“47… in exercising their right to expel such aliens Contracting States must have regard toArticle 3 of the Convention (art. 3), which enshrines one of the fundamental values of democratic societies. It is precisely for this reason that the Court has repeatedly stressed in its line of authorities involving extradition, expulsion or deportation of individuals to third countries that Article 3 (art. 3) prohibits in absolute terms torture or inhuman or degrading treatment or punishment and that its guarantees apply irrespective of the reprehensible nature of the conduct of the person in question… 49. It is true that this principle has so far been applied by the Court in contexts in which the risk to the individual of being subjected to any of the proscribed forms of treatment emanates from intentionally inflicted acts of the public authorities in the receiving country or from those of non-State bodies in that country when the authorities there are unable to afford him appropriate protection…Aside from these situations and given the fundamental importance of Article 3 in the Convention system, the Court must reserve to itself sufficient flexibility to address the application of that Article in other contexts which might arise. It is not therefore prevented from scrutinising an applicant’s claim under Article 3 where the source of the risk of proscribed treatment in the receiving country stems from factors which cannot engage either directly or indirectly the responsibility of the public authorities of that country, or which, taken alone, do not in themselves infringe the standards of that Article. To limit the application of Article 3 in this manner would be to undermine the absolute character of its protection . In any such contexts, however, the Court must subject all the circumstances surrounding the case to a rigorous scrutiny, especially the applicant’s personal situation in the expelling State.” [Emphasis added]
“in view of these exceptional circumstances and bearing in mind the critical stage now reached in the applicant’s fatal illness” that there would be a violation if the deportation were to proceed. 24. The introduction of the term “exceptional” in D was suggestive of a higher threshold than the “minimum level of severity” ordinarily applied. This was certainly the interpretation adopted by the Court in Bensaid v United Kingdom (App No. 44599/98),(2001) 33 EHRR 10 [at §40] : "40. … Having regard, however, to the high threshold set by Article 3, particularly where the case does not concern the direct responsibility of the Contracting State for the infliction of harm, the Court does not find that there is a sufficiently real risk that the applicant's removal in these circumstances would be contrary to the standards of Article 3. The case does not disclose the exceptional circumstances of [ D v the United Kingdom] …” [Emphasis added]
"42. In summary, the Court observes that since D v the United Kingdom it has consistently applied the following principles. Aliens who are subject to expulsion cannot in principle claim any entitlement to remain in the territory of a Contracting State in order to continue to benefit from medical, social or other forms of assistance and services provided by the expelling State. The fact that the applicant's circumstances, including his life expectancy, would be significantly reduced if he were to be removed from the Contracting State is not sufficient in itself to give rise to breach of Article 3. The decision to remove an alien who is suffering from a serious mental or physical 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, where the humanitarian grounds against the removal are compelling . In the D case the very exceptional circumstances were that the applicant was critically ill and appeared to be close to death, could not be guaranteed any nursing or medical care in his country of origin and had no family there willing or able to care for him or provide him with even a basic level of food, shelter or social support. 43. The Court does not exclude that there may be other very exceptional cases where the humanitarian considerations are equally compelling. However, it considers that it should maintain the high threshold set in D v the United Kingdom and applied in its subsequent case-law, which it regards as correct in principle, given that in such cases the alleged future harm would emanate not from the intentional acts or omissions of public authorities or non-State bodies, but instead from a naturally occurring illness and the lack of sufficient resources to deal with it in the receiving country ." [Emphasis added]
“282. If the dire humanitarian conditions in Somalia were solely or even predominantly attributable to poverty or to the state’s lack of resources to deal with a naturally occurring phenomenon, such as a drought, the test in N v United Kingdom may well have been considered to be the appropriate one. However, it is clear that while drought has contributed to the humanitarian crisis, that crisis is predominantly due to the direct and indirect actions of the parties to the conflict. The reports indicate that all parties to the conflict have employed indiscriminate methods of warfare in densely populated urban areas with no regard to the safety of the civilian population. This fact alone has resulted in widespread displacement and the breakdown of social, political and economic infrastructures. Moreover, the situation has been greatly exacerbated by al-Shabaab’s refusal to permit international aid agencies to operate in the areas under its control, despite the fact that between one-third and one-half of all Somalis are living in a situation of serious deprivation.”
“90. Second, the Court considers that the present case can be distinguished from M.S.S. In that case, a fellow Contracting State, Greece, was found to be in violation ofArticle 3 of the Convention through its own inaction and its failure to comply with its positive obligations under both European and domestic legislation to provide reception facilities to asylum seekers. Central to the Court’s conclusion was its finding that the destitution of which the applicant in that case complained was linked to his status as an asylum seeker and to the fact that his asylum application had not yet been examined by the Greek authorities. The Court was also of the opinion that, had they examined the applicant’s asylum request promptly, the Greek authorities could have substantially alleviated his suffering (see paragraph 262 of the judgment). By contrast, the present application concerns the living conditions and humanitarian situation in Afghanistan, a non‑Contracting State, which has no such similar positive obligations under European legislation and cannot be held accountable under the Convention for failures to provide adequate welfare assistance to persons with disabilities. In that regard, it is recalled that the Convention does not purport to be a means of requiring Contracting States to impose Convention standards on other States (see, as a recent authority, Al-Skeini and Others v. the United Kingdom [GC], no. 55721/07 , § 141,7 July 2011 ).” 35. We are accordingly satisfied that the MSS approach cannot be extended to cover situations in which non-ECHR signatories fail to meet their own regional or international commitments. It follows that the approach to take here is that set out in N , bringing us at last to the central legal issue before us: where is the N threshold to be set in such cases today? Non-intentional harm and the N threshold: Paposhvili applied? 36. As we have seen, in Said Burnett LJ expressly equated cases involving non-intentional material deprivation with those concerning ill-health: the Court held that it was the high N threshold that must be applied to such claims. This is also the view taken by the ECtHR, see for instance Sufi and Elmi [§282], and by the Court of Appeal, see for instance MI (Palestine) v Secretary of State for the Home Department[2018] EWCA Civ 1782 , [2019] Imm AR 75 [§16-23]. To date there has never been any suggestion that different approaches should be taken to these related species of claims. Yet before us this was the case put by Mr Anderson. 37. The reason that the Secretary of State is now concerned to draw a distinction between these two types of ‘non-intentional harm’ cases is the modification of the N test introduced by the ECtHR in Paposhvili v Belgium (App No. 41738/10), [2017] Imm AR 876 and endorsed in December 2020 by the UK Supreme Court in AM (Zimbabwe) v Secretary of State for the Home Department[2020] UKSC 17 , [2020] Imm AR 1167 . Following N claimants were required to demonstrate circumstances so exceptionally appalling that they reached the high threshold set in D : where the applicant was critically ill and appeared to be close to death, could not be guaranteed any nursing or medical care in his country of origin and had no family there willing or able to care for him or provide him with even a basic level of food, shelter or social support. That ‘deathbed’ scenario has now been held to set too high a threshold to properly reflect the values that Article 3 is designed to protect. The formula posited in Paposhvili was that there must be a real risk 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”
“87. In interpreting the Convention regard must be had to its special character as a treaty for the collective enforcement of human rights and fundamental freedoms. Thus, the object and purpose of the Convention as an instrument for the protection of individual human beings require that its provisions be interpreted and applied so as to make its safeguards practical and effective. In addition, any interpretation of the rights and freedoms guaranteed has to be consistent with "the general spirit of the Convention, an instrument designed to maintain and promote the ideals and values of a democratic society". 88 … The question remains whether the extradition of a fugitive to another State where he would be subjected or be likely to be subjected to torture or to inhuman or degrading treatment or punishment would itself engage the responsibility of a Contracting State under Article 3. That the abhorrence of torture has such implications is recognised in Article 3 of the United Nations Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, which provides that "no State Party shall ... extradite a person where there are substantial grounds for believing that he would be in danger of being subjected to torture". The fact that a specialised treaty should spell out in detail a specific obligation attaching to the prohibition of torture does not mean that an essentially similar obligation is not already inherent in the general terms ofArticle 3 of the European Convention . It would hardly be compatible with the underlying values of the Convention, that "common heritage of political traditions, ideals, freedom and the rule of law" to which the Preamble refers, were a Contracting State knowingly to surrender a fugitive to another State where there were substantial grounds for believing that he would be in danger of being subjected to torture, however heinous the crime allegedly committed. Extradition in such circumstances, while not explicitly referred to in the brief and general wording of Article 3, would plainly be contrary to the spirit and intendment of the Article, and in the Court’s view this inherent obligation not to extradite also extends to cases in which the fugitive would be faced in the receiving State by a real risk of exposure to inhuman or degrading treatment or punishment proscribed by that Article [6] .” [Emphasis added]
“38. … So the starting-point is the text, and any implication or enlargement requires a careful avoidance of the imposition of obligations beyond the actual or assumed scope of the States parties' agreement. But there is at once a difficulty, unacknowledged in these dicta . How is the "living instrument" approach to be reconciled with the court's duty to be loyal to the founders' agreement? The notion that the modern scope of ECHR rights may be resolved by asking whether the States parties might have consented to this or that outcome suggested by circumstances which were or might have been beyond contemplation when the text was agreed is surely problematic. I think the best one can do is to confine any implication or enlargement to situations which have some affinity with the paradigm case; situations which are, so to speak, within the spirit of the paradigm case, whose identification therefore assumes a considerable importance.” 48. As a matter of principle, this is plainly correct, and it accords with the general rule of interpretation set down in Article 31(1) of the Vienna Convention on the Law of Treaties. Decision makers must be careful not to read into the Convention protections beyond its scope, since to do so would be to bind signatories to obligations that they never agreed to. It would however be equally wrong to take a restrictive, originalist approach to the text. T he Convention is to be interpreted and applied in a manner which renders its rights practical and effective, not theoretical and illusory, and in a manner which continues to reflect the values of the societies that it serves. A review of the jurisprudence since 1950 reveals just how far, applying those principles, the branches of the tree have already spread. 49. The first decades of the Convention’s lifespan saw little legal activity in Strasbourg: the Convention then simply served as a declaration of the values and political will of post-war Europe. In this early period it was seen primarily as a mechanism by which that democratic order could be enforced: see for instance the Greek Case [7] , in which other members of the Council of Europe charged the fascist junta in Athens with the torture of political opponents. It was not in fact until the mid-1960s that the United Kingdom, in common with other major powers, accepted the right of individual petition at all [8] . Having taken that leap, however, the ECtHR soon accepted that it is the purpose of the Convention which is to be given primacy in its interpretation, taking a teleological approach in Wemhoff v Federal Republic of Germany (App No 2122/64), (1979-80) 1 EHRR 55, Golder v United Kingdom (App No. 4451/70), (1979-80) 1 EHRR 524 and then Tyrer v United Kingdom (App No. 5856/72) , 2 EHRR 1 i n which the court expressly recognised that this purpose was to be interpreted in light of societal developments: The Court must also recall that the Convention is a living instrument which, as the Commission rightly stressed, must be interpreted in the light of present-day conditions. 50. Applying the ‘living instrument’ doctrine the ECtHR has since Tyrer repeatedly enlarged the scope of the Convention’s protections beyond scenarios within the contemplation of the signatory parties in 1950. In for instance Marckx v Belgium (App No 6833/74),(1980) 2 EHRR 330 the ECtHR recognised the Article 8 family life rights of children born out of wedlock, and in Dudgeon v United Kingdom (App No 7525/76),(1981) 4 EHRR 149 the private life rights of gay men. As Mr Anderson’s own chronology demonstrates, the protection of the Convention was then (in effect) extended outwith the borders of Europe in Soering , and in D to cases far beyond the original paradigm. As these cases illustrate, the ‘living instrument’ doctrine has already yielded results which would seventy years ago have been regarded as radical, but in applying it the ECtHR has expressly recognised that its decisions must reflect the prevailing norms in the societies that it serves. As the court put it in Wemhoff , it is necessary “to seek the interpretation that is most appropriate in order to realise the aim and achieve the object of the treaty, not that which would restrict to the greatest possible degree the obligations undertaken by the Parties”. 51. This being so, we find a number of ECtHR cases in which social, cultural and economic rights feature, either tangentially, or centrally, notwithstanding their apparent exclusion by the signatories in 1950. It is trite history that in this wholly western European project the drafters selected from the Universal Declaration of Human Rights only those civil and political rights believed to best reflect democratic values: the economic rights ideologically vaunted by the eastern bloc were deliberately omitted [9] . Yet as early as 1979 the ECtHR had in Airey v Ireland (App No. 6289/73) , (1979-80) 2 EHRR 305 cautioned against imagining a “water-tight division” between the two classes of rights. The Court subsequently recognised the multifaceted nature of suffering in cases such as Seljuk and Asker v Turkey(1998) 26 EHRR 477 , Bilgin v Turkey (App. No 23819/94) 36 EHRR 50, and Dulas v Turkey (App. No 25801/94)[2001] ECHR 60 , all applications in which Turkey was found to be in violation of Article 3 (and 8) notwithstanding that they were ostensibly concerned with the destruction of property and homelessness. Both Commission and Court have further accepted that dire poverty is capable of engaging Article 3: see for instance Larioshina v Russia (App No. 56869/00), (23 rd April 2002) and then in another case concerning inadequate provision for pensioners, Budina v Russia (App. No 45603/05)[2009] ECHR 1104 ,[2002] ECHR 862 (18 June 2009 ). In Budina the Court expressly rejected the Russian submission that it lacked the jurisdiction to consider such matters [10] : “as to compatibility ratione materiae , the Court reiterates that the mere fact that an interpretation of the Convention may extend into the sphere of social and economic rights should not be a decisive factor against such an interpretation”. 52. An analysis to the same effect is found in our own domestic jurisprudence in Adam, Limbuela and Tesema v Secretary of State for the Home Department[2005] UKHL 66 ,[2007] 1 All ER 951 where the House of Lords was asked to consider whether legislation depriving those who had failed to claim asylum on arrival - “late applicants” - of financial support had given rise to a violation of Article 3. Their Lordships expressly recognised that the Convention imposes no positive obligations upon signatory states to guarantee socio-economic rights [11] , but where the lack of them is abject, the Article may be engaged. As Lord Bingham of Cornhill puts it [at §7]: “Treatment is inhuman or degrading if, to a seriously detrimental extent, it denies the most basic needs of any human being. As in all article 3 cases, the treatment, to be proscribed, must achieve a minimum standard of severity, and I would accept that in a context such as this, not involving the deliberate infliction of pain or suffering, the threshold is a high one. A general public duty to house the homeless or provide for the destitute cannot be spelled out of article 3. But I have no doubt that the threshold may be crossed if a late applicant with no means and no alternative sources of support, unable to support himself, is, by the deliberate action of the state, denied shelter, food or the most basic necessities of life. It is not necessary that treatment, to engage article 3, should merit the description used, in an immigration context, by Shakespeare and others in Sir Thomas More when they referred to "your mountainish inhumanity". 53. In all of the cases to which we have been referred, whether they are about poverty, or a lack of palliative care, or homelessness, the ‘living instrument’ approach has enabled the ECtHR to focus not on fact that the suffering endured by the claimants is socio-economic in nature, but on the suffering itself, and in particular its assault on the human dignity of the individuals concerned. There is no right to health care, but it may be a violation if the lack of it exposes the sick to inhuman and degrading conditions: see D v United Kingdom . Nor is there a right to a minimum level of income, but an existence below that subsistence level could engage Article 3 if it is damaging to physical or mental health, or leaves the individual in “a situation of degradation incompatible with human dignity”: Budina v Russia. There is no guarantee under the Convention of a right to housing per se (see for instance Muslim v Turkey (App No. 53566/99),(2006) 42 EHRR 16 ) but there may be a violation of Article 3 if the lack of housing fundamentally undermines the dignity of the homeless: in Moldavan v Russia (No 2) (Apps No 41138/98 and 64320/02) 44 EHRR 16, the severely overcrowded and unsanitary conditions endured by the applicants over a long period was found, in light of the state’s indifference to their plight, to arouse in them feelings of “humiliation and debasement”. 54. This focus upon dignity has led the Court in recent years to find violations in some arguably unlikely sc enarios. In Vinter & Ors v United Kingdom (Apps Nos 66069/09 130/10 and 3896/10) III ECHR 317, for instance, the Court found the hopelessness faced by prisoners serving sentences without the prospect of parole to be incompatible with the UK’s obligations under Article 3, notwithstanding the s ECtHR’s long stated commitment to giving signatory states a wide margin of appreciation when it came to penal policy. In Bouyid v Belgium (App No 23380/09),[2015] ECHR 819 the facts, a single slap by a police officer, did not at first blush come close to reaching the minimum level of severity required: indeed it had been the unanimous verdict of the Chamber that they did not. By a substantial majority the Grand Chamber overturned the decision below. Central to the Grand Chamber’s reasoning was a confirmation that although the word does not feature in Article 3 itself - the Court lists no fewer than 20 human rights instruments in which it does - human dignity is, and always has been, “the very essence of the Convention” [12] : 87. Ill-treatment that attains such a minimum level of severity usually involves actual bodily injury or intense physical or mental suffering. However, even in the absence of these aspects, where treatment humiliates or debases an individual, showing a lack of respect for or diminishing his or her human dignity, or arouses feelings of fear, anguish or inferiority capable of breaking an individual’s moral and physical resistance, it may be characterised as degrading and also fall within the prohibition set forth in Article 3 … 89. The word “dignity” appears in many international and regional texts and instruments (see paragraphs 45-47 above). Although the Convention does not mention that concept - which nevertheless appears in the Preamble to Protocol No. 13 to the Convention, concerning the abolition of the death penalty in all circumstances - the Court has emphasised that respect for human dignity forms part of the very essence of the Convention. 90. Moreover, there is a particularly strong link between the concepts of “degrading” treatment or punishment within the meaning ofArticle 3 of the Convention and respect for “dignity”
“74. In Salah Sheekh v. the Netherlands , cited above, the Court held that socio-economic and humanitarian conditions in a country of return did not necessarily have a bearing, and certainly not a decisive bearing, on the question of whether the persons concerned would face a real risk of ill treatment within the meaning of Article 3 in those areas (§ 141). 75. However, in N. v. the United Kingdom, cited above, the Court held that although the Convention was essentially directed at the protection of civil and political rights, the fundamental importance of Article 3 meant that it was necessary for the Court to retain a degree of flexibility to prevent expulsion in very exceptional cases. Noting that Article 3 did not place an obligation on Contracting States to alleviate disparities in the availability of medical treatment in different States through the provision of free and unlimited health care to all aliens without a right to stay within their jurisdictions, the Court nevertheless held that humanitarian conditions would give rise to a breach ofArticle 3 of the Convention in very exceptional cases where the humanitarian grounds against removal were compelling ( §42 ). … 89. The Court finds that the principles of N. v. the United Kingdom should apply to the circumstances of the present case for the following reasons. First, the Court recalls that N. concerned the removal of an HIV‑positive applicant to Uganda, where her lifespan was likely to be reduced on account of the fact that the treatment facilities there were inferior to those available in the United Kingdom. In reaching its conclusions, the Court noted that the alleged future harm would emanate not from the intentional acts or omission of public authorities or non-State bodies but from a naturally occurring illness and the lack of sufficient resources to deal with it in the receiving country . The Court also stated that Article 3 did not place an obligation on the Contracting State to alleviate disparities in the availability of medical treatment between the Contracting State and the country of origin through the provision of free and unlimited health care to all aliens without a right to stay within its jurisdiction (ibid, § 44). The Court acknowledges that, in the present case, the applicant’s disability cannot be considered to be a “naturally” occurring illness and does not require medical treatment. Nevertheless, it is considered to be significant that in both scenarios the future harm would emanate from a lack of sufficient resources to provide either medical treatment or welfare provision rather than the intentional acts or omissions of the authorities of the receiving State .” [Emphasis added]
“I was initially looked after by the Social Services under the leaving care provisions, but I lost their support and accommodation in 2011 and became homeless and had no support. I started sofa surfing. I had fallen in with a bad crowd, and started behaving badly myself, first drinking alcohol and later taking drugs. When I arrived in the UK I had never had any alcohol and when I started drinking I became dependent on it and could not live without drugs….I did not have any money to buy them. The dealers who I got my drugs from said that I could have drugs if I sold the drugs for them and gave them money for the drugs and so this is what I did….” 87. He received his first conviction, for selling cannabis, in November 2011. A number of other minor convictions followed before the index offence of possession of a Class A drug with intent to supply led to the sentence of 4 years, handed down at Chichester Crown Court on the 19 th April 2014. MAA served 24 months [15] . Although he admits to having tried Spice in prison he states that he has been clean since the beginning of 2015. He worked in the prison’s education department and claims to have undertaken some courses, although he has lost the certificates. Since his release he has complied with all his probation requirements and his licence ended in May 2018: he has been assessed as being at a low risk of reoffending. He currently spends his time volunteering for a Somali community group in Brixton. He has been supported by AH but since the pandemic started she has lost her job in accountancy and is finding it difficult to give him what she once did. 88. Having had regard to the probation materials and MAA’s circumstances the First-tier Tribunal was satisfied that he presented a low risk of reoffending and accordingly found MAA to have rebutted the presumption ins72 Nationality, Immigration and Asylum Act 2002 that he is a danger to the community. That finding is unchallenged by the Secretary of State. The Medical Evidence 89. MAA relies on the expert assessment of two mental health professionals. We have been provided with a report by Consultant Forensic Psychologist Dr Lisa Davies, dated 20 th September 2019, and a report by Consultant Psychiatrist Dr DL Bell dated 8 th March 2021. We are satisfied that both Dr Davies and Dr Bell are suitably qualified to give evidence in this capacity. We note Mr Anderson’s objections to the late admission of Dr Bell’s evidence, which was not filed and served until the day before the hearing. We recognise that this was contrary to directions, but in view of the potential significance of such evidence, and the fact that Mr Anderson was able to produce a cogent supplementary skeleton addressing it, we do not consider that the Secretary of State was so disadvantaged that it would in the interests of justice to exclude it. 90. In 2019 Dr Davies met with MAA for two and half hours and interviewed him with the assistance of a Somali interpreter. Her report is primarily concerned with whether he presented a risk of reoffending: it was relied upon before the First-tier Tribunal to rebut the presumption that MAA is a danger to the community. Dr Davies does however make some findings of potential relevance to the assessment which we must make today, in respect of MAA’s circumstances upon return to Somalia. It was not Dr Davies’ view that MAA was suffering from Post- Traumatic Stress Disorder or depression, but she acknowledged that at some points he had experienced symptoms associated with both, for instance in 2015 when he witnessed the suicide of a peer in prison. MAA reported to Dr Davies that even in these periods he had not sought medical help but had rather managed his symptoms himself by actively socialising and playing football. Dr Davies found no indications of maladaptive coping strategies being used to manage the stress MAA faced as a result of his proposed deportation. There was at the time that she prepared her report no evidence of suicidal ideation, nor past engagement in suicide attempts or self-harm, but she did conclude that the risk of suicide “could increase if deported”, given his reported past history of depressed mood. Dr Davies concluded: “Deportation would likely result in an exacerbation of symptoms of depression and trauma should he be exposed to further conflict and the separation from current supportive relationships would likely render him vulnerable to exploitation in his future and a relapse of drug and alcohol abuse”. 91. This year, very shortly before the hearing, MAA was interviewed online by Dr Bell. He observed MAA to be clean and appropriately dressed, and that he did not appear to be obviously psychiatrically unwell. The history presented to Dr Bell by MAA was that as a young child he was regularly beaten by his father, with whom he did not enjoy a good relationship; thereafter he witnessed many traumatic scenes such as seeing dead bodies in the street and people being killed or injured around him. He was separated from his family and after his arrival in this country ended up abusing drugs. He then spent time in prison. 92. MAA explained to Dr Bell that he feels depressed and ruminates about his current predicament: he is unable to work, his future is uncertain, and he is filled with feelings of guilt and remorse. He tries to prevent these feelings overwhelming him but sometimes he becomes filled with rage, and when he is very low he cries. Dr Bell records: “he does suffer suicidal ideation wishing he were dead or would not wake, although he has never acted upon this, that is there have been no suicide attempts. It is clear that he feels protected by his religion beliefs, being a Muslim he believes it to be a sin to kill himself” 93. MAA told Dr Bell that he has difficulty sleeping, and that sometimes he stays in the same clothes for days without washing. Dr Bell thought this to be a “very significant degree of self-neglect”
“It is highly likely that the support provided to him by his cousin and his network of friends, particularly those with whom he plays football, has been of great importance in terms of providing emotional and social support. Disorders such as these are however highly context dependent. Any disruption to the current context will result in a relapse into a more disturbed psychiatric state, similar to that which he has encountered previously… The prognosis for [MAA] is entirely dependent on the outcome of the immigration proceedings…In the event that a decision is made to return him to Somalia there will be a deterioration in his psychiatric state…” 95. Dr Bell notes that although MAA does not currently receive any treatment in this country, given the stability of a regularised immigration status his capacity for further rehabilitation would be improved. By contrast Dr Bell believes that if returned to Somalia, there will “in all likelihood be a deterioration in his mental state”
“conditions in most camps are desperate, with inadequate flimsy shelters made from twigs, cloth and plastic, limited food, water and sanitation”