QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
Strand London WC2 |
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B e f o r e :
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THE QUEEN ON THE APPLICATION OF D B | (CLAIMANT) | |
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IMMIGRATION APPEAL TRIBUNAL | (DEFENDANT) | |
SECRETARY OF STATE FOR THE HOME DEPARTMENT | (INTERESTED PARTY) |
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Computer-Aided Transcript of the Stenograph Notes of
Smith Bernal Wordwave Limited
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(Official Shorthand Writers to the Court)
MISS G WARD (instructed by Duncan Lewis & Co) appeared on behalf of the CLAIMANT
MISS S BROADFOOT (instructed by Treasury Solicitors) appeared on behalf of the DEFENDANT
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Crown Copyright ©
"Mr B presented to our hospital through casualty in December 2000. He was extremely unwell at presentation and would have died without urgent treatment that he received then. During his admission he was found to have pulmonary tuberculosis and at our recommendation he had a HIV test that also proved positive.
"When Mr B first presented he had AIDS, in addition to the tuberculosis infection he also had a low CD4 count of 10 and his viral load was 120,000. Mr B made a good initial recovery due to his therapy soon after. He was having a good response but then developed further illness in 2001 and was found to be diagnosed with mycobacterium leprae, known as leprosy, and this was affecting his left face and eye.
"He was referred to the Hospital for Tropical Diseases at University College London and has been receiving dual management from our own unit on T1 ward in the North Middlesex Hospital for his HIV infection and has been receiving treatment for his leprosy at the Hospital for Tropical Diseases. Both conditions are still requiring active therapy and without appropriate treatment and monitoring they would both relapse rapidly.
"Mr B's HIV viral load is now less than 50 but his CD4 count is only 80 so he is immunocompromised. However, his prognosis and current situation is likely to be in the order of 5 to 10 years or quite possibly much more. Were he forced to stop his therapy, his condition would deteriorate rapidly and his prognosis would be in the order of 6 to 12 months. Mr B is currently requiring complex therapy for his HIV infection and also for his leprosy, including the immunosupressant drug azathioprine and rifabutin."
"Were he denied leave to remain in the UK and sent back to Uganda, he would not be able to continue his therapies and we would expect both of his conditions to deteriorate rapidly. At least two of his essential drugs (azathioprine and rifabutin) [a drug for the treatment of leprosy] are not available in Uganda.
"Were he forced to leave the UK and return to Uganda, he would therefore have to stop his therapies. In this situation his immune system would deteriorate rapidly. His leprosy would worsen and it is likely that his tuberculosis would return. His prognosis would then be reduced enormously to the order of 6 to 12 months. During this time his condition would worsen, he would deteriorate with increasing weight loss, weakness, disability that would ultimately lead to his death. If Mr B is allowed to remain in the UK then he would be able to continue treatment and the unnecessary suffering and death described above would not occur."
"The National Strategic Framework for HIV/AIDS Activities in Uganda for 2001-2005/6, the executive summary, shows that the Government is addressing the problem of AIDS seriously and that there is available treatment for AIDS sufferers in Uganda. Turning to CIPU at paragraph 5.66 onwards regarding medical services, I note from paragraph 5.67 that according to a report issued in July 2002 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) Uganda's HIV infection rate has declined from the seventeenth high in the world to the twentieth highest. In December 2000, Ugandan radio reported that HIV and AIDS in urban areas had dropped by 30 per cent. Also in December 2000 the Bill Gates Foundation donated US$15.3 million to Uganda for the implementation of national population programmes focusing on adolescents and HIV/AIDS.
"In December 2000, the Government of Uganda signed an agreement with two US based drugs manufacturers to reduce the prices of two new anti-AIDS drugs, crixivan and stokrin, by 70 and 50 per cent respectively. A report in May 2001 stated that the Government of the United States of America was to introduce two new development programmes and inject a total of 50 million to help fight the HIV/AIDS pandemic in Uganda. I note from paragraph 5.69 that in an effort to control the HIV/AIDS pandemic, the Government promised soon to start distributing free condoms in villages countrywide according to a UN integrated regional information network report issued on 17th January 2002. Uganda has been cited as the success in sub-Saharan Africa in an effort to reduce HIV prevalence levels, according to the Joint United Nations Programme on HIV/AIDS, UNAIDS."
"32. The appellant in this case claims that he suffers from HIV/AIDS. He claims that he will not receive the type of medical treatment that he can expect to receive from the United Kingdom. There is clear evidence in support of his claim that he does suffer from HIV/AIDS, including a report recently enclosed in a letter from North Middlesex University Hospital dated 25th March 2003 from Dr Chris Wood MRCP.
"34. The objective material on Uganda clearly shows that Uganda is addressing the problem of AIDS. It also shows that there is available in Uganda, at considerably reduced prices, medication that would be available in this country. AIDS is treatable in Uganda as in many other countries albeit that it might not have the same standard of treatment as is available in the United Kingdom.
"I have considered the submissions made on behalf of the appellant, bearing in mind the decision of the High Court in the case of Kasasa. Clearly there is every effort by the Ugandan authorities to deal with the problems of AIDS and they are in receipt of considerable international funding to assist in that region. The objective material also shows that the appellant in this case is far from unique in his case. Very sadly, his position is not unique and there is nothing exceptional in this case. Clearly, there is availability of facilities in Uganda to deal with his condition.
"In my opinion, his return to Uganda at the present time would not amount to inhuman or degrading treatment or reach the high threshold contemplated by Article 3 in order to breach the European Convention. Nor can it be said in present circumstances that his return to Uganda would be a breach of his moral or physical integrity since medical facilities there are available."
"3. Despite this evidence, the Adjudicator held at paragraph 34 of his determination that Mr B's 'position is not unique and there is nothing exceptional in his case. Clearly there is availability of facilities in Uganda to deal with his condition.'
"4. The finding of the Adjudicator was flawed in that the clear evidence was that two of Mr B's essential drugs are not available in Uganda. Mr B's combination of conditions is very unusual (see letter from Dr Woods dated 11th August 2003) and if he were to be returned to Uganda the certainty is that he would not be able to receive any effective treatment for his conditions and his life expectancy would accordingly be reduced to the 6-12 months set out in Dr Woods' evidence to the Adjudicator.
"6. The clear evidence in this case is that:
"(i) Mr B has a very unusual combination of AIDS and leprosy;
"(ii) The only effective treatment for this combination of illnesses is a specific combination of drug therapies;
"(iii) At least two of the essential components of the drug therapy are not available in Uganda.
"(iv) If any part of Mr B's treatment is withdrawn, he will rapidly relapse and his prognosis will be approximately 6-12 months.
"7. The Adjudicator's finding that there is treatment available for Mr B's condition in Uganda is not therefore supported by the objective evidence when the facts of this case are properly analysed. The Adjudicator should have held that Mr B's inability to access treatment if returned to Uganda would lead to breach of his rights under Article 3 ECHR and allowed this appeal on human rights grounds."
"8. It is acknowledged that this application is made significantly outside the time limit for applying for permission to appeal. It is not clear why Mr B's previous solicitors did not advise him to appeal within time. Mr B's current solicitors were instructed only very shortly before removal directions were set for Mr B and have until now been concentrating on the ongoing judicial review proceedings to quash those directions."
"1. An application notice for permission to appeal must be filed in accordance with rule 15.2 or served in accordance with rule 15.2(b) ...
"(b) In any other case where the appellant is in the United Kingdom not later than ten days after he is served with the Adjudicator's determination ...
"2. The tribunal may extend the time limits in paragraph 1 if it is satisfied that by reason of special circumstances it would be unjust not to do so."
"The tribunal may grant permission to appeal only if it is satisfied that (a) the appeal would have a real prospect of success or (b) there is some other compelling reason why the appeal should be heard."
"2. The claimant sought leave to appeal on 3 November 2003 and was substantially out of time over five months.
"3. By a letter dated 6 November 2003, Messrs Duncan Lewis & Co Solicitors told the tribunal that, 'It is not clear as to why our client's previous solicitors did not lodge an appeal to the tribunal.'
"4. The tribunal may extend the time limits in which to appeal if it is satisfied that by reason of special circumstances it would be unjust not to do so.
"5. There is nothing in the letter of 6 November 2003 insofar as it relates to any reason for this claim to amount to special circumstances.
"6. I have, however, considered the evidence in the round. Like millions of other people, the claimant suffers from AIDS. He also serves from leprosy and tuberculosis. I have read the medical report of Dr Meadway, dated 21 October 2003. I note the treatment the claimant has already received to treat his leprosy.
"7. In N, the Court of Appeal reconsidered the high threshold required to establish a breach of an individual's human rights based on that person's medical condition and whether there were exceptional circumstances over and above the absence of affordable treatment such that the humanitarian appeal cannot properly be resisted.
"8. The Adjudicator considered the medical evidence and the provision of healthcare, see paragraph 6 [a mistyping for paragraph 26] of the determination.
"9. Having considered the medical evidence and the absence of a suitable reason for the delay, these are not special circumstances rendering it unjust to refuse the claimant permission to extend time to appeal."
"Mr B's health: summary of my previous report."
"Mr B has very advanced HIV disease as shown by his profoundly low CD4 count. He has rapidly progressive HIV disease as shown by his high viral load. Mr B has leprosy affecting his face and his eye. Mr B is having treatment for his HIV and his leprosy. If he continues both treatments in full dose he can expect to live for some years.
"If Mr B does not continue full treatment for his leprosy, his leprosy will deteriorate and this will lead to a deterioration also in his HIV. If Mr B does not continue antiretrovirals in full doses his HIV will deteriorate, leading to severe opportunistic infections and other AIDS complications. His leprosy will also deteriorate.
"In Uganda Mr B would not have access to free antiretrovirals. He would not have access to full treatment for opportunistic infections and other complications."
"Many medications interact with antiretroviral drugs and cannot be used at the same time. Rifampicin is the most potent component of standard combination treatment for tuberculosis and leprosy, but cannot be used with many antiretroviral drugs because of troublesome interactions. Rifabutin is a drug in the same group as rifampicin and shares its effectiveness in combination therapy for tuberculosis and leprosy, but its interactions are less marked and it can be used with antiretroviral therapy ... Mr B cannot take standard rifampicin combination treatment for his leprosy while taking his present antiretroviral regime."
"Mr B's prognosis if he remains on antiretrovirals and leprosy treatment.
"On his regime Mr B's viral load is completely suppressed (less than 50) and his CD4 has risen to 80. His CD4 would be higher if he had not developed leprosy. The effectiveness of his treatment is likely to persist whilst he is taking almost 100 per cent of doses of his antiretrovirals as long as he also has full leprosy treatment. If Mr B continues to take his medications in this way and his HIV physician and tropical diseases specialist continue to monitor him and to plan treatment in the UK then he can expect to survive for some years in reasonable health with improvement in his leprosy and without opportunistic infections or other AIDS-related complications.
"Mr B's prognosis if he does not have antiretrovirals and leprosy treatment.
"If Mr B has no antiretrovirals or inadequate antiretrovirals then his HIV will deteriorate, leading to opportunistic infections and other complications. His leprosy would deteriorate as a result of the worsening immunity.
"If Mr B did not have full leprosy treatment then his leprosy would deteriorate. Mr B has leprosy involving the face and eye. Any deterioration would lead to tissue destruction and loss of the eye. Further extension of the leprosy infection would lead to destruction of the nose, causing terrible disfigurement, and involvement of other eye would lead to total blindness. Extension to other parts of the body could lead to loss of fingers and toes and severe disability. Deterioration in the leprosy will also worsen Mr B's HIV disease, making him more likely to develop other AIDS complications. His tuberculosis would be likely to recur and to become disseminated throughout the body, leading to fevers, sweats and extreme weakness."
"While standard anti-leprosy treatment may be provided free in Uganda, the alternative anti-leprosy treatment of rifabutin and azathiaprine required by Mr B would not be provided free by the Government or by NGO healthcare providers ... The medical information department of Pharmacia, the UK firm manufacturing rifabutin, inform me that they do not export rifabutin to Uganda. They have no export or import licence for Uganda and anyone wishing to import rifabutin from a country to which Pharmacia supply rifabutin would first have to make arrangements in Uganda for its import licence. It is therefore not possible for Pharmacia to state any price applicable in Uganda."
"Organisations treating leprosy would not make arrangements to import rifabutin as an alternative treatment in view of its high price and their access to standard treatment without payment."
"If Mr B returned to Uganda he could have full leprosy treatment only if he stopped his antiretroviral treatment. His health would then deteriorate and he would be prone to AIDS-related complications. He could have antiretroviral treatment only if he paid for it and while taking it would not have access to compatible anti-leprosy treatment.
"In Uganda Mr B would not have access to full therapy for his HIV and his leprosy and his health would deteriorate as a result, leading to severe physical and mental suffering and distress."
"The condition from which she now suffers is indeed AIDS and that without the sophisticated treatment which is she is now receiving she would die within a matter of months. I find that the treatment she needs would not be available to her in Uganda."
"But I am no less clear that D should be very strictly confined. I do not say that its confinement is to deathbed cases; that would be a coarse rule and an unwise one: there may be other instances which press with equal force. That said, in the light of the considerations I have described I would hold that the application of Article 3, where the complaint in essence is of want of resources in the applicant's home country (in contrast to what has been available to him in the country from which he is to be removed) is only justified where the humanitarian appeal of the case is so powerful that it could not in reason be resisted by the authorities of a civilised State.
"This does not, I acknowledge, amount to a sharp legal test. There are no sharp legal tests in this area. I intend only to emphasise that an Article 3 case of this kind must be based on facts which are not only exceptional, but extreme; extreme, that is, judged in the context of cases all or many of which, like this one, demand one's sympathy on pressing grounds. On its facts, D was such a case."
"Sadly, there are many examples of persons who enter the UK and other Member States from developing world countries and who suffer from HIV/AIDS. They receive sophisticated treatment here and if returned to their countries of origin they will receive much less effective treatment and, in some cases, no treatment at all. The antiretroviral drugs which they receive in this country may give them a life expectancy of many years. If they are returned to their countries of origin their life expectancy may, and in many cases almost certainly will, be substantially reduced. But, tragic though all such cases are, it seems to me that it is clear from D that the ECHR would not, without more, recognise such cases as raising humanitarian considerations so compelling as to engage Article 3.
"The court would not regard such circumstances as exceptional, still less very exceptional. The fact that an applicant's life expectancy will be reduced, even substantially reduced, because the facilities in the receiving country do not match those in the expelling country is not sufficient to engage Article 3. Something more is required. I have already referred to the special circumstances which enabled the court in D to find that Article 3 was engaged. I do not say that Article 3 will only ever be engaged where the applicant is in the last stages of a terminal illness. But I consider that the class of case recognised in D as engaging Article 3 should be confined to situations where, broadly speaking, the humanitarian considerations are as compelling as they were in that case."
"An Adjudicator's decision that to send a HIV positive expectant mother to Ghana in circumstances in which it was unlikely that she would witness the collapse and possible death of her newborn child from HIV transmitted by delivery or by breast feeding by her was capable of satisfying that test as a matter of law."
"In all cases, the quality of the explanation for the delay is likely to influence the ultimate grant of leave to appeal."