Expulsion of seriously ill migrants: a new ECtHR ruling reshapes ECHR and EU law

Dr Lourdes Peroni*, Postdoctoral Research Fellow, Ghent University Human Rights Centre (ECHR aspects) and Professor Steve Peers (EU law aspects)

In what is possibly one of the most important judgments of 2016, Paposhvili v. Belgium, the Grand Chamber of the European Court of Human Rights (ECtHR) has memorably reshaped its case law on when Article 3 ECHR (which bans torture or other inhuman or degrading treatment) applies to the expulsion of seriously ill migrants. In a unanimous judgment, the Court leaves behind the restrictive application of the high Article 3 threshold set in N. v. the United Kingdom and pushes for a more rigorous assessment of the risk of ill-treatment in these cases. For us at the Human Rights Centre of Ghent University, it was a thrill to intervene as a third party in such an important case. In our third party intervention we submitted that Paposhvili offered a unique opportunity to depart from the excessively restrictive approach adopted in N. We are delighted that the Grand Chamber has seized the opportunity to re-draw the standards in this area of its case law in a way that does fuller justice to the spirit of Article 3.

This main part of the post addresses the ECtHR’s interpretation of the ECHR in Paposhvili, while in the Annex to this post, Steve Peers considers its application within the scope of EU law.

The ECHR judgment

Mr. Paposhvili, a Georgian national living in Belgium, was seriously ill. He claimed that his expulsion to Georgia would put him at risk of inhuman treatment and an earlier death due to the withdrawal of the treatment he had been receiving in Belgium (for more on the facts, see my previous post). He died in Belgium last June, while his case was pending before the Grand Chamber. The Court did not strike his application out of the list. It found that “special circumstances relating to respect for human rights” required its continued examination based on Article 37 § 1 in fine ECHR (§ 133). The Court held that there would have been a violation of Article 3 if Belgium had expelled Mr. Paposhvili to Georgia without having assessed “the risk faced by him in the light of the information concerning his state of health and the existence of appropriate treatment in Georgia.” It found a similar violation of Article 8 if Belgium had expelled him without having assessed the impact of his return on his “right to respect for his family life in view of his state of health.”

Opening Up “Other Very Exceptional Cases”

The Chamber judgment in Paposhvili followed N. and Yoh-Ekale Mwanje v. Belgium where the Court had taken into account that “the applicants’ condition had been stable as a result of the treatment they had been receiving, that they were not ‘critically ill’ and that they were fit to travel” (§ 119). The Chamber thus concluded that though Mr. Paposhvili suffered from “a fatal and incurable disease … his conditions are all stable and under control at present; his life is therefore not in imminent danger and he is able to travel” (§ 120).

As readers might remember, the N. Grand Chamber established that removing a non-national suffering from a serious illness to “a country where the facilities for the treatment of that illness are inferior to those available in the Contracting State may raise an issue under Article 3, but only in a very exceptional case” (§ 42). The Grand Chamber concluded that the applicant’s circumstances in N. were not exceptional, as found in D. v. United Kingdom (§ 42). D was critically ill, close to death, and had no prospect of medical care and family support in his home country. The N. Grand Chamber, however, left a window open: it did not exclude that “there may be other very exceptional cases where the humanitarian considerations are equally compelling” (§ 43, emphasis added).

In our third party intervention, we argued that being medically stable and fit to travel as a result of the treatment received should not be a determining criterion in allowing an expulsion. We respectfully invited the Court to develop a less extreme approach, one that considered the difference between applicants’ suffering in the sending state and the suffering they would face in the receiving state. The aim, we submitted, should be to determine whether the reduction of applicants’ life expectancy and the deterioration of their quality of life would be such as to reach the level of severity required by Article 3. The applicant argued that his expulsion to Georgia would place him at risk of “a severe and rapid deterioration in his state of health leading to his swift and certain death” (§ 148). He asked the Court “to go beyond its findings in N. v. the United Kingdom” and to define “a realistic threshold of severity that was no longer confined to securing a ‘right to die with dignity’” (§ 149).

The Paposhvili Grand Chamber enters through the window N. left open. It notes that since N. no other “very exceptional cases” had been found (§ 178). It importantly recognizes that the application of Article 3 only to persons close to death has deprived those whose condition was less critical but who were still seriously ill from “the benefit of that provision” (§ 181). In a pivotal paragraph, the Grand Chamber considers

… that the “other very exceptional cases” within the meaning of the judgment in N. v. the United Kingdom (§ 43) which may raise an issue under Article 3 should be understood to refer to situations involving the removal of a seriously ill person in which substantial grounds have been shown for believing that he or she, although not at imminent risk of dying, would face a real risk, on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment, of being exposed to a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering or to a significant reduction in life expectancy. The Court points out that these situations correspond to a high threshold for the application of Article 3 of the Convention in cases concerning the removal of aliens suffering from serious illness (§ 183). Emphasis added.

This is a graceful move that softens the unduly restrictive approach that had so far been followed in cases concerning the expulsion of seriously ill migrants. Paposhvili thus comes to fill what Judge Lemmens calls a “gap in the protection against inhuman treatment” (concurring opinion in Paposhvili § 3) by including as exceptional more than just cases of imminent death. My first impression is that the Court does not formally leave behind N.’s exceptional character and the high threshold of Article 3 in cases concerning the expulsion of seriously ill non-nationals (see last sentence § 183 and Judge Lemmens’ opinion § 3). Rather, it appears to open up what in practice has resulted in a limited application of the high threshold. The commendable effect of the Court’s move is, in any event, a less extreme approach more compatible with the spirit of Article 3. Elements of both our third party intervention and the applicant’s arguments are reflected positively in the Grand Chamber reasoning in this regard.

Real Rather Than Theoretical Access to “Sufficient” and “Appropriate” Care

In our third party intervention we proposed that the risk assessment should consider the adequacy of the medical care available in the receiving state and the person’s actual access to such care. The question, we argued, is not just whether adequate treatment is generally available but, crucially, whether the available treatment would in reality be accessible to the person concerned. The applicant argued that the alleged Article 3 violation should be examined “in concreto,” taking into consideration, among other things, “the accessibility of treatment in the country of destination” (§ 139).

The Grand Chamber seizes the occasion to meticulously set out a range of procedural duties for the domestic authorities in the ECHR state parties. All these duties point in one clear direction: a more rigorous assessment of the risk as required by the absolute nature of the Article 3 prohibition (Saadi v. Italy § 128). In assessing the alleged risk of ill-treatment, the domestic authorities should verify whether the care available in the receiving state is “sufficient and appropriate in practice for the treatment of the applicant’s illness so as to prevent him or her being exposed to treatment contrary to Article 3” (§ 189, emphasis added). The domestic authorities should also consider “the extent to which the individual in question will actually have access to this care and these facilities in the receiving State” (§ 190, emphasis added). Referring to existing case law, the Court points to several factors to be taken into account: “cost of medication and treatment, the existence of a social and family network, and the distance to be travelled in order to have access to the required care” (§ 190).

Duty to Obtain Assurances from the Receiving State

With reference to Tarakhel (a 2014 ECtHR ruling on the application of the EU’s Dublin rules on allocation of asylum responsibility), our third party intervention proposed that Article 3 impose on the domestic authorities in the returning state the procedural duty to seek or obtain assurances from the receiving state that the person concerned would actually have access to the treatment s/he needed. We argued that access to appropriate medical care should not be a theoretical option, but a real and guaranteed one, and the burden of proving that such a real option exists should lie on the expelling state (on assurances and the benefits of adopting this path, see Eva Brems’ commentary on Tatar v. Switzerland).

On this point, the Grand Chamber states in paragraph 191:

Where, after the relevant information has been examined, serious doubts persist regarding the impact of removal on the persons concerned – on account of the general situation in the receiving country and/or their individual situation – the returning State must obtain individual and sufficient assurances from the receiving State, as a precondition for removal, that appropriate treatment will be available and accessible to the persons concerned so that they do not find themselves in a situation contrary to Article 3 (on the subject of individual assurances, see Tarakhel, cited above, § 120).

Conclusion

There is so much more to say about the Court’s reasoning in Paposhvili. I have highlighted some of its most remarkable Article 3 principles. Together with others, such as the one establishing when the responsibility of the returning state is engaged (§ 192), these principles firmly move a body of the Court’s case law closer to its principles on the absolute nature of the Article 3 prohibition.

*This part of the post is reblogged with permission from the Strasbourg Observers blog

Barnard & Peers: chapter 26

JHA4: chapter I:7

Photo: OLV hospital, Belgium

Photo credit: Sapa group

Annex: the impact on EU law

By Professor Steve Peers

How does this judgment impact upon EU law?

First of all, it’s necessary to explain the existing EU law position, set in the Abdida and M’Bodj judgments of the ECJ, which was referred to in the ECtHR judgment (paras 120-22), and which I discussed further here. In short, ‘medical cases’ are not within the scope of EU asylum law, either as regards refugee status or subsidiary protection (M’Bodj). However, if the person concerned faces an expulsion order, then the Returns Directive applies. (Note that the latter Directive doesn’t apply to the UK, Ireland or Denmark.)

Although the Returns Directive was mainly intended to ensure removal of irregular migrants from the territory, in ‘medical cases’ (at least), as interpreted by the ECJ in Abdida, it has the opposite effect. According to the Court, the requirement in Article 5 of the Directive to ‘respect the principle of’ non-refoulement means that irregular migrants who fall outside the scope of EU asylum law but nevertheless face an Article 3 ECHR risk, as defined in the case law of the ECtHR, cannot be removed. Moreover, in further displays of legal alchemy, the ECJ ruled that the challenge to their removal must have suspensive effect, and they must receive the necessary health care and social benefits.  

The ECJ has not developed this case law since, although further relevant cases are pending. In MP, the Court has been asked to clarify the line between asylum cases and medical cases, where the medical conditions are more directly linked to persecution or serious harm suffered in the country of origin. In Gnandi, it has been asked to clarify the suspensive effect of a legal challenge in medical cases, following a failed asylum application. In K.A. and others, the Court has been asked about the requirement to ‘take due account’ of family life in Article 5 of the Returns Directive; its ultimate ruling might be relevant to the ‘non-refoulement’ aspect of the same clause by analogy. Equally in Nianga the Court has been asked whether Article 5 applies to the decision to issue a return decision or removal order in the first place: a crucial point because if it does not apply, the person concerned might well fall outside the scope of EU law entirely.  

What impact will the new ECtHR ruling have on the interpretation of EU law? First of all, there’s nothing to suggest it will, by itself, move the dividing line between asylum cases and medical cases, as applied by the ECJ. So we are still looking at the interpretation of the Returns Directive, if that Directive applies.

Since the ECJ committed itself to follow the case-law of the ECtHR as regards medical cases when interpreting the non-refoulement provision of the Returns Directive, it should follow that the new ECtHR ruling applies to the Directive too. Therefore this enlarges the group of people who can benefit from the specific provisions of EU law as interpreted by the ECJ, as regards suspensive effect of appeals and access to health care and social benefits.

Equally the ECtHR’s strong stress on the procedural elements of such cases logically applies by analogy to cases falling within the scope of the Returns Directive. While the ECJ in the Abdida judgment did not refer to its own jurisprudence on the right to a hearing for irregular migrants (discussed here), it is now necessary to update that approach in light of the ECtHR ruling, given the strong link which the latter judgment establishes between the procedural and substantive aspects of what I have referred to as ‘alternative protection’. The ECJ will have an opportunity to address this issue in the months to come, in the pending cases referred to above.

While the ECtHR judgment referred to a need to cooperate with the country of origin in order to check conditions there, in the EU context this might arguably in some cases entail by analogy a check on health conditions in another Member State, which would be responsible for that person under the Dublin rules. The ECJ has yet to determine how its interpretation of the Returns Directive in medical cases fits together with the application of the Dublin rules, which in principle apply if the person concerned has at one point applied for international protection (refugee status or subsidiary protection) within the EU. (Mr. Paposhvili was originally subject to the Dublin rules, but it seems that the plan to remove him to Italy pursuant to those rules petered out).  

Finally, it should be noted that the ECtHR also found a breach of Article 8 ECHR (the right to family life), on similar procedural grounds. This might be relevant to interpretation of the EU’s family reunion Directive, for those who fall within the scope of that Directive and who argue on the basis of the factors to consider during expulsion proceedings pursuant to Articles 17 and 18 of that law.