SS-850/2020-OLR

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UDSKRIFT AF ØSTRE LANDSRETS DOMBOG

____________ K E N D E L S E Afsagt den 19. maj 2020 af Østre Landsrets 19. afdeling (landsdommerne Lone Kerrn-Jespersen, Nikolaj Aarø-Hansen og Mette Damgaard (kst.)). 19. afd. nr.

S-850-20:Anklagemyndighedenmod Domfældte (CPR nr. (Født 1975))(advokat Stefan Reinel, beskikket) Københavns Byrets kendelse af 17. marts 2020 (SS 2-23915/2019) er kæret af DomfældteDomfældte med påstand om, at bestemmelsen om udvisning ophæves. Anklagemyndigheden har påstået stadfæstelse. Kæremålet er behandlet mundtligt, jf. retsplejelovens § 972, stk. 2.

Kæremålet er tillagt opsættende virkning.Supplerende oplysningerAf Københavns Byrets dom af 28. september 2018 fremgår bl.a.: ”Tiltalte har om sine personlige forhold forklaret, at han er født i Tyrkiet, oghan kom til Danmark i 1998. … Han har ikke en uddannelse i Tyrkiet, men hanhavde en restaurant i By 1, som havde mange skandinaviske kunder. …Han har en stor familie i Tyrkiet.

Han har mange søskende, så familien erenorm. Hans fader bor stadig i Tyrkiet.”

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Forklaring Domfældte har supplerende forklaret bl.a., at han i Tyrkiet kun har sin far,som han sidst så for tre år siden. Faderen er meget syg med hjerte- og rygproblemer. Faderen vil ikke kunne hjælpe ham. Herudover har han nogen familie i Tyrkiet, men de ses ikke. Hans venner bor i København, ikke i Tyrkiet. Han er kurder fra det østlige Tyrkiet.

Hanstammer fra byen By 2, hvor der i dag er krig, idet militæret angriber civile kurdere.Parternes anbringenderDomfældte har navnlig anført, at udvisning af ham vil være i strid med Den Europæiske Menneskerettighedskonventions artikel 3.

Til støtte herfor har han navnlighenvist til Den Europæiske Menneskerettighedsdomstols dom af 1. oktober 2019 i sag nr.57467/15, Savran mod Danmark, hvor domstolen fastslog, at udvisning af en skizofrentyrkisk borger til Tyrkiet var i strid med konventionens artikel 3, fordi den pågældendeikke var sikret tilstrækkelig behandling i Tyrkiet.

Det forhold, at dommen af 1. oktober2019 er indbragt forMenneskerettighedsdomstolens storkammer, ændrer– indtil storkam-merets dom foreligger– ikke ved, at den fortolkning af konventionens artikel 3, som dom-men er udtryk for, må lægges til grund ved denne sags afgørelse.

Det fremgår af dommens præmis 62-67, at Menneskerettighedsdomstolen lagde vægt på, atklagerens psykiske sygdom gjorde, at han havde brug for omfattende behandling og somminimum havde brug for en kontaktperson, der kunne hjælpe ham med at følge behandlin-gen.

IfølgeMenneskerettighedsdomstolenburde de danske myndigheder have sikret sig, atklageren ville få tilbudt en kontaktperson af de tyrkiske myndigheder.Faktum i Savran-sagen er ganske sammenligneligt med Domfældtes sag.

Domfældte har ikke noget netværk i Tyrkiet, idet bemærkes, at hans far er 80 år oghjertesyg.Det bestrides ikke, at den medicin, han har brug for, kan skaffes i Tyrkiet, mendet er ikke godtgjort, at det overhovedet er muligt for en skizofren person at få en kontakt-person, der kan påse, at han får den nødvendige behandling, idet Udlændingestyrelsensudtalelse herom af 5. februar 2019 vedrører en kontaktperson eller bistandsværge til enretarderet person.

Dertil kommer, at de tyrkiske myndigheder ikke har bekræftet, at DomfældteDomfældte konkret vil blive tildelt en kontaktperson eller bistandsværge ved sin an-komst til landet. Det er således alene generelt oplyst, at det som udgangspunkt er retten,som tildeler og udnævner en værge til en retarderet person, hvilket ikke lever op til kraveneidommens præmis 66 og 67.

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Anklagemyndighedenhar navnlig gjort gældende, at Domfældte i Tyrkiet kanopnå den relevante behandling, at han fortsat har familiemæssig tilknytning til Tyrkiet,herunder sin far.

Hans helbredsmæssige forhold er derfor ikke til hinder for udvisning.Endvidere har anklagemyndigheden henvist til, at Domfældte er dømt for al-vorlige seksualforbrydelser i form af flere voldtægter efter henholdsvis straffelovens § 216,stk. 1, nr. 1 og 2, over for den samme forurettede under et længere tidsforløb.

Supplerende retsgrundlagAf Menneskerettighedsdomstolens dom i sag 41738/10 af 13. december 2016, Paposhvilimod Belgien (storkammeret), fremgår bl.a.: ”D.The Court’s assessment1.General principles172.The Court reiterates that Contracting States have the right as a matter ofwell-established international law and subject to their treaty obligations, in-cluding the Convention, to control the entry, residence and expulsion of aliens(seeN. v. the United Kingdom, cited above, § 30).

In the context of Article 3,this line of authority began with the case ofVilvarajah and Others v. the Unit-ed Kingdom (30 October 1991, § 102, Series A no. 215). 173.Nevertheless, the expulsion of an alien by a Contracting State may giverise to an issue under Article 3 of the Convention where substantial groundshave been shown for believing that the person concerned faces a real risk of be-ing subjected to torture or inhuman or degrading treatment or punishment inthe receiving country.

In such circumstances, Article 3 implies an obligationnot to expel the individual to that country (seeSaadi, cited above, § 125;M.S.S. v. Belgium and Greece, cited above, § 365;Tarakhel, cited above, § 93;andF.G. v. Sweden, cited above, § 111). 174.The prohibition under Article 3 of the Convention does not relate to allinstances of ill-treatment.

Such treatment has to attain a minimum level of se-verity if it is to fall within the scope of that Article. The assessment of this min-imum is relative; it depends on all the circumstances of the case, such as theduration of the treatment, its physical and mental effects and, in some cases,the sex, age and state ofhealth of the victim (seeN. v. the United Kingdom, cit-ed above, § 29; see alsoM.S.S. v.

Belgium and Greece, cited above, § 219;Ta-rakhel, cited above, § 94; andBouyid v.

Belgium [GC], no. 23380/09, § 86,ECHR 2015). 175.The Court further observes that it has held that the suffering which flowsfrom naturally occurring illness may be covered by Article 3, where it is, orrisks being, exacerbated by treatment, whether flowing from conditions of de-tention, expulsion or other measures, for which the authorities can be held re-sponsible (seePretty, cited above, § 52).

However, it is not prevented fromscrutinising an applicant’s claim under Article 3 where the sourceof the risk of

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proscribed treatment in the receiving country stems from factors which cannotengage either directly or indirectly the responsibility of the public authorities ofthat country (seeD. v. the United Kingdom, cited above, § 49). 176.In twocases concerning the expulsion by the United Kingdom of alienswho were seriously ill, the Court based its findings on the general principlesoutlined above (see paragraphs 172-74 above).

In both cases the Court pro-ceeded on the premise that aliens who were subject to expulsion could not inprinciple claim any entitlement to remain in the territory of a Contracting Statein order to continue to benefit from medical, social or other forms of assistanceand services provided by the returning State (seeD. v. the United Kingdom,cited above, § 54, andN. v. the United Kingdom, cited above, § 42). 177.InD. v. the United Kingdom (cited above), which concerned the decisiontaken by the United Kingdom authorities to expel to St Kitts an alien who wassufferingfrom Aids, the Court considered that the applicant’s removal wouldexpose him to a real risk of dying under most distressing circumstances andwould amount to inhuman treatment (seeD. v. the United Kingdom, citedabove, § 53).

It found that the case was c haracterised by “very exceptional cir-cumstances”, owing to the fact that the applicant suffered from an incurableillness and was in the terminal stages, that there was no guarantee that hewould be able to obtain any nursing or medical care in St Kitts or that he hadfamily there willing or able to care for him, or that he had any other form ofmoral or social support (ibid., §§ 52-53).

Taking the view that, in those circum-stances, his suffering would attain the minimum level of severity required byArticle 3, the Court held that compelling humanitarian considerations weighedagainst the applicant’s expulsion (ibid., § 54).178.In the case ofN. v. the United Kingdom, which concerned the removal ofa Ugandan national who was suffering from Aids to her co untry of origin, theCourt, in examining whether the circumstances of the case attained the level ofseverity required by Article 3 of the Convention, observed that neither the de-cision to remove an alien who was suffering from a serious illness to a countrywhere the facilities for the treatment of that illness were inferior to those avail-able in the Contracting State, nor the fact that the individual’s circumstances,including his or her life expectancy, would be significantly reduced, constitutedin themselves “exceptional” circumstances sufficient to give rise to a breach ofArticle 3 (seeN. v. the United Kingdom, cited above, § 42).

In the Court’sview, it was important to avoid upsetting the fair balance inherent in the wholeof the Convention between the demands of the general interest of the commu-nity and the requirements of the protection of the individual’s fundamentalrights.

A finding to the contrary would place too great a burden on States byobliging them to alleviate the disparities between th eir health-care system andthe level of treatment available in the third country concerned through the pro-vision of free and unlimited health care to all aliens without a right to staywithin their jurisdiction (ibid., § 44).

Rather, regard should be had to the factthat the applicant’s condition was not critical and was stable as a result of theantiretroviral treatment she had received in the United Kingdom, that she wasfit to travel and that her condition was not expected to deteriorate as long asshe continued to take the treatment she needed (ibid., § 47).

The Court alsodeemed it necessary to take account of the fact that the rapidity of the deterio-ration which the applicant would suffer in the receiving country, and the extent

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to which she would be able to obtain access to medical treatment, support andcare there, including help from relatives, necessarily involved a certain degreeof speculation, particularly in view of the constantly evolving situation with re-gard to the treatment of Aids worldwide (ibid., § 50).

The Court concluded thatthe implementation of the decision to remove the applicant would not give riseto a violation of Article 3 of the Convention (ibid., § 51).

Nevertheless, it spec-ified that, in addition to situations of the kind addressed inD. v. the UnitedKingdom in which death was imminent, there might be other very exceptionalcases where the humanitarian considerations weighing against removal wereequally compelling (seeD. v. the United Kingdom, cited above, § 43).

An ex-amination of the case-law subsequent toN. v. the United Kingdom has not re-vealed any such examples.179.The Court has applied the case-law established inN. v. the United King-dom in declaring inadmissible, as being manifestly ill-founded, numerous ap-plications raising similar issues, concerning aliens who were HIV positive (see,among other authorities,E.O. v.

Italy (dec.), no. 34724/10, 10 May 2012) orwho suffered from other serious physical illnesses (see, among other authori-ties,V.S. and Others v. France (dec.), no. 35226/11, 25 November 2014) ormental illnesses (see, among other authorities,Kochieva and Others v. Sweden(dec.), no. 75203/12, 30 April 2013, andKhachatryan v. Belgium (dec.), no.72597/10, 7 April 2015).

Several judgments have applied this case-law to theremoval of seriously ill persons whose condition was under control as the resultof medication administered in the Contracting S tate concerned, and who werefit to travel (seeYoh-Ekale Mwanje v. Belgium, no. 10486/10, 20 December2011;S.H.H. v. the United Kingdom, no. 60367/10, 29 January 2013;Tatar,cited above; andA.S. v.

Switzerland, no. 39350/13, 30 June 2015). 180.However, in its judgment inAswat v. the United Kingdom (no. 17299/12,§ 49, 16 April 2013), the Court reached a different conclusion, finding that theapplicant’s extradition to the United States, where he was being prosecuted forterrorist activities, would entail ill-treatment, in particular because the condi-tions of detention in the maximum security prison where he would be placedwere liable to aggravate his paranoid schizophrenia.

The Court held that therisk of significant deterioration in the applicant’s mental and physical healthwas sufficient to give rise to a breach of Article 3 of the Convention (ibid., §57). 181.The Court concludes from this recapitulation of the case-law that the ap-plication of Article 3 of the Convention only in cases where the person facingexpulsion is close to death, which has been its practice since the judgment inN.v. the United Kingdom, has deprived aliens who are seriously ill, but whosecondition is less critical, of the benefit of that provision.

As a corollary to this,the case-law subsequent toN. v. the United Kingdom has not provided moredetailed guidance regarding the “very exceptional cases” referred to i n N. v. theUnited Kingdom, other than the case contemplated inD. v. the United King-dom. 182.In the light of the foregoing, and reiterating that it is essential that theConvention is interpreted and applied in a manner which renders its rightspractical and effective and not theoretical and illusory (seeAirey v.

Ireland, 9October 1979, § 26, Series A no. 32;Mamatkulov and Askarov v. Turkey [GC],

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nos.46827/99 and 46951/99, § 121, ECHR 2005-I; andHirsi Jamaa and Oth-ers v.

Italy [GC], no. 27765/09, § 175, ECHR 2012), the Court is of the viewthat the approach adopted hitherto should be clarified.183.The Court considers that the “other very exceptional cases” within themeaning of the judgment inN. v. the United Kingdom (§ 43) which may raisean issue under Article 3 should be understood to refer to situations involvingthe removal of a seriously ill person in which substantial grounds have beenshown 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 thereceiving country or the lack of access to such treatment, of being exposed to aserious, rapid and irreversible decline in his or her state of health resulting inintense suffering or to a significant reduction in life expectancy.

The Courtpoints out that these situations correspond to a high threshold for the applica-tion of Article 3 of the Convention in cases concerning the removal of alienssuffering from serious illness.184.Asto whether the above conditions are satisfied in a given situation, theCourt observes that in cases involving the expulsion of aliens, the Court doesnot itself examine the applications for international protection or verify howStates control the entry,residence and expulsion of aliens.

By virtue of Article1 of the Convention the primary responsibility for implementing and enforcingthe guaranteed rights and freedoms is laid on the national authorities, who arethus required to examine the applicants’ f ears and to assess the risks theywould face if removed to the receiving country, from the standpoint of Article3.

The machinery of complaint to the Court is subsidiary to national systemssafeguarding human rights. This subsidiary character is articulated in Article13 and Article 35 § 1 of the Convention (seeM.S.S. v. Belgium and Greece, cited above, §§ 286-87, andF.G. v.

Sweden, cited above, §§ 117-18). 185.Accordingly, in cases of this kind, the authorities’ obligation under Arti-cle 3 to protect the integrity of the persons concerned is fulfilled primarilythrough appropriate procedures allowing such examination to be carried out(see,mutatis mutandis,El-Masri v. the former Yugoslav Republic of Macedo-nia [GC], no.39630/09, § 182, ECHR 2012; Tarakhel, cited above, § 104; andF.G. v.

Sweden, cited above, § 117).186.In the context of these procedures, it is for the applicants to adduce evi-dence capable of demonstrating that there are substantial grounds for believingthat, if the measure complained of were to be implemented, they would be ex-posed to a real risk of being subjected to treatment contrary to Article 3 (seeSaadi, cited above, § 129, andF.G. v. Sweden, cited above, § 120).

In this con-nection it should be observed that a certain degree of speculation is inherent inthe preventive purpose of Article 3 and that it is not a matter of requiring thepersons concerned to provide clear proof of their cl aim that they would be ex-posed to proscribed treatment (see, in particular,Trabelsi v.

Belgium, no.140/10, § 130, ECHR 2014 (extracts)).187.Where such evidence is adduced, it is for the authorities of the returningState, in the context of domestic procedures, to dispel any doubts raised by it(seeSaadi, cited above, § 129, andF.G. v. Sweden, cited above, § 120). Therisk alleged must be subjected to close scrutiny (seeSaadi, cited above, § 128;

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Sufi and Elmi v. the United Kingdom, nos. 8319/07 and 11449/07, § 214, 28June 2011;Hirsi Jamaa and Others, cited above, § 116; andTarakhel, citedabove, § 104) in the course of which the authorities in the returning State mustconsider the foreseeable consequences of removal for the individu al concernedin the receiving State, in the light of the general situation there and the individ-ual’s personal circumstances (seeVilvarajah and Others, cited above, § 108;El-Masri, cited above, § 213; andTarakhel, cited above, § 105).

The assess-ment of the risk as defined above (see paragraphs 183-84) must therefore takeinto consideration general sources such as reports of the World Health Organi-sation or of reputable non-governmental organisations and the medical certifi-cates concerning the person in question. 188.As the Court has observed above (see paragraph 173), what is in issuehere is the negative obligation not to expose persons to a risk of ill -treatmentproscribed by Article 3.

It follows that the impact of removal on the personconcerned must be assessed by comparing his or her state of health prior to re-moval and how it would evolve after transfer to the receiving State. 189.As regards the factors to be taken into consideration, the authorities in thereturning State must verify on a case-by-case basis whether the care generallyavailable in the receiving State is sufficient and appropriate in practice for thetreatment of the applicant’s illness so as to prevent him or her being exposed totreatment contrary to Article 3 (see paragraph 1 83 above).

The benchmark isnot the level of care existing in the returning State; it is not a question of ascer-taining whether the care in the receiving State would be equivalent or inferiorto that provided by the health-care system in the returning State.

Nor is it pos-sible to derive from Article 3 a right to receive specific treatment in the receiv-ing State which is not available to the rest of the population.190.The authorities must also consider the extent to which the individual inquestion willactually have access to this care and these facilities in the receiv-ing State.

The Court observes in that regard that it has previously questionedthe accessibility of care (seeAswat, cited above, § 55, andTatar, cited above,§§ 47-49) and referred to the need to consider the cost of medication andtreatment, the existence of a social and family network, and the distance to betravelled in order to have access to the required care (see Karagoz v.

France(dec.), no. 47531/99, 15 November 2001;N. v. the United Kingdom, citedabove, §§ 34-41, and the references cited therein; andE.O. v.

Italy (dec.), citedabove). 191.Where, after the relevant information has been examined, serious doubtspersist regarding the impact of removal on the persons concerned– on accountof the general situation in the receiving country and/or their individual situation– the returning State must obtain individual and sufficient assurances from thereceiving State, as a precondition for removal, that appropriate treatment willbe available and accessible to the persons concerned so that they do not findthemselves in a situation contrary to Article 3 (on the subject of individual as-surances, seeTarakhel, cited above, § 120). 192.The Court emphasises that, in cases concerning the removal of seriouslyill persons, the event which triggers the inhuman and degrading treatment, andwhich engages the responsibility of the returning State unde r Article 3, is not

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the lack of medical infrastructure in the receiving State. Likewise, the issue isnot one of any obligation for the returning State to alleviate the disparities be-tween its health-care system and the level of treatment existing in the receivingState through the provision of free and unlimited health care to all aliens with-out a right to stay within its jurisdiction.

The responsibility that is engaged un-der the Convention in cases of this type is that of the returning State, on ac-count of an act–in this instance, expulsion– which would result in an individ-ual being exposed to a risk of treatment prohibited by Article 3. 193.Lastly, the fact that the third country concerned is a Contracting Party tothe Convention is not decisive.

Wh ile the Court agrees with the Governmentthat the possibility for the applicant to initiate proceedings on his return toGeorgia was, in principle, the most natural remedy under the Convention sys-tem, it observes that the authorities in the returning State are not exempted onthat account from their duty of prevention under Article 3 of the Convention(see, among other authorities,M.S.S. v.

Belgium and Greece, cited above, §§357-59, andTarakhel, cited above, §§ 104-05).”I Menneskerettighedsdomstol ens dom af 1. oktober 2019 i sag 57467/15, Savran modDanmark, udtalte domstolen bl.a.:“The Court’s assessment…b)Application of the general principles to the present case 50.Applying these principles to the present case, the Court notes from the out-set that the City Court passed its decision on 14 October 2014, the High Courtpassed it appeal decision on 13 January 2015, and that the Appeals PermissionBoard refused leave to appeal on 20 May 2015, all before the delivery of theCourt’s judgment inPaposhvili on 13 December 2016. 51.Nevertheless, the Court observes that both judicial instances scrutinised whether the applicant’s medical treatment was available in Turkey and whetherthe applicant wouldde facto have access to such treatment, taking into accountthe cost of medication and care, the distance to be travelled in order to have ac-cess to care as well as the availability of medical help in the applicant’s lan-guage, an assessment which reflects the criteria set out in Paposhvili. 52.The national courts had regard to statements from various experts, and rel-evant information from the country concerned, including the information fromthe social security institution in Turkey, a physician at a rehabilitation clinic inKonya under the auspices of the public hospital, and a public hospital in Kon-ya, which confirmed that it was possible for a patient to receive intensive carein a psychiatric hospital matching the applicant’s needs (see paragraph 24above).

The national courts were satisfied that the medication at issue wasavailable in Turkey, including in the area where the applicant would most like-ly settle down. 53.The Court notes that neither in the application nor in the observations havethe applicant or the Government referred to or reliedon any subsequent factual

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information about the availability of medical and psychiatric treatment in Tur-key or about a deterioration or change in the applicant’s medical condition orsituation in general.

Therefore, the Court will proceed with an assessment ofthe case in light of the information that was also available when the final deci-sion of the domestic authorities was taken.54.Regarding the applicant’s concrete possibility of having access to medicaltreatment required, the City Court accepted as fact, based on the medical in-formation, that there was a high risk of pharmaceutical failure and resumedabuse and consequently a worsening of his psychotic symptoms if he were notsubjected to follow-up and control in connection with intensive outpatient the-rapy when discharged, and that this would give rise to a significantly higherrisk that he would again commit offences against the person of others.

It haddoubts, notably as to whether the applicant had a real possibility of receivingthe necessary follow-up and control in connection with intensive outpatienttherapy, if returned to Turkey.

The City Court therefore found it conclusivelyinappropriate to enforce the expulsion order. 55.On appeal, however, the High Court concluded that the applicantwouldhave access to the medical treatment required upon return to Turkey. 56.From the outset, it noted that according to the data of the MedCOI data-base and the information provided by the Ministry of Foreign Affairs, the ap-plicant could continue the same medical treatment in the Konya area in Turkeyas he received in Denmark, and that psychiatric treatment would be available atpublic hospitals, and from private healthcare providers who have concluded anagreement with the Turkish Ministry of Health.

Moreover, according to the in-formation obtained, the applicant would be eligible to apply for free or subsi-dised treatment in Turkey if he has no income or limited income, and in certaincases it is also possible to be exempted from paying the 20% patient’s share formedicines.

Kurdish- speaking staff would also be available to assist at hospitals.The High Court was thus convinced that the cost of medication and treatmentin Turkey would not be an obstacle for the applicant to obtain actual access tothe medical treatment required. 57.Before the national courts it was assumed that upon return to Turkey theapplicant would settle down in the village where the applicant’s mother camefrom, in a Kurdish-speaking region, located 100 km away from Konya (seeparagraph 27 above).

It thus appears that the High Court considered that such adistance to medical treatment would not in itself be an obstacle for the appli-cant to obtain actual access to the medical treatment required, which is in linewith the Court’s finding in, for example,Bensaid v. the United Kingdom (citedabove,§§ 36 and 39) andTatar v.

Switzerland (no. 65692/12, §§ 47-48, 14April 2015). 58.The Court notes that in the present case, the applicant’s possibility of re-ceiving follow-up and control in connection with intensive outpatient treatmentwas an additional important element.

The High Court had before it, inter alia,the statement of 5 April 2013 by Consultant Psychiatrist, K.A., pointing outthat the applicant’s current medication in the form of Leponex should be ad-ministered on a daily basis, which was deemed to constitute a risk of pharma-ceutical failure and consequently the worsening of his psychotic symptoms and

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a greater risk of aggressive behaviour.

The High Court also had before it thestatement of 13 January 2014 by Consultant Psychiatrist P.L., setting out thatthe applicant’s recovery prospects were good if he could be reintegrated intosociety by being offered a suitable home and intensive outpatient therapy in thefollowing years, whereas his recovery prospects were bad if he were to be dis-charged without follow-up and control.

Before the City Court on 7 October2014 Consultant Psychiatrist P.L. added that the medical treatment of the ap-plicant was an expert task.

Moreover, in his opinion, besides medication, in or-der to prevent a relapse, it was essential that the applicant had a regular contactperson for supervision, that a follow-up scheme was in place to make sure thatthe applicant pays attention to the medical treatment administered, that he hadassistance from a social worker to deal with any dependence and other prob-lems, and assistance for making sure that he was in the right environment andwas offered occupation.

Those initiatives were part of the applicant’s treatmentin Denmark. In addition, on 6 January 2015, before the High Court, P.L. point-ed out that the applicant needed to undergo blood tests regularly in order toverify that he had not developed an immune disorder, which could be a side-effect of Leponex. 59.The High Court did not address those statements.

It stated more generallythat the fact that the applicant was aware of his disease and, according to hisown statement, was aware of the importance of adhering to his medical treat-ment and taking the drugs prescribed, would not make removal conclusivelyinappropriate.

Furthermore, the applicant could continue the same medicaltreatment in the Konya area in Turkey as he received in Denmark, psychiatrictreatment was available in Turkey, and the said treatment would be accessiblein practice to the applicant.

The Court observes, however, that according toP.L., in the circumstances of the present case, the applicant’s awareness of hisillness would not suffice to avoid a relapse; it was essential that he also had aregular contact person for supervision.60.On the one hand, the Court reiterates that, when verifying whether the caregenerally available in the receiving State is sufficient and appropriate in prac-tice for the treatment of the applicant’s illness so as to prevent him or her beingexposed to treatment contrary to Article 3, the benchmark is not the level ofcare existing in the returning State.

It is not a question of ascertaining whetherthe care in the receiving State would be equivalent or inferior to that providedby the health-care system in the returning State (see paragraph 46 above).

Ra-ther, the question is whether the applicant, if he were not be able to receive“appropriate” treatment in Turkey, would be exposed to a serious, rapid and ir-reversible decline in his state of health, resulting in intense suffering (see para-graph 45 above). 61.On the other hand, in the light of the above statements by Consultant Psy-chiatrists K.A. and P.L., insisting on the necessity of follow-up and control inconnection with intensive outpatient therapy, the Court finds it noteworthy thatthe High Court, in contrast to the City Court, did not develop on this issue.62.The Court reiterates that the existence of a social and family network is al-so one of the important elements to take into account when assessing whetheran individual has access to medical treatment in practice (see Paposhvili , citedabove, § 190).

In the present case, the applicant maintained that he had no fam-

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ily or other social network in Turkey.

On this particular point the present casehas similarities withAswat v. the United Kingdom (no. 17299/12, § 57, 16April 2013), and can be distinguished from, for example,Bensaid (cited above§ 20) andTatar (cited above, § 12). 63.Although recognising that there is no medical information in the presentcase pointing to the importance of a family network as part of the applicant’streatment, the Court cannot ignore that the applicant is suffering from a seriousand long-term mental illness, paranoid schizophrenia, and permanently needsmedical and psychiatric treatment.

Returning him to Turkey, where he has nofamily or other social network, will unavoidably cause him additional hardship,and make it even more crucial, in the Court’s view, that he will be providedwith the necessary follow-up and control in connection with intensive outpa-tient therapy upon return.

It reiterates in this respect,inter alia, that accordingto the psychiatric reports (see, in particular, paragraphs 19, 22, and 58 above)the applicant has been prescribed complex treatment and the treatment pla n hasto be carefully followed.

Antipsychotic medication must be administered on adaily basis, which was deemed to constitute a risk of pharmaceutical failureand consequently the worsening of the applicant’s psychotic symptoms and agreater risk of aggressive behaviour. 64.Therefore, a follow-up and control scheme is essential for the applicant’spsychologicaloutpatient therapy and for the prevention of a degeneration of hisimmune system.

For that purpose he would need, at least, assistance in theform of a regular and personal contact person.

Accordingly, in the Court’sview, the Danish authorities should have assured themselves that upon return toTurkey, a regular and personal contact person would be available, offered bythe Turkish authorities, suitable to the applicant’s needs.65.Accordingly, although the threshold for the application of Article 3 of theConvention is high in cases concerning the removal of aliens suffering from se-rious illness, the Court shares the concern expressed by the City Court, that it isunclear whether the applicant has a real possibility of receiving relevant psy-chiatric treatment, including the necessary follow-up and control in connectionwith intensive outpatient therapy, if returned to Turkey (see paragraph 27above). 66.In the Court’s view, this uncertainty raises serious doubts as to the impactof removal on the applicant.

When such serious doubts persist, the returningState must either dispel such doubts or obtain individual and sufficient assur-ances from the receiving State, as a precondition for removal, that appropriatetreatment will be available and accessible to the persons concerned so that theydo not find themselves in a situation contrary to Article 3 (see Paposhvili , citedabove, §§ 187 and 191). 67.It follows that if the applicant were to be removed to Turkey without theDanish authorities having obtained such individual and sufficient assurances,there would be a violation of Article 3 of the Convention.”Dommen, der er afsagt med dommerstemmerne 4-3, er den 27. januar 2020 indbragt fordomstolens storkammer.

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Landsrettens begrundelse

og resultatDomfældte er ved Østre Landsrets ankedom af 28. maj 2019 dømt for tre til-fælde af voldtægt efter straffelovens § 216, stk. 1, nr. 1 og2, begået over tre dage mod densamme person.

Han blev dømt til at undergive sig behandling på psykiatrisk afdeling medtilsyn af Kriminalforsorgen i forbindelse med afdelingen under udskrivning, således atKriminalforsorgen sammen med overlægen kan træffe bestemmelse om genindlæggelse. Der blev ikke fastsat længstetid for foranstaltningen.

Han blev endvidere udvist af Dan-mark med indrejseforbud for bestandigt.Idet Psykiatrisk Center Amager, hvor Domfældte er indlagt, ønsker at udskrive ham,har anklagemyndigheden indbragt sagen for retten efter udlændingelovens § 50 a, stk. 2. Retten skalderforunder denne sag i første række tage stilling til, om udvisningen af Domfældte skal opretholdes eller ophæves, jf. udlændingelovens § 50 a.

Det fremgår af udlændingelovens § 50 a, stk. 2, at retten ophæver udvisning, hvis udlæn-dingens helbredsmæssige forhold afgørende taler imod, at udsendelse finder sted.

Af forar-bejderne til denne bestemmelse (de specielle bemærkninger til § 1, nr. 42, i lovforslag nr.59 af 16. april 1998 ogbetænkning nr. 1326/1997, side 782-783) fremgår, at der ved afgø-relsen blandt andet kan lægges vægt på, om udlændingen er i en tilstand, hvor det efter delægefaglige oplysninger i sagen kan befrygtes, at den pågældende vil begå personfarligkriminalitet, og på karakteren og grovheden af den kriminalitet, der begrundede udvisnin-gen.

Der vil endvidere skulle lægges vægt på de lægefaglige erklæringer om den pågæl-dendes helbredsmæssige tilstand, herunder om det hidtidige behandlingsforløb og om ka-rakteren af og behovet for fortsat behandling, om konsekvenserne af at behandlingsforløbetafbrydes, samt om muligheden for i hjemlandet at kunne opnå fortsat behandling.

Domsto-lene skal endvidere på sædvanlig vis påse, at en gennemførelse af udvisningen er i over-ensstemmelse mod Danmarks internationale forpligtelser, herunder Den Europæiske Men-neskerettighedskonventions artikel 3.

Udsendelse af en udlænding med et fortsat behandlingsbehov vil kun i helt særlige tilfælderejse spørgsmål i forhold til artikel 3,jf. navnlig Den Europæiske Menneskerettighedsdom-stols domi sag 41738/10af 13. december 2016, Paposhvili mod Belgien, præmis 183.

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Det er ikke afgørende for vurderingen efter udlændingelovens § 50 a, stk. 2, om en personved udsendelse kan opnå den samme behandling i hjemlandet som i Danmark, men det harbetydning, om domfældte har reel mulighed for relevant behandling i hjemlandet.Det fremgår af de lægelige oplysninger, at Domfældte er velbehandlet for pa-ranoid skizofrenimed Cisordinol 40 mg daglig.

Efter en periode at være blevet tvangsbe-handlet tager han aktuelt sin medicin uden problemer. Han tilhører den ca. fjerdedel af pa-tienter med skizofreni, som trods langvarig behandling med en høj dosis pot ent antipsyko-tisk medicin ikke bliver helt uden psykotiske symptomer, men han erikke længere åbenlystpsykotisk, fremstår relativt psykisk stabil,og han vurderes ikke at være til fare for sig selveller andre.

Det er oplyst,at den omhandlede medicin er tilgængelig i Tyrkiet på et privatapotek i Ankara,at det er muligt at blive fulgt af en psykiater på et offentligt hospital i An-kara, ogat det på samme hospital er muligt at konsultere en psykolog.DomfældteDomfældte er som nævnt dømt for flere tilfælde af voldtægt efter straffelovens§ 216, stk. 1, nr. 1 og 2.Efter udtalelsen fra Retslægerådet af 28. marts 2019 må det læggestil grund, at der i hvert fald er en vis risiko for, at Domfældte vil begå ny per-sonfarligsædelighedskriminalitet, hvis behandlingen afbrydes.

Ved vurderingen af, om han reelt vil kunne få en behandling for sin sindssygdom , læggerlandsretten vægt på,at Domfældte efter de lægelige oplysninger absolut ingensygdomsindsigt eller oplevelse af skyld har,at Domfældte stammer fra byenBy 2 i det østlige Tyrkiet og har arbejdet i By 1, ogat han derfor i mangel af andreoplysninger må antages atter at ville slå sig ned der, såfremt han udvises til Tyrkiet.

Hensettil den betydelige afstand mellem By 2 hhv. By 1 og Ankara må det på det grundlag,der er forelagt landsretten, herefter anses for uvist, om han vil have en reel mulighed for atfå den nødvendige medicin, hvis han udvises til Tyrkiet. På den baggrund finder landsretten, at domfældtes helbredsmæssige tilstand afgørendetaler imod, at udsendelse finder sted.

Landsretten tager herefterDomfældtes påstand om ophævelse af bestemmel-sen om udvisningtil følge. T h ib e s t e m m e s:

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Byrettens kendelse i sagen modDomfældte ændres, således at bestemmelsen ilandsrettens dom af 28. maj 2019 om udvisning ophæves.Statskassen skal betale sagens omkostninger for landsretten. (Sign.)