CEDH · CASELAW;JUDGMENTS;GRANDCHAMBER;ENG — 13 décembre 2016

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BELGIUM   (Application no. 41738/10)                     JUDGMENT     STRASBOURG       13 December 2016         This judgment is final but it may be subject to editorial revision. In the case of Paposhvili v. Belgium, The European Court of Human Rights, sitting as a Grand Chamber composed of:   Guido Raimondi, President,   Işıl Karakaş,   Luis López Guerra,   Khanlar Hajiyev,   Nebojša Vučinić,   Kristina Pardalos,   Julia Laffranque,   André Potocki,   Paul Lemmens,   Helena Jäderblom,   Valeriu Griţco,   Faris Vehabović,   Ksenija Turković,   Dmitry Dedov,   Egidijus Kūris,   Robert Spano,   Jon Fridrik Kjølbro, judges, and Johan Callewaert, Deputy Grand Chamber Registrar, Having deliberated in private on 16 September 2015 and on 20 June, 22   September and 17 November 2016, Delivers the following judgment, which was adopted on the last ‑ mentioned date: PROCEDURE 1.     The case originated in an application (no. 41738/10) against the Kingdom of Belgium lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Georgian national, Mr Georgie Paposhvili (“the applicant”), on 23 July 2010. The applicant died on 7 June 2016. On 20   June 2016 the applicant’s family, namely his wife, Ms   Nino   Kraveishvili, and their three children, Ms Ziala Kraveishvili, Ms   Sophie Paposhvili and Mr Giorgi Paposhvili, expressed the wish to pursue the proceedings before the Court. 2.     The applicant, who had been granted legal aid, was represented by Ms   J. Kern, a lawyer practising in Antwerp, and Ms C. Verbrouck, a lawyer practising in Brussels. The Belgian Government (“the Government”) were represented by their Agent, Mr M. Tysebaert, Senior Adviser, Federal Justice Department. 3.     On 23 July 2010 the applicant applied to the Court requesting interim measures under Rule 39 of the Rules of Court, with a view to staying execution of the order to leave the country. Alleging that his removal to Georgia would expose him to risks to his life and physical well-being and would infringe his right to respect for his family life, the applicant claimed to be a victim of a potential violation of Articles 2, 3 and 8 of the Convention. Although the domestic proceedings had not yet been concluded at the time the application was lodged, the applicant nevertheless argued that the remedies in question would not have the effect of staying execution of his removal. On 28 July 2010, under Rule 39 of the Rules of Court, the Court requested the Government not to remove the applicant pending the outcome of the proceedings before the Aliens Appeals Board. 4.     The application was assigned to the Fifth Section of the Court (Rule   52 § 1). A Chamber of that Section composed of Mark Villiger, President, Angelika Nußberger, Boštjan M. Zupančič, Ann Power-Forde, Ganna Yudkivska, Paul Lemmens and Aleš Pejchal, judges, and Claudia   Westerdiek, Section Registrar, delivered a judgment on 17 April 2014. The Chamber unanimously declared the application admissible and held that the enforcement of the decision to remove the applicant to Georgia would not entail a violation of Articles 2 and 3 of the Convention. It held by a majority that there had been no violation of Article 8 of the Convention. A dissenting opinion by Judge Pejchal was annexed to the judgment. On 14   July 2014, in accordance with Article 43 of the Convention, the applicant requested the referral of the case to the Grand Chamber. The panel of the Grand Chamber granted the request on 20 April 2015. 5.     The composition of the Grand Chamber was determined in accordance with Article 26 §§ 4 and 5 of the Convention and Rule 24. 6.     From the deliberations of 21 June 2016 onwards, Guido Raimondi, the newly elected President of the Court, replaced Dean Spielmann. From the deliberations of 22 September 2016 onwards, Nebojša Vučinić, substitute judge, replaced Johannes Silvis, who was prevented from sitting (Rule 24 § 3). 7.     The applicant and the Government each filed further written observations on the merits (Rule 59 § 1). 8.     The Georgian Government exercised their right to intervene (Article   36 § 1 of the Convention and Rule 44 § 1 (a)). The Human Rights Centre of Ghent University, a non-governmental organisation, was granted leave to intervene in the written procedure (Article 36 § 2 of the Convention and Rule 44 § 3). 9.     A hearing took place in public in the Human Rights Building, Strasbourg, on 16 September 2015 (Rule 59 § 3). There appeared before the Court: (a)     for the Government Ms   I. Niedlispacher ,   Co-Agent, Mr   F. Motulsky , Lawyer,   Counsel ; (b)     for the applicant Ms   C. Verbrouck , Lawyer, Ms   J. Kern , Lawyer,   Counsel ; (c)     for the Georgian Government, third-party intervener Mr   A. Baramidze , First Deputy to the Minister of Justice.   The Court heard addresses by Ms Verbrouck, Ms Kern, Mr Motulsky, Ms   Niedlispacher and Mr Baramidze, and their replies to the questions asked by one of the judges. THE FACTS I.     THE CIRCUMSTANCES OF THE CASE 10.     The applicant was born in 1958. He lived in Brussels and died there on 7 June 2016. 11.     He arrived in Belgium via Italy on 25 November 1998, accompanied by his wife and a six-year-old child. The applicant claimed to be the father of the child, an assertion which the Government contested. The couple subsequently had a child together in August 1999 and another in July 2006. A.     Criminal proceedings 12.     On 29 December 1998 the applicant was arrested and taken into custody on charges of theft. On 14 April 1999 he received a sentence of seven months’ imprisonment, which was suspended except for the period of pre ‑ trial detention. 13.     In 1999 and 2000 the applicant and his wife were arrested on several occasions in connection with theft offences. 14.     On 28 April 2000 the applicant’s wife was sentenced to four months’ imprisonment for theft. 15.     On 18 December 2001 the applicant was convicted of a number of offences including robbery with violence and threats, and received a sentence of fourteen months’ imprisonment, which was suspended except for the period of pre-trial detention. 16.     On 9 November 2005 the applicant was sentenced by the Ghent Court of Appeal to three years’ imprisonment for involvement in a criminal organisation with a view to securing pecuniary advantage using intimidation, deception or corruption. 17.     Having already spent time in pre-trial detention, he was subsequently detained in Forest Prison and then in Merksplas Prison, where he continued to serve his sentence. B.     Asylum proceedings 18.     On 26 November 1998, the day after their arrival, the applicant and his wife lodged an asylum application. 19.     As the applicant’s wife stated that she had travelled through Germany, a request to take back the applicant and his family was sent to the German authorities under the Dublin Convention of 15 June 1990 determining the State responsible for examining applications for asylum lodged in one of the Member States of the European Communities (“the Dublin Convention”). 20.     After the German authorities had refused the request, it transpired that the applicant and his family were in possession of a Schengen visa issued by the Italian authorities. A request to take charge of them was therefore sent to the Italian authorities and was accepted on 4 June 1999. 21.     On 22 September 1999 the applicant lodged a further asylum application, using a false identity. It was immediately rejected after his fingerprints had been checked. 22.     On 23 October 2000 the Aliens Office informed the applicant’s lawyer that the proceedings concerning the asylum application of 26   November 1998 had been concluded on 11 June 1999 with the refusal of the application. C.     Requests for leave to remain on exceptional grounds 1.     First request for regularisation on exceptional grounds 23.     On 20 March 2000 the applicant lodged a first request for regularisation for a period of more than three months, on the basis of section   9(3) (since 1 June 2007, section 9 bis ) of the Aliens (Entry, Residence, Settlement and Expulsion) Act of 15 December 1980 (“the Aliens Act”). In support of his request the applicant stated that he and his wife had a daughter born in Georgia before their arrival in Belgium and another daughter born in Belgium in 1999. 24.     On 30 March 2004 the Aliens Office declared the request devoid of purpose as the applicant had left the country and been intercepted in Germany. It found that the request was in any case unfounded in view of the fact that the applicant’s medical treatment for tuberculosis had ended (see   paragraph 49 below). The Aliens Office also referred to the applicant’s lack of integration in Belgium and the numerous breaches of public order he had committed. 2.     Second request for regularisation on exceptional grounds 25.     On 28 April 2004 the applicant lodged a second request for regularisation of his residence status on the basis of section 9(3) of the Aliens Act. He cited as exceptional circumstances the duration of his residence in Belgium and his integration into Belgian society, the risks that a return to Georgia would entail for his children’s schooling, the fact that he had been the victim of persecution and his state of health. 26.     The Aliens Office declared the request inadmissible on 5 April 2007 on the ground that the evidence adduced did not amount to exceptional circumstances for the purposes of section 9(3) of the Act such as to warrant the lodging of the request in Belgium rather than with the competent diplomatic mission or consulate, as was the rule. The Aliens Office noted that the applicant had been allowed to remain in the country for the sole purpose of the asylum proceedings, which had been concluded by a final decision. It also cited as reasons the lack of any need for medical supervision, the applicant’s precarious and unlawful residence status, the absence of a risk of persecution in Georgia and the possibility for the children to continue their schooling in that country. 27.     In a judgment of 29 February 2008 the Aliens Appeals Board rejected an application by the applicant to set aside the Aliens Office’s decision. It noted in particular that, since the decision complained of had not been accompanied as such by a removal measure, it could not give rise to a risk of violation of Article 3 of the Convention. 3.     Third request for regularisation on exceptional grounds 28.     On 10 September 2007, relying on the same grounds as those invoked under section 9 ter of the Aliens Act (see paragraph 54 below) and on his family situation, the applicant lodged a request for regularisation on exceptional grounds under section 9 bis of the Aliens Act. 29.     On 7 July 2010 the Aliens Office refused the request for regularisation, taking the view that the protection of the State’s best interests took precedence over the applicant’s social and family interests and that by committing serious punishable acts the applicant himself had placed his family’s unity in jeopardy. That decision was served on the applicant on 11   July 2010. 30.     On 26 July 2010 the applicant lodged a request with the Aliens Appeals Board under the ordinary procedure for a stay of execution of the decision of 7 July 2010 rejecting his request for regularisation of his status, together with an application to have that decision set aside. In so far as necessary, the application also related to the order to leave the country issued on the same date (see paragraph 78 below). The applicant alleged a violation of Articles 2 and 3 of the Convention and argued that his serious health problems amounted to exceptional humanitarian circumstances as defined by the Court in D. v. the United Kingdom (2 May 1997, Reports of Judgments and Decisions 1997 ‑ III), that he would not have access to treatment in Georgia and that the discontinuation of treatment would lead to his premature death. He further alleged an infringement of Article 8 of the Convention and of the International Convention on the Rights of the Child, on the ground that if he were returned to Georgia he would be separated from his family permanently. 31.     The request and application were refused by the Aliens Appeals Board in a judgment of 16 March 2015 on the ground that the applicant had not attended the hearing or been represented. 4.     Regularisation of the residence status of the applicant’s family 32.     On 5 November 2009 the applicant’s wife lodged a request for regularisation on exceptional grounds under section 9 bis of the Aliens Act, relying on her family situation and the duration of her residence in Belgium. 33.     On 29 July 2010 she and her three children were granted indefinite leave to remain. D.     The applicant’s state of health 1.     Chronic lymphocytic leukaemia 34 .     In 2006, while the applicant was in prison (see paragraph 17 above), he was diagnosed with chronic lymphocytic leukaemia in Binet stage B, with a very high level of CD38 expression. No treatment was commenced. 35.     As his health had deteriorated, the applicant was admitted to the Bruges prison hospital complex from 14 August to 23 October 2007 in order to receive a course of chemotherapy. 36.     A report prepared on 11 February 2008 by Antwerp University Hospital, where the applicant was being treated, stated that his condition was life-threatening and that, on the basis of the averages observed in 2007, his life expectancy was between three and five years. The report stated that, following treatment, his white blood cell count had fallen significantly. 37.     From 8 to 14 May 2010 the applicant was confined to hospital in Turnhout with respiratory problems. The medical report concerning his stay recommended that the applicant be treated as an outpatient by a lung specialist and a haematologist. This treatment did not materialise on his return to Merksplas Prison, where he was being held. 38.     On 22 July 2010 a doctor from Antwerp University Hospital visited the applicant in the Merksplas closed facility for illegal aliens (see paragraph 79 below), to which he had been transferred in the meantime, in order to carry out a full medical check-up. The doctor’s report noted that the applicant’s leukaemia, which was progressing rapidly towards Binet stage   C, had not been monitored sufficiently and that a different course of chemotherapy was required. 39.     In August 2011 the applicant’s condition worsened and the doctors observed that his leukaemia had progressed to Binet stage C, with anaemia and widespread enlargement of the lymph nodes (life expectancy of twenty ‑ four months). It was decided to switch to a different course of chemotherapy. 40.     On 12 September 2012 a doctor from the haematology department of St Pierre University Hospital in Brussels, where the applicant was being treated following his release (see paragraph 82 below), drew up a certificate which stated as follows: “... D.     Possible complications if treatment is discontinued. Failure to treat the liver and lung disease could result in organ damage and consequent disorders (respiratory insufficiency, cirrhosis and/or liver cancer). Without treatment, the [chronic lymphocytic leukaemia] could lead to the patient’s death as a result of the disease itself or the effects of serious infections. A return to Georgia would expose the patient to inhuman and degrading treatment. E.     Progression and prognosis. Chronic lymphocytic leukaemia (CLL): good if treated, but the risk of relapse is real, so that close monitoring is required even during remission. ...” 41.     After a relapse diagnosed in 2013, the doctors in St Pierre University Hospital observed in March 2014 that the applicant’s leukaemia had developed into lymphocytic lymphoma, and his chemotherapy was adjusted accordingly. A positron ‑ emission tomography (PET) scan performed on 22   September 2014 showed a lack of response to the chemotherapy, a progression of the disease in the lymph nodes and the liver, and a pulmonary infection. 42.     The applicant’s treatment was handed over to the Institut Bordet in Brussels, a hospital devoted exclusively to the treatment of cancer patients. 43.     In December 2014 the applicant began to receive a new course of treatment as part of a study. He was given Ibrutinib, designed in particular to improve his overall condition, which had been compromised by complications arising out of the treatment (fungaemia, pulmonary infections, septicaemia and cholecystitis, resulting in his being admitted to hospital on several occasions). The treatment was prescribed in order to improve the applicant’s overall condition in preparation for a donor stem cell transplant. 44.     A medical certificate issued on 25 May 2015 by the specialist treating the applicant, Dr L., head of the experimental haematology laboratory at the Institut Bordet, stated that the patient’s viral load was stable. The doctor stressed that discontinuing treatment would result in the patient’s death. Because of the patient’s immunosuppression and the aggressive nature of the leukaemia, treatment in a specialised haematology unit was necessary, as was a donor stem cell transplant, which offered the only remaining prospect of a cure provided that it was performed during the two-year “window of response” to Ibrutinib. 45.     The applicant stated that the stem cell transplant, originally scheduled to take place in April 2015, had not been performed to date because he did not have a residence permit in Belgium as required by the Organ Removal and Transplant Act of 13 June 1986. 46 .     On 14 July 2015 a new medical report was prepared by Dr L. which read as follows: “The patient’s CLL [chronic lymphocytic leukaemia] ... The patient has been suffering from CLL for nine years (diagnosed in 2006), and by 2011 had already reached stage C and Rai IV [stage IV according to the Rai criteria]. He had already had three lines of treatment prior to Ibrutinib, which he is currently taking, and was refractory to the third line of treatment (R-CVP chemotherapy). It is clear from the medical literature that if Ibrutinib is discontinued in such a situation, the average life expectancy is three months. ... The literature also shows that only 7% of patients being treated with Ibrutinib achieve complete remission. Mr Paposhvili is currently in partial remission and is thus wholly dependent on the treatment. This is a new targeted therapy to which he would have no access in his country of origin. With continuous treatment the patient’s prognosis is more favourable, with an 87% survival rate after three years. ... CLL and especially treatment with Ibrutinib can give rise to serious complications which fully justify regular supervision in a specialised setting. This is particularly true since the patient is in a weak state and has a serious medical history (tuberculosis and stroke) and significant comorbidities (active chronic hepatitis and COPD [chronic obstructive pulmonary disease]). ... In the case of a young person – Mr Paposhvili is only 57 – the current guidelines advocate using Ibrutinib in order to obtain the best possible response, followed by a donor peripheral blood stem cell transplant. A HLA [human leukocyte antigen] matched donor has been identified for the patient. Although risky, a donor transplant offers the only prospect of a cure for the patient; he would be unable to have such a transplant in his country of origin. ... Conclusions The [Aliens Office’s medical adviser] concludes ... [that] the condition of the patient’s vital organs is not directly life-threatening. That all depends on what is meant by ‘directly’. The patient is suffering from a cancer that is potentially fatal in the short term (median survival time nineteen months) ... and most likely within six months without appropriate treatment. Moreover, if the treatment is not tailored to the patient’s overall immunosuppression, there is a serious risk of death caused by infection, especially in a Gold stage II COPD patient with a history of tuberculosis. ...” 47.     On 1 August 2015 treatment with Ibrutinib became eligible for reimbursement in Belgium. 48.     Because of the side-effects of this treatment, which might compromise the donor transplant, the dose of Ibrutinib was reduced from three doses to one dose per day. 2.     Other illnesses 49 .     In 2000 the applicant was diagnosed with active pulmonary tuberculosis. He was treated for that condition under the emergency medical assistance and social welfare assistance schemes. 50.     During 2008 the applicant’s tuberculosis was found to have become active again. 51.     As a result of that disease the applicant developed chronic obstructive pulmonary disease, for which he received treatment. 52.     In addition, the applicant suffered from hepatitis C, which was also diagnosed in 2006 and was probably linked to a history of drug abuse. It was accompanied by liver fibrosis. According to a medical report dated 24   April 2015 his hepatitis, which had been treated effectively in 2012 and 2013, had become stable. 53.     A magnetic resonance imaging scan carried out in March 2015 showed that the applicant had suffered a stroke, resulting in permanent paralysis of the left arm. The effects of the stroke were managed with an anti-epilepsy drug. E.     Requests for regularisation on medical grounds 1.     First request for regularisation on medical grounds 54 .     On 10 September 2007, relying on Articles 3 and 8 of the Convention and alleging, in particular, that he would be unable to obtain treatment for his leukaemia (see paragraph 34 above) if he were sent back to Georgia, the applicant lodged a first request for regularisation on medical grounds on the basis of section 9 ter of the Aliens Act. 55 .     On 26 September 2007 the Aliens Office refused the request on the ground that, under section 9 ter (4) of the Act, the applicant was excluded from its scope on account of the serious crimes which had given rise in the meantime to a ministerial deportation order issued on 16 August 2007 (see paragraph 73 below). 56.     On 17 December 2007 the applicant lodged a request for a stay of execution of that decision under the ordinary procedure, together with an application to set aside. He alleged in particular that the Aliens Office had relied exclusively on the ministerial deportation order in excluding him from the scope of section 9 ter of the Aliens Act, without investigating his state of health or the risk he ran of being subjected to treatment contrary to Article 3 of the Convention, and without weighing up the interests at stake as required by Article 8 of the Convention. 57.     In a judgment of 20 August 2008 the Aliens Appeals Board dismissed the applicant’s claims in the following terms: “It is clear from the wording of [section 9 ter ] that there is nothing to prevent the administrative authority, when dealing with a request for leave to remain on the basis of the above-mentioned section 9 ter , from ruling immediately on the exclusion of the person concerned from the scope of the said section 9 ter without first being required to take a decision on the medical evidence submitted to it, if it considers at the outset that there are substantial grounds for believing that the person concerned has committed any of the acts referred to in section 55/4, cited above. Indeed, the examination of that evidence is superfluous in such a situation since the person responsible for taking the decision has in any event already decided that the individual is excluded from the scope [of section 9 ter ]. ... As regards the alleged violation of Article 3 of the Convention, it should be observed that the decision complained of in the present application is not accompanied by any removal measure, with the result that the alleged risk of discontinuation of treatment in the event of the applicant’s return to Georgia is hypothetical.” 58.     The Aliens Appeals Board also dismissed the complaint under Article 8 of the Convention in view of the fact that the impugned decision had not been accompanied by any removal measure. 2.     Second request for regularisation on medical grounds 59 .     In the meantime, on 3 April 2008, the applicant had lodged a second request for regularisation on medical grounds on the basis of section 9 ter of the Aliens Act. In addition to his various health problems he referred to the fact that he had been continuously resident in Belgium for eleven years and had lasting social ties in that country, and to his family situation. He also argued that if he was sent back he would be left to fend for himself while ill in a country in which he no longer had any family ties and where the medical facilities were unsuitable and expensive. 60 .     The request was refused by the Aliens Office on 4 June 2008 for the same reason it had cited previously (see paragraph 55 above). 61.     On 16 July 2008 the applicant lodged an application with the Aliens Appeals Board to have that decision set aside. 62 .     In a judgment of 21 May 2015 the Aliens Appeals Board rejected the application to set aside. It held that, where the above-mentioned exclusion clause was applied, the Aliens Office was not required to rule on the medical and other evidence contained in the request for regularisation. According to the Aliens Appeals Board, such examination was superfluous by virtue of the exclusion clause alone. The Board pointed out that its task was to review the lawfulness of the measure. This review did not permit it to substitute its own assessment of the facts that were deemed to have been established and were not apparent from the administrative file; rather, its task was confined to ensuring that the formal requirement to provide reasons had been complied with and that the reasoning was not based on a manifest error of assessment. As to the complaints alleging a violation of Articles 2 and 3 of the Convention, the Aliens Appeals Board stated that the assessment of the medical situation of an alien facing removal whose request for regularisation had been rejected should be carried out, as applicable, at the time of enforcement of the removal measure. 63.     On 22 June 2015 the applicant lodged an appeal on points of law against that judgment with the Conseil d’État . One of the grounds of appeal was based on Articles 2 and 3 of the Convention. The applicant submitted that the Aliens Appeals Board could not have been unaware that several orders to leave the country had already been issued against him prior to the decision not to examine his request for leave to remain, and that his expulsion had been suspended only as a result of the interim measure applied by the Court (see paragraph 87 below). The applicant further argued that the Aliens Appeals Board had breached the provisions of the Convention by postponing until the date of enforcement of the removal measure the examination of the medical situation of an alien suffering from a serious illness who had requested leave to remain on medical grounds, without studying the specific risks. 64 .     In an order of 9 July 2015 the appeal on points of law was declared inadmissible. The Conseil d’État held that, contrary to the applicant’s assertion, the grounds for setting aside advanced before the Aliens Appeals Board had simply stressed, in a theoretical and general manner, that section   9 ter of the Act encompassed the application in domestic law of the obligation under Articles 2 and 3 of the Convention prohibiting the removal of a seriously ill person if such a measure was liable to result in death or inhuman and degrading treatment; no specific explanation had been given, however, as to how the applicant himself risked facing that situation. The Conseil d’État also observed that the applicant had not argued before the Aliens Appeals Board that orders to leave the country had been issued against him, or that a removal measure could be revived; he was therefore unable to rely on those arguments in his appeal on points of law. In any event, the Conseil d’État held that the Aliens Appeals Board had in no way erred in finding that the examination of the medical situation of an alien facing removal whose request for leave to remain had been rejected should be carried out, as applicable, at the time of enforcement of the measure. 3.     Review of the applicant’s situation in connection with the proceedings before the Court 65.     The applicant was requested to report to the Aliens Office’s medical service on 24 September 2012 for a medical check-up and to enable the Belgian authorities to reply to the Court’s questions. 66.     The report prepared by the medical adviser on that occasion listed the consultations held and the treatment that had been administered to the applicant. It stated that his leukaemia had stabilised after several cycles of chemotherapy and was being monitored closely, and that the applicant was under medical supervision for his lung disease. 67 .     Referring to the Court’s judgment in the case of N. v. the United Kingdom ([GC], no. 26565/05, ECHR 2008), the report concluded as follows: “On the basis of this medical file it cannot ... be concluded that the threshold of severity required by Article 3 of the Convention, as interpreted by the Court, has been reached ... It appears from the medical file that the diseases to which the medical certificates refer ... do not disclose a direct threat to the patient’s life. The conditions from which the applicant suffers are serious and potentially fatal but are currently under control. None of the patient’s vital organs is in a condition that is directly life-threatening. His hepatitis C is not currently causing any cirrhosis. The pulmonary disease is being controlled by treatment consisting solely of an inhaled corticosteroid. The patient’s haematological disorder is currently stable. The lymph nodes are no longer swollen and the patient’s haemolytic anaemia is resolved. Chemotherapy has been discontinued for the time being. ... Neither monitoring of the patient’s vital parameters nor ongoing medical supervision is necessary in order to ensure the patient’s survival. The disease cannot be considered at present to be in the terminal stages. ... The patient is close to Binet stage A at present. His chronic obstructive pulmonary disease is also currently under control.” 68.     A medical report drawn up on 23 June 2015 by the medical adviser to the Aliens Office provided a detailed review of the applicant’s clinical history and current state of health and the treatment being administered. It concluded as follows: “On the basis of [the] medical file it cannot therefore be concluded that the threshold of severity set by Article 3 of the Convention, which requires a risk to life on account of the applicant’s critical condition or the very advanced stage of his or her illness, has been reached ( N . v. the United Kingdom [GC], no.   26565/05, ECHR 2008, and D.   v.   the United Kingdom , 2   May 1997, Reports of Judgments and Decisions 1997 ‑ III). The diseases referred to in the most recent update to the medical file ([Dr L.], 25   May 2015) ... do not disclose: – a direct threat to the life of the patient. The illnesses from which the applicant suffers are serious and potentially fatal but are currently under control. ... – that the condition of the patient’s vital organs is directly life-threatening. ... – a critical state of health. Neither monitoring of the patient’s vital parameters nor ongoing medical supervision is necessary in order to ensure the patient’s survival. The disease cannot be said to be in the terminal stages at present ...” F.     Removal proceedings and the Court’s intervention 1.     Order to leave the country under the Dublin Convention 69.     On 10 June 1999, on the grounds that the Belgian authorities did not have responsibility under the Dublin Convention for examining the asylum application, the Aliens Office issued an order for the applicant and his wife to leave the country with a view to their transfer to Italy. However, their departure was postponed because the applicant’s wife was pregnant. 70.     After the birth, the family was granted leave to remain until 14   October 1999 because the new-born baby was in hospital. Their leave to remain was subsequently extended until 15 March 2000 on the ground that the child needed regular supervision by a paediatric gastroenterologist. 71.     The time-limit for enforcement of the order for the family to leave the country was extended several times during the first half of 2000 because of the need to treat the applicant’s tuberculosis (see paragraph 49 above) and the six-month course of anti-tubercular treatment required by the whole family. 72.     On 23 October 2000 the Aliens Office informed the applicant’s lawyer that the time-limit had been extended until such time as the applicant and his child were fully recovered. 2.     Ministerial deportation order 73 .     On 16 August 2007, while the applicant was serving a prison sentence (see paragraph 17 above), the Minister of the Interior, in a deportation order issued under section 20 of the Aliens Act, directed the applicant to leave the country and barred him from re-entering Belgium for ten years. The order referred to the applicant’s extensive criminal record, allied to the fact that “the pecuniary nature of the offences demonstrate[d] the serious and ongoing risk of further breaches of public order”. 74.     The order became enforceable on the date of the applicant’s release but was not in fact enforced because the applicant was undergoing medical treatment at the time. 75.     The applicant, who was in hospital, did not contact his lawyer in order to lodge an application to have the ministerial order set aside. However, on 15 November 2007 the lawyer lodged an application on his own initiative. In a judgment of 27 February 2008 the Aliens Appeals Board rejected the application as being out of time. 76.     In the meantime, as the applicant was about to finish serving the prison sentence imposed in 2005, he was transferred on 14 August 2007 to Bruges Prison with a view to implementation of the ministerial deportation order. He remained there until 27 March 2010, when he was transferred to Merksplas Prison. 77.     During his time in Bruges Prison the applicant was visited on an almost daily basis by his wife and/or his children. The authorities of Merksplas Prison, to which he was subsequently transferred and where he remained until 11 July 2010, informed the applicant that they did not have a record of the number of visits he had received. 3.     Orders to leave the country following refusal of the regularisation request 78 .     In parallel with its decision of 7 July 2010 refusing the applicant’s request for regularisation on exceptional grounds (see paragraph 29 above), the Aliens Office on 7 July 2010 issued an order for him to leave the country, together with an order for his detention. These orders, made on the basis of section 7(1)(1) of the Aliens Act, were served on the applicant on 11 July 2010. 79 .     Also on 7 July 2010 it was decided that the applicant should be transferred on 13 July to the Merksplas closed facility for illegal aliens with a view to his removal to Georgia. 80.     On 16 July 2010 the Georgian embassy in Brussels issued a travel document valid until 16 August 2010. 81.     On the same day the applicant lodged a request for a stay of execution under the ordinary procedure, together with an application to set aside, directed specifically against the above-mentioned order to leave the country of 7 July 2010. 82.     On 30 July 2010, two days after the indication by the Court of an interim measure (see paragraph 87 below), an order was made for the applicant’s release and he was given until 30 August 2010 to leave the country voluntarily. 83.     In a letter dated 30 August 2010 counsel for the applicant applied for an extension of the time-limit for enforcement of the order to leave the country. The time-limit was initially extended until 13 November 2010 and was subsequently extended several times until 19 February 2011. 84 .     On 18 February 2012 the Aliens Office issued an order to leave the country “with immediate effect” pursuant to the ministerial deportation order of 16 August 2007. 85 .     The above-mentioned request and application were rejected by the Aliens Appeals Board in a judgment of 29 May 2015 on the ground that the applicant had not attended the hearing or been represented. 4.     Indication of an interim measure under Rule 39 of the Rules of Court 86.     In the meantime, on 23 July 2010, the applicant applied to the Court for interim measures under Rule 39 of the Rules of Court. Relying on Articles 2, 3 and 8 of the Convention, he alleged that if he were removed to Georgia he would no longer have access to the health care he required and that, in view of his very short life expectancy, he would die even sooner, far away from his family. 87.     On 28 July 2010 the Court indicated to the Belgian Government that it was desirable, in the interests of the parties and the proper conduct of the proceedings before the Court, to suspend enforcement of the order for the applicant to leave the country issued on 7 July 2010 “pending the outcome of the proceedings before the Aliens Appeals Board”. G.     Other events 88.     The applicant was arrested on several occasions between 2012 and 2015 for shoplifting. 89.     In addition, in July 2013 the Aliens Office was contacted by the Luxembourg police and customs cooperation centre, which reported that the applicant was in detention in the Grand Duchy of Luxembourg. 90.     In May 2014 a warrant was issued for the applicant’s arrest for theft. The applicant was detained in Bruges Prison and released a few days later. 91.     Two notarised deeds of sale dated 24 March and 5 August 2015 record the transfer by the applicant, represented by E.B., to a certain Aleksandre Paposhvili, of a plot of building land for a sum of 30,000 euros (EUR) and a plot of farmland for a sum of EUR 5,000. Both plots are located in the village of Kalauri in the Gurjaani region of Georgia. II.     RELEVANT DOMESTIC LAW AND PRACTICE A.     Regularisation procedures 1.     Regularisation on exceptional grounds 92.     In order to be allowed to remain in Belgium for more than three months, aliens must normally obtain permission before arriving in the country. Section 9(2) of the Aliens Act provides: “... Except where an international treaty, statute or royal decree otherwise provides, such permission [to remain in the Kingdom beyond the period laid down in section 6, namely for more than three months] shall be requested by the aliens concerned at the Belgian diplomatic mission or consulate responsible for their place of permanent residence or their temporary residence abroad.” 93.     Aliens whose residence status in Belgium is unlawful or precarious, and who wish to obtain long-term leave to remain without having to return to their country of origin, may apply directly in Belgium if they can claim exceptional circumstances. According to established case-law and practice, regularisation of residence status may be granted on a case ‑ by-case basis under section 9 bis (former section 9(3)) of the Aliens Act. Section 9 bis (1) reads as follows: “In exceptional circumstances, and provided that the alien concerned is in possession of identity papers, leave to remain may be requested from the mayor of the municipality in which he or she is resident, who forwards the request to the Minister or his or her representative. Where the Minister or his or her representative grants leave to remain, the residence permit shall be issued in Belgium. ...” 94.     The Act does not specify either the exceptional circumstances on the basis of which the request may be made from within Belgium or the substantive grounds on which leave to remain may be granted. It is for the Aliens Office to assess the circumstances alleged by the alien concerned in each individual case. It begins by examining the exceptional circumstances invoked, in order to determine whether the request is admissible. If this is the case, it rules subsequently on the substantive grounds relied on by the alien concerned in support of the request for leave to remain. 2.     Regularisation on medical grounds (a)     Section 9 ter of the Aliens Act 95.     Section 9 ter of the Aliens Act provides for the possibility of granting leave to remain on medical grounds. The first paragraph, as inserted by the Act of 15 September 2006, amended by the Act of 7 June 2009 and replaced by the Act of 29 December 2010, provided as follows at the material time: “1.     Aliens resident in Belgium who provide proof of identity in accordance with paragraph 2 and who are suffering from an illness entailing a real risk to their life or physical well-being or a real risk of inhuman or degrading treatment if no appropriate treatment exists in their country of origin or previous country of residence may apply to the Minister or his or her representative for leave to remain in the Kingdom. The request must be made by registered letter to the Minister or his or her representative and must include the actual address of the alien concerned in Belgium. The alien concerned must submit the request together with all the relevant information concerning his or her illness and the availability and accessibility of appropriate treatment in the country of origin or the previous country of residence. He or she shall submit a standard medical certificate as provided for by royal decree approved by the Cabinet. The medical certificate shall indicate the illness, its degree of seriousness and the treatment considered necessary. The assessment of the risk referred to in the first sub-paragraph, the possibilities for treatment, the accessibility of such treatment in the country of origin or of previous residence, together with the assessment of the illness, its seriousness and the treatment considered necessary, as indicated in the medical certificate, shall be carried out by a medical officer or a doctor appointed by the Minister or his or her representative, who shall issue an opinion in this regard. The doctor in question may, if he or she deems necessary, examine the individual concerned and seek additional expert opinions.” 96.     The procedure for examining requests for regularisation takes place in two stages. The first stage involves an examination by an official of the Aliens Office of the admissibility of the request, with particular regard to the information that must be included on the medical certificate (indication of the illness, its seriousness and the treatment considered necessary). In that connection the Aliens Appeals Board has stated that “[the legislature’s] aim of clarifying the procedure would be thwarted if [the Aliens Office] were required to carry out an in-depth examination of each medical certificate produced and the accompanying documents in order to ascertain the nature of the illness, its seriousness and the treatment considered necessary, given that the [official responsible] is neither a medical officer nor another doctor appointed for the purpose” (see, in particular, Aliens Appeals Board, judgment no. 69.508 of 28 October 2011). The second stage, which concerns only those requests deemed to be admissible, consists of a comprehensive review by the Aliens Office of the individual’s state of health and a substantive assessment of the factors enumerated in the legislation, on the basis of the opinion of a medical officer or another doctor appointed for the purpose. 97.     It is clear from the drafting history of section 9 ter that the question whether appropriate and sufficiently accessible treatment exists in the receiving country is examined on a case-by-case basis, taking into account the requesting party’s individual situation, assessed within the confines of the Court’s case-law (explanatory report, Doc. Parl. , 2005-06, no.   51   2478/1, p. 35). 98.     If the request is hel