In what is possibly one of the most important judgments of 2016, Paposhvili v. Belgium, the Grand Chamber has memorably reshaped its Article 3 case law on 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.
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, 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).
There is so much more to say about the Court’s reasoning in Paposhvili. I am afraid the brief space I am allowed in this post cannot do justice to the judgment. 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.