR 500,000) per family to 100,000,000 families in India annually.

39. Having considered the totality of the evidence before me, I accept on balance that the appellant is unlikely to secure a live kidney donor in India given the evidence about the scarcity of live donors. I accept this means that he would be reliant on dialysis, at least three times per week to keep him alive together with the associated medication to keep him as well as possible.

40. As for the cost of dialysis, the evidence before me does not present a clear picture. Whilst there are some examples of free dialysis provision, the Chandigarh hospital being one such provider, there is also reference in the CPIN to the problems with state funded healthcare. At [1.3.1] the CPIN states:

“While each Indian state is required to provide free universal access to health services, health care is chronically underfunded, meaning that although they are entitled to free care, many go without. Because of the severe shortages of staff and supplies at government health facilities, many people seek care from private providers and pay out-of-pocket.”

41. That chimes with the next section of the CPIN which refers to the growth in the private sector providing healthcare to make up the shortfall in the public service and the private sector supply about 70% of the medical services in India [1.4.1].

42. As to the costs of private dialysis, the CPIN does not provide the likely costs at all. The figures provided by Dr Vikrant are significantly higher (per dialysis) than those on the Karetrip website as are the figures which the appellant put into his witness statement. However, it is to the Karetrip evidence Mr Swain directed me at the hearing and, accordingly, it is from that evidence that I arrive at my conclusions re the likely cost of dialysis in India. I have taken a cautious approach and taken the highest costs for dialysis from the range provided therein (INR 30,000 per month) so that it reflects the fact that Dr Vikrant provided a higher amount, and then added that to the medication monthly costs which the appellant provided (INR 5618). Together these result in an annual overall cost of INR 427,424.

43. Based on the amounts the appellant provided in his witness statement (see [37] above), the annual amount he and his father could earn between them would be about INR 270,000. Accordingly, I accept that if the appellant had to self-fund his dialysis, it would be unaffordable for him as it far exceeds his father’s earnings and the realistic amount the appellant could earn given the limitations on how often he could work. That is consistent with the background material that private costs are unaffordable for most ESKD patients in India.

44. As for the Government aid scheme, the evidence here also presents an unclear picture as to the detail of the scheme. In addition to the reference in Dr Vikrant’s letter and the appellant’s witness statement, it is also referred to in the CPIN [1.12]. The Australian Department of Foreign Affairs and Trade report of December 2020 identifies that the scheme is designed to assist the poorest households (which could mean up to 40% of the population) and concerns have been raised that there is insufficient budget allocation and the amount of INR 500,000 is insufficient and “leaves patients with a large gap for some procedures” [1.12.1]. It is not clear that all medical treatment is covered because reference is made to it being limited to “three days of hospitalisation and 15 days post-hospitalisation, including diagnostic care and medication expenses”. Elsewhere, the MedCOI from April 2020 said this scheme is specific to Punjab and only applies at certain government and private hospitals but is likely to provide protection for 75% of the Punjab’s population [1.12.3].

45. The appellant’s overarching position however is that he would be eligible for INR 500,000 per family per year but that would be insufficient to pay for his dialysis and associated costs. He did not raise that he would not be eligible for it and neither did Dr Vikrant. Accordingly, given the lack of clear evidence to the contrary, I proceed on that basis.

46. I turn to travel costs below, but on the face of it, my findings as to the annual cost of the appellant’s dialysis falls within the amount of the government aid. The appellant has not provided any other evidence about the health of the rest of the family or how much, if at all, of the state-provided amount they may require and whether or not any excess could be covered by his father’s earnings. Accordingly, the evidence does not establish on the balance of probabilities that treatment would be unaffordable once the state aid is taken into account.

47. As to travel to reach a dialysis centre, I note that the appellant’s travel costs have been calculated on the basis of his travel to the hospital in Chandīgarh referenced in the CPIN. That was an illustration and it does not mean to say it is the only establishment offering nephrology services. That said, from the map the appellant provided it is clear that Himachal Pradesh, the appellant’s home area, is remote. It is at the foot of the Himalayas and there do not appear to be many urban centres nearby. In fact, Chandigarh is one of the nearest and that is 148 miles away by road with a travel time of just over 5 hours (in light traffic). Looking at the map and directions, even what appears to be the nearest bigger town (Mandi) is about 50 miles away.

48. Taking the pattern of dialysis the appellant has here, assuming the nearest centre is in Chandigarh (based on a combination of the respondent’s evidence and the map provided) and allowing for traffic problems, the appellant will need to allow 6 hours each way. He has post-dialysis fatigue so he would not necessarily be safe to drive himself home immediately after the dialysis. In any event, the FTT accepted the appellant’s evidence that sitting for long periods was uncomfortable for him (see [37]). That is referenced in Dr Vikrant’s letter. At the hearing before me, he had to break due to discomfort. He would need to ensure that he had suitable food with him given the impact of his condition on his diet. Assuming dialysis was in the evening like it is here, on a Monday he would need to leave home by say late morning to arrive in time for a 6pm slot. He would have dialysis for about 4-5 hours. By then it would be late evening and for the reasons I have given, it is not likely he would be able to drive home and he would need to rest for the night and return home the following day. The oral evidence, which I accept, is that the post-dialysis fatigue continues throughout the following morning and only clears in the afternoon. Accordingly, he may not be able to return until the afternoon. He may not return home until late afternoon on the Tuesday and would then need to leave again by late morning on the Wednesday, with the same pattern repeating through Wednesday and Thursday and then again from Friday to Saturday. Sunday is the only day on which he would not have a 6-hour drive.

49. This analysis reveals that it is likely to be impractical for the appellant to live in the family home and undertake this regularity of long journey to access his dialysis. In any event, even if he did, it is more likely he would need to be driven given the problems he has with fatigue but in any event, even as a passenger, the protracted sitting (which presumably he is also doing when receiving the dialysis) will still be problematic.

50. Accordingly, I find it more likely that the only practical way the appellant can access his dialysis is by relocating to Chandīgarh (or another urban centre which offers dialysis). The impact of that is that there will be the additional cost to the appellant (and/or his family) of accommodating and maintaining him outside of the family home. It also means that the appellant will need to establish himself into a new area of India.

51. As a general point, the appellant has not supplied any background material to support his claim that he will be unable to work part-time in India as he does here. There is no good reason why work, such as the chef work he does here, would not generally be available on a shift basis. I accept the appellant is more limited as to the shifts he can offer and I accept that his employer here has adjusted his pattern to fit in with his dialysis. He will be reliant on similar accommodation by any prospective employer in India and I accept that means that finding suitable employment would be harder for him than someone without his medical commitments and limitations. If he were able to secure employment, I find he would be able to fund his living costs and local travel to his dialysis in the same way as he does here. That would top up any state funding which the appellant receives.

52. Assuming he can do so, I see no reason why the appellant cannot live in India as he does here. The key difference is that here, at some stage, it is hoped he can secure a live kidney donor and receive a successful transplant. I do not find that likely to happen in India. Accordingly, in India, the pattern of life he has here now, characterised as it is by modest part-time work (for which I accept the appellant is over-qualified) and dialysis, is likely to subsist for a much longer period, and possibly indefinitely.

53. I was not directed to medical or other evidence as to any medical impact upon the appellant of long-term dialysis. I raised this with Mr Swain at the hearing and he appeared to accept that, but he relied on the corresponding impact on the appellant’s quality of his life here (and therefore in India) which was the real issue and which he submitted clearly engaged the test at PL5.1 of Appendix PL.

54. I accept that the quality of the appellant’s private life if he were to remain on dialysis for the rest of his life (which he would have to absent a transplant) is likely to be inferior to his situation post-transplant. However, the evidence before me is that a donor kidney has a 12-year lifespan before a repeat transplant would be required; for the reasons set out above, the appellant’s case is a more complex one requiring greater monitoring and, until an operation is carried out, its success or otherwise cannot be known. Accordingly, this is likely to be a situation where even in the UK, if the appellant manages to secure a live donor, there is likely to be considerable on-going medical intervention arising from the appellant’s ESKD and the need for repeat transplant(s) given his young age or even on-going dialysis if any transplant is unsuccessful.

Conclusions

55. Applying the above to the test at PL5.1 in light of the test in Kamara, I am not persuaded that the appellant has demonstrated very significant obstacles to his integration into India given that he is a national; that he speaks one of the officially recognised languages; his family and cultural ties, and the additional findings I have made about his ability to work and support himself there as he does here. His lack of a quality of life as he may wish for it to be, all things being equal, whilst entirely understandable, is not the test. There is no reason to think the appellant will be treated as an outsider. He lived in India all his life before coming to the UK and he will understand how life there operates, even if he has to relocate. He is clearly educated and intelligent. When not having dialysis and in the immediate post-dialysis fatigue phase, there is insufficient, if any, evidence that he is unable to meet people and develop relationships. His family will be closer to him there than they are here, even if he is to relocate. The appellant has proved himself to be incredibly resourceful in the face of significant challenges and there is simply insufficient evidence to show that he would not demonstrate the same qualities on return to India. I do not find the appellant able to meet the requirements of the Rules on private life grounds.

56. Returning to the Razgar framework, Article 8 is engaged here on private life grounds given that the appellant has lived and worked in the UK for a significant period of time, and in light of his former study here. His medical treatment is also a characteristic of his private life. Self-evidently if the respondent’s decision is implemented, he would be removed from that life, so Article 8 is potentially engaged. There is no suggestion the decision is otherwise unlawful.

57. As to whether it is necessary and proportionate, given that the appellant cannot meet the requirements of the Immigration Rules to remain here on any other basis, the public interest in effective immigration control would require his removal unless to do so results in unjustifiably harsh consequences for him. In order to decide that I need to carry out a balance sheet approach.

58. On the respondent’s side of that balance sheet, I place the following factors:

a) Effective immigration control (section 117B(1) of the 2002 Act). This is a weighty consideration given the appellant is unable to meet the requirements of the Rules.

b) Although the appellant is financially independent because he supports himself, he utilises considerable public resources through his access to medical services provided through the NHS and which, if he remains here, is likely to continue indefinitely albeit potentially at a reduced rate following a transplant if he is able to successfully obtain one. This is a matter to which considerable weight applies.

59. The appellant speaks English so that is a neutral factor applying section 117B(2).

60. The factors on the appellant’s side of the balance sheet are as follows – these are summarised but I also rely on the more detailed discussion of them elsewhere in this decision:

a) His length of residence and employment in the UK (i.e. his private life) although little weight attaches to that given that he has been in the UK precariously throughout (section 117B(5) applies).

b) The fact that his ill-health came on suddenly and without warning. In other words, this is not a situation he orchestrated to obtain medical treatment in the UK.

c) The fact he is unlikely to be able to obtain a live donor transplant in India means that he is likely to be dependent on dialysis to keep him alive for the rest of his life there. This is a factor to which I attach some weight, but not significant weight, given I have not been asked to consider the appeal on Article 3 grounds and in light of my findings that otherwise, treatment for his ESKD is available for him in India.

d) In order to access that treatment, he will need to relocate to a different area of India away from his family and re-establish himself there and look for a job, which will be more difficult for him given the limitations on his ability to work. Given the longevity of dialysis in India, his quality of private life there in the long-term may not be as good as it would be in the UK if he were permitted to stay. Whilst not amounting to ‘very significant obstacles’ to reintegration, it is a factor to which I can properly attach reasonable weight.

61. Having identified these factors, I return to the relevant authorities on the interplay between Article 3 medical cases and Article 8. The most significant factor on the appellant’s side of the scales here is the combination of the differential treatment pathways between the UK and India, and the fact the appellant will need to relocate internally to access the treatment that there is. I have considered carefully whether the remaining factors on the appellant’s side of the balance sheet are capable of elevating these impacts out of the primarily ‘medical’ arena into one properly reflecting a disproportionate interference with the appellant’s private life because it amounts to unjustifiably harsh consequences as a result of the combination of those factors, rather than just because of the medical impact.

62. Whilst acknowledging the consequences for the appellant, given the limited weight attaching to the appellant’s private life in the UK and in light of what the authorities I have cited at [26] and [27] above remind us, I do not find that this is a situation where the appellant’s private life or obstacles to integration on return to India are sufficiently weighty to permit the appeal to be lawfully allowed under Article 8, particularly where I am not invited to allow it under Article 3. I find that to allow the appeal in these circumstances would fall foul of the ‘no-obligation to treat’ principle. I do not find the respondent’s decision to lead to unjustifiably harsh consequences for the appellant or to be a disproportionate interference with his right to respect for his private life under Article 8.

Notice of Decision

The appeal is dismissed on human rights grounds.

SJ Rastogi

Judge of the Upper Tribunal
Immigration and Asylum Chamber

30 September 2026