The European Court of Human Rights ruled on May 27 in N v. the United Kingdom, Application No. 26565/05, that the United Kingdom’s demand that a Ugandan woman living with AIDS return to her home country does not violate the U.K.’s obligations under the European Convention on Human Rights. According to the Court, the likelihood that the woman would die a painful death within two years of her return to Uganda makes no difference, because at present her medical condition is stable and there is no physical impediment to her traveling to Uganda.
The ruling reflects a narrow interpretation of Article 3 of the Convention, which provides: "No one shall be subjected to torture or to inhuman or degrading treatment or punishment." As construed by the European Court, this provision provides protection against deportation for non-citizens only in the most extreme circumstances. The vote of the "grand chamber" of the court was 14-3.
The woman, identified only as "N," entered the U.K. on March 28, 1998, under an "assumed name." She was seriously ill at the time and quickly admitted to a hospital, where she was diagnosed with HIV, "considerable immunosuppression" and tuberculosis. Within days, British attorneys had filed a petition on her behalf seeking asylum, claiming that she was abused and raped by members of the National Resistance Movement in Uganda and that she feared for her life if forced to return to that nation. Within months of her arrival in the U.K., she also developed Kaposi’s sarcoma, the skin cancer emblematic of a full-blown AIDS diagnosis.
Luckily for N, she responded well to the state-of-the-art treatment provided by the U.K.’s public health service, and by 2005, the last date at which medical evidence was introduced in this case, her AIDS-related symptoms had gone into remission and her immune system had rebounded. Nonetheless, the British government was seeking to deport her back to Uganda.
British immigration authorities denied her asylum claim, finding credibility problems with her testimony and concluding that she was not at risk from the Ugandan government. Furthermore, in light of her relatively good state of health, they rejected her claim under Article 3 of the Convention that returning her to Uganda would subject her to "torture or to inhuman or degrading treatment or punishment," or somehow violate her right to privacy and autonomy as guaranteed by Article 8 of the Convention.
N’s attorneys appealed this ruling through the British court system, achieving some success at first but ultimately losing out at the highest level in the Law Committee of the House of Lords. British authorities took the view that under European case law, they were only obligated to provide refuge on medical grounds to somebody who was so grievously ill that it would be inhumane to transport them, or whose condition was such that they were likely to die quickly and painfully if cut off from their treatment in the U.K.
Despite medical testimony that the kind of treatment N needed and was receiving in the U.K. to maintain her current state of health was difficult to obtain in Uganda, and that it was likely that she would relapse to full-blown AIDS and die a painful death within a few years if forced to return there, the Law Committee voted that this did not meet the high standard for relief set by Article 3.
By overwhelming vote, the European Court agreed, quoting with approval lengthy excerpts from the opinions by the British Law Lords. Apparently the European Court has faced a series of cases over the past decade from HIV-positive Africans who have been able to make their way to various European Union countries, where national health systems made available to them the kind of state-of-the-art treatment not easily accessible in their home countries and restored them to relatively good health. The upside of national health systems is that such treatment is available to everybody without charge. The downside is that the government is acutely aware of who is accessing the service and the expenses involved in providing it, and governments seek to deport such expensive "guests" at the first opportunity.
According to the European Court, "It is the Court’s settled case-law that as a matter of well-established international law, and subject to their treaty obligations, including those arising from the Convention, Contracting States have the right to control the entry, residence and removal of aliens." This right to expel aliens is subject to the requirements of the Convention. In this connection, "Article 3 principally applies to prevent a deportation or expulsion where the risk of ill-treatment in the receiving country emanates from intentionally inflicted acts of the public authorities there or from non-State bodies when the authorities are unable to afford the applicant appropriate protection."
In light of these principles, the Court pointed out, its developing law governing the claims of HIV-positive aliens has tried to achieve a balance between the humanitarian concerns embodied in the Convention and the realistic social and economic concerns of the countries that have signed on to the Convention. The Court has distinguished between suffering intentionally inflicted by a government, and suffering for which a government may not be held responsible. The Court has also tried to draw a line, sometimes difficult to discern, between the civil and political rights guaranteed by the Convention, and social and economic rights that are implicated but not directly addressed. Thus, the Convention has not been construed to require governments to provide free health care, even though that is the political norm in much of Europe.
In light of these concerns, wrote the Court in summarizing its approach to the issue, "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."
The prime example of such an "exceptional" case, also involving a person with AIDS, had been decided before the introduction of the first generation of protease inhibitors. In that case, D v. the United Kingdom (judgment of 2 May 1997, Reports of Judgment and Decisions 1997-III), the Court had ruled that Article 3 would be violated if the U.K. forcibly returned a man who was literally at death’s door to his home country in Africa. The case of N, who is now stable and reasonably healthy, was clearly distinguishable in the eyes of the Court, so she was totally out of luck.
"The Court accepts that the quality of the applicant’s life, and her life expectancy, would be affected if she were returned to Uganda," the opinion concluded. "The applicant is not, however, at the present time critically ill. The rapidity of the deterioration which she would suffer and the extent to which she would be able to obtain access to medical treatment, support and care, including help from relatives, must involve a certain degree of speculation, particularly in view of the constantly evolving situation as regards treatment of HIV and AIDS worldwide." Thus, the Court found that her deportation to Uganda would not violate Article 3.
Unaccountably, the court decided not to provide any independent analysis of N’s Article 8 claim, baldly asserting, "The Court does not consider that any separate issue arises under Article 8 of the Convention. It is not necessary, therefore, to examine this complaint."
The dissenters argued that the particular circumstances of N’s case, especially the unanimous medical opinions in the record that her return to Uganda would almost inevitably lead to her deterioration and death due to lack of access to adequate treatment, placed her case much closer to the precedent of D v. the United Kingdom than the Court was willing to admit. They also pointed out that the Court’s refusal to evaluate the Article 8 claim was a startling departure from its usual practice of scrutinizing an alternative claim to relief if the principal ground was denied. The dissenters pointed out that the main policy argument made by the British government, that granting relief in such cases would turn the European countries into some sort of medical refuge for the ill of developing countries, was not applicable in this case, because N had not been diagnosed when she fled Uganda, her flight being attributable to fear of persecution rather than a search for medical treatment.