D.O. and L.A. v. Sweden

FIRST SECTION

Application no. 30033/24 D.O. and L.A. against Sweden

The European Court of Human Rights (First Section), sitting on 7 July 2026 as a Chamber composed of:

Ivana Jelić , President , Erik Wennerström, Raffaele Sabato, Frédéric Krenc, Davor Derenčinović, Alain Chablais, Anna Adamska-Gallant , judges , and Ilse Freiwirth, Section Registrar,

Having regard to the above application (no. 30033/24) against the Kingdom of Sweden lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by two Syrian nationals, Mr D.O. (the first applicant) and Ms L.A. (the second applicant) on 10 October 2024;

the decision to give notice to the Swedish Government (“the Government”) of the application;

the decision not to have the applicants’ names disclosed;

the decision to indicate an interim measure to the respondent Government under Rule 39 of the Rules of Court and the fact that this interim measure has been complied with;

the observations submitted by the respondent Government and the observations in reply submitted by the applicants;

the joint comments submitted by the non-governmental organisations (NGOs), Refugee Support Aegean (RSA) and Stiftung PRO ASYL, which had been granted leave to intervene by the President as third parties in the proceedings (Article 36 § 2 of the Convention and Rule 44 § 3 of the Rules of Court);

Having deliberated, decides as follows:

Introduction

1 The case concerns the removal of the applicants, who are married to each other and are Syrian nationals, from Sweden to Greece, where they had previously been granted asylum. They relied on Articles 3 and 8 of the Convention.

THE FACTS

2 The applicants were born in 1965 and 1955 and live in Sundsvall. They were represented by Ms J. Bratt, a lawyer practising in Stockholm.

3 The Government were represented by their former Agent, Mr F. Bergius from the Ministry of Foreign Affairs.

4 The facts of the case may be summarised as follows.

5 . In 2018 the applicants applied, apparently from Syria, for family reunification with their adult daughter, who lived in Sweden. Their request was refused by the Swedish authorities by a final decision of 22 November 2018. The applicants had three other adult children living in Sweden.

6 In March 2020 the applicants arrived in Greece and applied for asylum.

7 Almost two years later, on 12 January 2022, the applicants entered Sweden. They stayed with one of their sons.

8 . On 14 January 2022 the first applicant suffered a cerebral haemorrhage, which required his hospitalisation until 14 March 2022. He was left with several disabilities as a result, including aphasia (an impairment in the ability to understand and express information). He was prescribed several medicines to prevent another cerebral haemorrhage.

9 On 18 January 2022 the applicants applied for asylum in Sweden. In support of their claims for asylum the second applicant submitted to the Migration Agency ( Migrationsverket ) that they were dependent on their four children, who were living in Sweden, and that they had also been supported financially by their children while they had been in Greece. She further stated that the healthcare in Greece had been terrible and that she could not imagine returning there. Referring to her husband’s illness, she submitted that they needed to be close to their family.

10 The first applicant was also interviewed by the agency, but as he was not physically able to speak his son spoke for him. The first applicant confirmed his son’s answers with nods. The son stated that his father had been denied medical treatment in Greece and had therefore been without medication for a year. The first applicant was in need of rehabilitation.

11 The first applicant was appointed a State appointed legal representative, who submitted that the applicants’ deportation would violate Article 3 of the Convention since the first applicant was in need of constant assistance with his day-to-day activities. He required assistance taking the necessary medication. He could visit the restroom, dress himself and eat, but only with assistance. His wife could help him to a certain extent, but he was too heavy for her to manage. She was also seriously traumatised, had issues sleeping and took medicine for anxiety. The applicants lived with their son, who was a nurse.

12 . The applicants further submitted a medical certificate, dated 3 August 2022 and written by a consultant, H.D., which stated that the first applicant was still undergoing rehabilitation treatment. The certificate stated that the first applicant was still suffering weakness on the right side of his body, speech impairment (dysarthria and dysphasia) and minor issues eating and swallowing. It was important that the rehabilitation could continue so that he could regain as many of his functions as possible. Removing him from Sweden to Greece would risk decreasing his chances of making a successful rehabilitation and recuperation, and of receiving medical follow ‑ ups. The applicants also submitted a medical certificate dated 24 March 2023, also written by the consultant H.D., which listed the medication prescribed to the first applicant to prevent another cerebral haemorrhage.

13 . The Migration Agency sent information requests to the Greek authorities based on matches with the applicants’ fingerprints found in the European Asylum Dactyloscopy Database (Eurodac). The Greek authorities informed the Migration Agency that the applicants had been granted refugee status there on 23 March 2021 and issued with residence permits valid until 22 March 2024.

14 . On 15 May 2023, the Migration Agency dismissed the applicants’ asylum applications pursuant to Chapter 5, section 1b(1)(i), of the Aliens Act, on the basis that the Greek authorities had already granted them refugee status. In its decision, the Migration Agency referred to case ‑ law (specifically MIG 2013:8) from the Migration Court of Appeal on the said provision, according to which it had to be assessed whether a dismissal of the application would be considered unacceptable/offensive ( stötande ) from a humanitarian perspective, in a similar way as to when a transfer under the Dublin Regulation was being considered. The agency concluded that there was no such obstacle to dismissing the applications. Consequently, it further decided, in accordance with Chapter 8 of the Aliens Act, to order the applicants’ deportation to Greece.

15 . The Migration Agency stated that it had no doubt that the applicants had been through a tumultuous and difficult period. However, it concluded that they had not shown that they had consistently been denied healthcare in Greece and determined that such a denial was unlikely to have happened, given that the Greek authorities were bound by European Union (EU) law to provide those who had received international protection the same healthcare as provided to their own citizens. It had furthermore not been shown that the Greek authorities lacked the will and ability to give the applicants the necessary care upon a return to Greece. The agency assessed the issue of whether an interruption of the first applicant’s healthcare in Sweden would be harmful. It noted that it was not stated in the medical certificate of 24 March 2023 that the first applicant’s health would deteriorate if he travelled to Greece. Moreover, the Migration Agency could ensure that the Greek authorities received the necessary information regarding his health before deporting him. Lastly, they noted that the applicants’ children could still assist them even if they lived in different countries, and that the applicants would not be separated from each other.

16 . The applicants appealed against that decision to the Migration Court ( Migrationsdomstolen ) and submitted a certificate of 17 June 2023 from the consultant H.D., which stated that it would be “unacceptable from a humanitarian perspective to refuse the applicants’ claims for asylum in Sweden”, in particular given that the first applicant had communication difficulties and was in need of his children’s support, and given that the second applicant only spoke Arabic.

17 . By a judgment of 19 October 2023 the Migration Court upheld the Migration Agency’s decision, finding that it could not be considered unacceptable from a humanitarian perspective, or in breach of Chapter 12, section 1 or 2, of the Aliens Act or of the Convention to deport the applicants to Greece.

18 . The applicants’ request for leave to appeal to the Migration Court of Appeal ( Migrationsöverdomstolen ) was refused on 19 December 2023.

19 One month later, on 16 January 2024, the applicants submitted a notification of impediments to the enforcement of the expulsion orders under Chapter 12, sections 18 and 19, of the Aliens Act to the Migration Agency, on the basis of new circumstances to do with the applicants’ health and medical conditions. They sought, under those provisions, to be granted residence permits or to have their asylum applications re ‑ examined.

20 . They submitted a medical certificate of 18 January 2024, written by the consultant H.D., which stated that the first applicant still had aphasia and some loss of use of his right hand, reduced balance, and cognitive effects such as memory difficulties and passiveness. He was taking medicine for depression and anxiety, symptoms which had recently worsened, probably owing to the risk of being deported. In H.D.’s opinion, the remaining after ‑ effects of the cerebral haemorrhage prevented the first applicant from managing independently. She added that “to deport [the first applicant] in his current state would be directly harmful and have nothing but damaging consequences, and would be in no way be defensible ( försvarbart ) from a medical or ethical point of view”.

21 On 9 February 2024, the Migration Agency rejected the applicants’ claims for residence permits under Chapter 12, section 18, of the Act. The Migration Agency, referring to, among other things, the new medical certificate, found that no new circumstances had been presented indicating that the enforcement of the expulsions should be stayed.

22 The Migration Agency also decided not to examine the claims for granting a new examination of the applicants’ asylum claims under Chapter 12, section 19, of the Act, since that would have required assessing the asylum applications on the merits.

23 The applicants appealed against those decisions to the Migration Court. On 6 March 2024 the appeal was rejected in so far as it concerned the decision not to grant a residence permit under Chapter 12, section 18, of the Aliens Act, given that such decisions were not open to appeal, and was dismissed in so far as it concerned the decision taken by the Migration Agency under Chapter 12, section 19, of the Act, which the Migration Court upheld.

24 The applicants requested leave to lodge an appeal with the Migration Court of Appeal against the decision not to grant them a re ‑ examination of their asylum applications, but that was refused on 8 April 2024.

25 . An additional medical certificate dated 22 April 2024 concerning the first applicant’s medical condition was sent to the Migration Agency by a consultant. The Court is not in possession of this certificate. Apparently it stated that allowing the first applicant to travel by aeroplane could have serious adverse consequences because his brain had been damaged and his skull was very fragile. The Migration Agency noted that the certificate had been submitted by a third party, and therefore examined it as a possible impediment to enforcement under Chapter 12, section 18, of the Aliens Act.

26 . On 29 April 2024 the Migration Agency found that no new circumstances had been submitted indicating that the first applicant’s medical condition had deteriorated to such an extent that it would give rise to practical impediments to the enforcement of the decision to expel him to Greece. Nor had it emerged that Greece was unable to offer him continued care with medication and appropriate treatment. Lastly, it was noted that an escort could be arranged if needed from a practical or security perspective.

27 . On 30 May 2024, the applicants submitted a new notification of impediments to the enforcement of the expulsion orders under Chapter 12, sections 18 and 19, of the Aliens Act. They sought, under those provisions, to be granted residence permits or to have their asylum applications re ‑ examined. They submitted a medical certificate dated 28 May 2024 and written by the consultant H.D. regarding the first applicant, which stated that even if he followed his prescribed treatment and medication, external circumstances could give rise to another stroke, which could be fatal. They also submitted a certificate of 29 May 2024 regarding the second applicant, which stated that she was suffering from depression. Lastly, they submitted a report by Refugee Support Aegean (RSA) and Stiftung PRO ASYL from March 2024 entitled “Beneficiaries of international protection in Greece: Access to documents and socio-economic rights” (see paragraph 55 below).

28 By a decision of 13 June 2024 the Migration Agency decided to reject the applicants’ claims for a residence permit under Chapter 12, section 18, of the Act and not to examine the requests that they be granted a re ‑ examination of their asylum claims under Chapter 12, section 19, of the Act. The agency found that it had not been shown that the applicants’ health had deteriorated such that they could not practically be moved to Greece, or that they could not receive the necessary healthcare in Greece.

29 . The applicants appealed against those decisions to the Migration Court. On 6 August 2024 the appeal was rejected in so far as it concerned the decision under Chapter 12, section 18, of the Aliens Act, given that such a decision could not be appealed against, and was dismissed in so far as it concerned the decision taken by the Migration Agency under Chapter 12, section 19, of the Act, which the Migration Court upheld.

30 The applicants requested leave to appeal against the decision refusing to re ‑ examine their asylum applications, but that was refused on 18 September 2024 by the Migration Court of Appeal.

31 . On 18 November 2024, further to a request by the applicants, the Court applied Rule 39 of the Rules of Court until further notice.

32 . With their observations to the Court, the applicants submitted a medical certificate dated 21 July 2025 and written by the consultant H.D., which stated that the first applicant’s condition had worsened over the preceding 18 months and that “he now meets the diagnostic criteria for subcortical vascular dementia”.

RELEVANT LEGAL FRAMEWORK AND PRACTICE

33 The basic provisions applicable in the present case, concerning the right of aliens to enter and remain in Sweden, are laid down in the Aliens Act ( utlänningslagen , 2005:716).

34 An alien who is considered to be a refugee or a person eligible for subsidiary protection is, with certain exceptions, entitled to a residence permit in Sweden (Chapter 5, section 1, of the Act).

35 Under Chapter 5, section 1b – which implements Article 33(2) of Directive 2013/32/EU of the European Parliament and of the Council of 26 June 2013 on common procedures for granting and withdrawing international protection (recast), OJ 2013 L 180, p. 60 (“the Asylum Procedures Directive”) – an asylum application may be dismissed if the applicant

36 The term “refugee” refers to an alien who is outside the country of his or her origin owing to a well ‑ founded fear of being persecuted on grounds of race, nationality, religious or political beliefs, or on grounds of gender, sexual orientation or other membership of a particular social group, and who is unable or, owing to such fear, is unwilling to avail himself or herself of the protection of that country (Chapter 4, section 1). The term “person eligible for subsidiary protection” refers to an alien who does not qualify as a refugee but is outside the country of his or her origin because there are substantial grounds for believing ( grundad anledning att anta ) that, upon return to his or her country of origin, the alien would be at risk of being punished by the death penalty or subjected to corporal punishment, torture or other inhuman or degrading treatment or punishment, or as a civilian would face a serious and personal risk of being harmed by reason of indiscriminate violence in connection with an external or internal armed conflict, and who is unable or, owing to such risk, unwilling to avail himself or herself of the protection of his or her country of origin. (Chapter 4, section 2). The above applies irrespective of whether the persecution or ill-treatment is at the hands of the authorities of the country or if those authorities cannot be expected to offer effective protection against such acts by private individuals.

37 Moreover, if a residence permit cannot be granted on any other grounds, a residence permit may be issued in cases where an overall assessment of the alien’s situation reveals such exceptionally distressing ( synnerligen ömmande ) circumstances that he or she should be allowed to stay in Sweden. In making this assessment, particular attention is to be paid to the alien’s state of health, his or her adaptation to Sweden and the situation in his or her country of origin (Chapter 5, section 6).

38 . As regards the enforcement of a deportation or expulsion order, in accordance with a special provision on impediments to enforcement, an alien must not be sent to a country where there are reasonable grounds for believing ( skälig anledning att anta ) that he or she would be in danger of being punished by the death penalty or subjected to corporal punishment, torture or other inhuman or degrading treatment or punishment (Chapter 12, section 1). In addition, an alien must not, in principle, be sent to a country where he or she risks persecution (Chapter 12, section 2).

39 . Under certain conditions, an alien may be granted a residence permit even if a deportation or expulsion order has acquired legal force. This is the case when new circumstances have emerged which indicate ( innebär ) that there are impediments to enforcement of the nature referred to in Chapter 12, sections 1 or 2, or where there are medical or other special reasons why the order should not be enforced (Chapter 12, section 18).

40 If a residence permit cannot be granted under those criteria, the Migration Agency may instead decide to re-examine the matter. Such re ‑ examination is to be carried out where it may be assumed ( kan antas ), on the basis of new circumstances relied upon by the alien, that there are lasting impediments to enforcement of the nature referred to in Chapter 12, sections 1 and 2, and that these circumstances could not have been raised previously or the alien shows that he or she has a valid excuse for not having done so. Should the applicable conditions not have been met, the Migration Agency will decide not to grant re-examination (Chapter 12, section 19).

41 As to the standard of proof in cases concerning applications for asylum, the Migration Court of Appeal has stated that when invoking refugee status or other grounds for protection, the asylum seeker must establish as probable ( göra sannolikt ) that they are in need of international protection. That includes establishing as probable their identity, including their name, age and nationality. However, the Migration Court of Appeal has also stated that the standard of proof cannot be set too high when it comes to claims of risk of persecution, as it is rarely possible to provide complete evidence that clearly demonstrates that such a risk exists. To the extent that the evidence is insufficient, the applicant’s account must therefore be accepted if it appears credible and probable. In this context, the Migration Court of Appeal has also referred to the principle of the “benefit of the doubt” as set out in the UNHCR Handbook on Procedures and Criteria for Determining Refugee Status under the 1951 Convention and the 1967 Protocol relating to the Status of Refugees (see, for example, the Migration Court of Appeal’s judgments in MIG 2007:12; MIG 2007:37; MIG 2010:6; MIG 2011:8; and MIG 2014:1).

42 Council Directive 2004/83/EC of 29 April 2004 on minimum standards for the qualification and status of third country nationals or stateless persons as refugees or as persons who otherwise need international protection and the content of the protection granted, OJ 2004 L 304, p. 12 (“the Qualification Directive”) regulates refugee status within the European Union legal order and makes provision for granting subsidiary protection status.

43 Article 2(d) defines a refugee as someone who, owing to a well ‑ founded fear of being persecuted for reasons of race, religion, nationality, political opinion or membership of a particular social group, is outside his or her country of origin and is unable or, owing to such fear, is unwilling to avail himself or herself of the protection of that country.

44 Article 2(e) defines a person eligible for subsidiary protection as someone in respect of whom substantial grounds have been shown for believing that the person concerned would face a real risk of suffering serious harm if returned to his or her country of origin and who is unable, or, owing to such risk, unwilling to avail himself or herself of the protection of that country.

45 . Article 15 of the Qualification Directive defines “serious harm” as consisting of:

“(a) death penalty or execution; or

(b) torture or inhuman or degrading treatment or punishment of an applicant in the country of origin; or

(c) serious and individual threat to a civilian’s life or person by reason of indiscriminate violence in situations of international or internal armed conflict.”

46 Article 33 (Inadmissible applications) of the Asylum Procedures Directive reads :

“1. In addition to cases in which an application is not examined in accordance with Regulation (EU) No 604/2013, Member States are not required to examine whether the applicant qualifies for international protection in accordance with Directive 2011/95/EU where an application is considered inadmissible pursuant to this Article.

2 Member States may consider an application for international protection as inadmissible only if:

(a) another Member State has granted international protection;

(b) a country which is not a Member State is considered as a first country of asylum for the applicant, pursuant to Article 35;

(c) a country which is not a Member State is considered as a safe third country for the applicant, pursuant to Article 38;

(d) the application is a subsequent application, where no new elements or findings relating to the examination of whether the applicant qualifies as a beneficiary of international protection by virtue of Directive 2011/95/EU have arisen or have been presented by the applicant; or

(e) a dependant of the applicant lodges an application, after he or she has in accordance with Article 7(2) consented to have his or her case be part of an application lodged on his or her behalf, and there are no facts relating to the dependant’s situation which justify a separate application.”

Relevant Country Information on Greece

47 . Asylum seekers in Greece are automatically issued with an Asylum Seeker Card and a temporary health insurance and care number ( Προσωρινού Αριθμού Ασφάλισης και Υγειονομικής Περίθαλψης Αλλοδαπού – “PAAYPA”) by the Asylum Service (section 59(2) of Law no. 4939/2022), which enables access to primary and secondary healthcare (in accordance with section 33(2) of Law no. 4368/2016 and Ministerial Decision no. 25132/2016).

48 . Beneficiaries of International Protection (“BIPs”) in Greece acquire a social security number ( Arithmos Mitroou Koinonikis Asfalisis – “AMKA”) (Article 8 of Joint Ministerial Decision no. 6058869/2022). It is granted un ‑ activated for all categories of beneficiaries (Article 2 of Joint Ministerial Decision no. F80320/109864/14-12-2023) and is activated upon submission of proof of a legal stay and actual residence in the country (ibid., Articles 5 and 6).

49 . The documents required to demonstrate an individual’s legal stay and actual residence in the country for the activation of an AMKA for adult third ‑ country nationals and stateless persons are set out in Article 6 § 5 of Joint Ministerial Decision no. F80320/109864/14-12-2023, which provides as follows:

“(a) As proof of legal residence, access to the labour market, and enrolment in the social security system:

(aa) a valid third-country passport or a valid travel document for a beneficiary of international protection, and

(ab) a valid residence permit in the country granting access to the labour market,

and

(b) As proof of residence in the country:

(ba) Proof of tax residence in Greece or proof of home ownership or a declaration of rental information in respect of real estate or a declaration of free accommodation or a declaration of hospitality, legally uploaded to the relevant AADE applications, or a certificate of residence in a student dormitory, or a certificate of studies in Greece, or a certificate of residence under the housing program for applicants for international protection, or a certificate of residence in the types of facilities set out in subsection 4 of section 8 of Law no. 4375/2016, or a certificate of residence in accommodation facilities for unaccompanied minors. ...

and

(bb) a letter of employment from an employer or an employment contract registered with ERGANI, or a certificate of commencement of business issued by the Tax Administration. In the specific case of an adult family member who wishes to be insured as a dependent, instead of the supporting documents listed in the preceding paragraph, a valid social security number (AMKA) of the primary insured person is required.”

50 . Section 33(1) of Law no. 4368/2016 provides that uninsured and vulnerable social groups, as defined in section 33(2), have a right to free access to public health facilities and are entitled to hospital and medical care. Among the groups referred to are the beneficiaries of international protection (recognised refugees and beneficiaries of subsidiary protection), whether they hold a valid residence permit or not.

51 . In a Fact Sheet concerning Greece dated February 2025, the United Nations High Commissioner for Refugees (UNHCR) stated that, as of mid ‑ 2024, Greece had recognised 214,574 people as refugees, and there were 20,887 asylum seekers in the country.

52 . On 4 April 2025, the EU Commission issued a communication to the Council and the European Parliament on the status of migration management in mainland Greece (Com 2025 170 final), setting out, among other things (footnotes omitted; emphasis in the original):

“1. Introduction

In the past ten years, Greece has been one of the most affected Member States when it comes to irregular arrivals of third country nationals at its land and sea borders, creating significant challenges and putting its national migration management system under considerable strain.

To address these significant challenges, boost national capacities and improve migration management procedures, the Commission and EU Agencies (European Border and Coast Guard Agency (Frontex), EU Agency for Asylum (EUAA), European Union Agency for Law Enforcement Cooperation (Europol) and Fundamental Rights Agency (FRA), hereinafter: ‘EU Agencies’) have worked particularly intensively with the Greek authorities. This work has supported the establishment of a comprehensive migration management system and has been underpinned by significant financial, operational, and technical support to help the responsible ministries and services involved.

Efforts were also undertaken to improve the overall implementation of the Dublin III Regulation by the Commission, in particular the implementation of the transfers of applicants for international protection as a precondition for the well-functioning of the Dublin system. This was a particular challenge for Greece and merited dedicated support from the Commission. In 2016, the Commission adopted several recommendations focusing on Dublin transfers to Greece. More recently, the Commission worked with Member States on a Roadmap on improving implementation of transfers under the Dublin III Regulation (‘the Dublin Roadmap’), as a basis necessary for the smooth transitioning towards the system established under the Asylum and Migration Management Regulation.

As a result of this continuous cooperation and support and the significant efforts of the Greek authorities in the last years, migration management in Greece has been significantly improved. Greece has set up functional asylum and reception systems and operational frameworks in key areas of migration management. Greece has also invested in novel initiatives in different areas such as the comprehensive system for supporting unaccompanied minors, IT systems for asylum and reception making the processes more efficient, and screening at the borders. These are particularly relevant for the implementation of the Pact on Migration and Asylum.

The number of irregular arrivals to Greece, mainly through the islands of Lesvos, Chios, Kos, Leros and Samos, and through the land border in the Evros region, has remained constantly high in the past two years. At the same time, Greece has remained one of the main countries of transit, with applicants and beneficiaries of international protection moving in an unauthorised manner from mainland Greece to other EU Member States and re-applying for protection there.

This Communication provides an updated overview of the current status of the asylum and reception systems in mainland Greece. The scope of this Communication focuses on the situation in the mainland, where Dublin transfers are received. Specifically, it focuses on the situation and services available to migrants, in particular for those going back or transferred to Greece from other EU Member States, be it international protection applicants under the Dublin Regulation or beneficiaries of international protection[.] Its main objective is to provide an update to Member State authorities in the EU and thus help ensure that those who deal with these cases have the necessary information available to facilitate their smooth implementation. This is important to ensure that the overall migration management system within the EU functions effectively, based on close cooperation among Member States.

...

3.2 Health

The Commission supports the Greek Ministry of Migration and Asylum and the Ministry of Health to provide access to medical care, mental health and psychosocial support to applicants and beneficiaries of international protection in Greece. Health services are provided both in reception facilities and other premises (clinics run by NGOs or public hospitals).

As of July 2024, medical care is supported through the Hippokrates project by medical teams deployed on the ground in all open accommodation sites in mainland Greece . The project aims to enhance flexible health care services in a comprehensive way, especially given past inefficiencies that were primarily related to the challenges in identifying and hiring medical personnel in the context of a generalised shortage. The project also addresses existing gaps, in particular through adequate and timely vulnerability assessments (identification of vulnerable applicants) and referrals to special care, as well as more focus on mental health care for both residents and staff of reception facilities.

Hippokrates is managed by the Hellenic Ministry of Migration and Asylum and implemented by the IOM and a third-party healthcare provider. Key responsibilities under the contract are primary health services, identification of vulnerable people upon arrival and throughout the asylum process, transportation facilitation to external healthcare providers, operation of mobile clinics equipped with nursery rooms, laboratories, x-ray facilities, and reception areas, including radiologists, lab technicians and drivers, and medical equipment provision.

The programme foresees the recruitment of 554 full-time and part-time medical specialists across different regions (106 for the Aegean islands, 182 for Northern Greece, and 147 for Southern Greece), including general practitioners, pathologists, gynecologists, pediatricians, psychiatrists, radiology technologists, midwives, nurses, laboratory technicians, social workers, and psychologists. The deployment of staff started in 2024 and is currently ongoing.

Beneficiaries of international protection have free access to healthcare in the same way as Greek citizens. Some have faced challenges due to administrative obstacles concerning the initial issuance or conversion of AMKA (Social Security Number) following the granting of status, or lack of information on the procedures and the required supporting documents. These challenges have been brought to the attention of the Task Force on Integration, instituted by the Ministry of Migration and Asylum (see also section 5).

...

5. Integration of beneficiaries of international protection

In February 2022, Greece adopted a National Strategy for Integration acknowledging the need for a comprehensive approach to integration. Numerous projects, many of which are EU funded, are under implementation and are supporting the integration of third-country nationals, in particular regarding their access to the labour market.

The HELIOS project has to date been the main integration project in Greece through which 47 753 beneficiaries of international protection have received welcome courses , education and employability support . The project also offered accommodation support and activities that helped people connect and contribute to their new community. Up to 10,816 households have been actively supported with rental subsidies from its activation until 31 October 2024. The HELIOS project has been implemented by IOM with around €60 million in EU funding and the support of several NGOs and municipalities. As of 1 January 2022, the Ministry of Migration and Asylum took over its management and funding.

The Helios project ended on 30 November 2024 and was replaced by Helios+ as of January 2025, funded under the European Social Fund (ESF+) to ensure its long ‑ term continuation of these services. Indeed, the services that will be provided to beneficiaries of international protection will remain similar, in particular regarding rental subsidies, language training and integration classes, but importantly offer more focus on employability .

...

While beneficiaries of international protection have access to some form of financial assistance (the minimum guaranteed income), administrative issues can limit their access. Moreover, they are not granted immediate access to some other social benefits available to Greek citizens upon recognition of their status, due to requirements linked to the duration of legal stay in the country. This restriction has resulted in a pending infringement procedure against Greece. In practice, beneficiaries of international protection often remain in reception facilities meant for international protection applicants beyond the applicable transition period.

Travel documents, requested by beneficiaries of international protection, are often issued together with the residence permit, often resulting in onward travelling of beneficiaries of international protection to other Member States.

In order to tackle these obstacles, an Integration Task Force was established by the Ministry of Migration and Asylum in January 2024. It aims to facilitate effective integration policies on the ground, and to enhance cooperation and coordination among different Ministries and public authorities. The implementation of the relevant legislation and administrative bottlenecks are regularly discussed in this forum.

6. Conclusions

Over recent years, Greece has developed a national migration management system, with the infrastructure, equipment and tools required. By scaling up its authorities’ capacity, Greece has addressed issues of overcrowding and sub-standard reception conditions in mainland centres. Reception and international protection procedures have been streamlined and accelerated. Protection of the most vulnerable persons has improved, and the legislative framework put in place for unaccompanied minors offers a positive outlook. Integration is now evolving as a national policy priority.

On this basis, while improvements may continue to be necessary in certain aspects of migration management, it can be concluded that there are no systemic deficiencies in the Greek mainland asylum and reception system resulting in a risk of inhuman or degrading treatment within the meaning of Article 4 of the Charter of Fundamental Rights of the EU. As a result, Dublin transfers to Greece should take place in the same manner as for the other Member States, i.e. without the requirement of individual assurances recommended by the Commission in its Recommendation (EU) 2016/1117, and in accordance with the jurisprudence of the Court [of Justice of the European Union] regarding the interpretation of Article 3(2) of Regulation (EU) 604/2013. This Recommendation therefore ceases to apply. The Commission will continue to be in close contact with the Greek authorities to ensure compliance with Regulation (EU) 604/2013 in particular, as well as the proper implementation of the EU acquis and the Pact on Migration and Asylum.

The Task Force Migration Management, in cooperation with all relevant stakeholders, proved to be an efficient and beneficial tool to achieve significant improvements in Greece, through better collaboration and communication. As in all Member States, there is room for improvement in certain policy areas . The Commission will continue working with Greece and the EU Agencies to consolidate the existing framework of cooperation and assist in fulfilling Greece’s declared goal of further improving the migration management system and the treatment of third-country nationals arriving in the country. Operational, technical and financial support to Greece will continue, including through the deployment of Commission staff and the EU Agencies deployed on the ground, as well as through the implementation of the EU Home Affairs Funds for the 2021 ‑ 2027 Multiannual Financial Framework.

Finally, the Commission is working closely with Member States, including Greece, to support the implementation of the Pact on Migration and Asylum. Following the Common Implementation Plan presented by the Commission in June 2024, Greece prepared its own National Implementation Plan , setting out the next steps envisaged by the national authorities to implement the provisions of the Pact by June 2026, following the suggested breakdown into thematic building blocks. It outlines targets and requirements needed to enable the corresponding legislative, structural and operational changes foreseen in the design of the national migration management system, including but not limited to the review of the reception system, procedures for examining applications for international protection, preparedness, integration, as well as rules on responsibility and solidarity. Until the Pact’s legal instruments start applying in mid ‑ 2026, the Commission will continue supporting Member States’ efforts to translate the Pact from legislative acts into an operational reality.”

53 The Asylum Information Database (“AIDA”) is managed by the European Council on Refugees and Exiles (“ECRE”). “It aims to provide up ‑ to ‑ date information which is accessible to researchers, advocates, legal practitioners and the general public through the dedicated website www.asylumineurope.org. It covers 24 countries, including 19 EU Member States. The database also seeks to promote the implementation and transposition of EU asylum legislation reflecting the highest possible standards of protection in line with international refugee and human rights law and based on best practice.”

54 . In September 2025 “Country Report on Greece (2024 Update)” was published, having been written by the Greek Council for Refugees and edited by ECRE. It stated, among other things (footnotes omitted and emphasis added):

“L[aw] 4368/2016, which provides free access to public health services and pharmaceutical treatment for persons without social insurance and vulnerable social groups is also applicable for asylum applicants and members of their families. However, in spite of the favourable legal framework, actual access to health care services has been consistently hindered in practice by significant shortages of resources and capacity for both foreigners and the local population, as the public health sector is under extreme pressure and lacks the capacity to cover all the needs for health care services.

Moreover, [section] 55 [of Law 4636/2019 on international protection and other provisions], subsequently replaced by Article 59 [§ 2 of the] Asylum Code, introduced a new Foreigner’s Temporary Insurance and Health Coverage Number (... PAAYPA) replacing the AMKA for asylum seekers.

Article 59 (2) provides that PAAYPA is to be issued to asylum applicants together with their asylum applicant’s card. With this number, asylum applicants are entitled free of charge to access the necessary health, pharmaceutical and hospital care, including the necessary psychiatric care where appropriate. The PAAYPA is deactivated if the applicant loses the right to remain on the territory.

...

... a recent legislative development automatically excludes from access to public healthcare beneficiaries of international protection (when one becomes a recognised refugee a PAAYPA needs to be converted to AMKA) who are not yet working or are not able to work because of their health condition or age (e.g. the elderly). Also, the possession of an active AMKA is necessary for access to the benefits of the Agency for Welfare Benefits and Social Solidarity (OPEKA).

...

In 2024, asylum seekers in Greece faced serious challenges in accessing medical care, given that on the one hand there was not adequate nor full-time medical staff available in all facilities nor available interpretation for most of the year. Well documented issues of ‘on and off’ healthcare service provision with PHILOS II (project implemented by EODY) persisted until July, when officially IPPOKRATIS project started with MoMA’s [the Ministry of Migration and Asylum] implementing partner being IOM. In July 2024, IPPOKRATIS started with the former EODY as a transition personnel and by September 1st 2024, it was implemented by a private sector entity ... and [the NGO] Doctors without Borders.

According to MoMA’s Minister’s answer to the Greek parliament, this programme concerns the provision of medical and psychosocial services, including prevention, health education, diagnosis and treatment to third-country nationals who live in [Reception and Identification Centre]s, C[losed Control Access Centre]s, C[ontrol Access Facilities Temporary Accommodation of Asylum Seeker]s and includes: (a) the treatment of urgent cases - screening, (b) the identification of vulnerable persons, and (c) the provision of a comprehensive approach to the provision of health care services c) taking a medical history - registration, d) clinical physical examination, e) referral to a medical service, f) identification of vulnerable groups (e) referral to further care (secondary/tertiary) and also, the provision of psychosocial care to residents within the facilities by specialised staff. This programme has been included in the new multiannual programme of the Asylum, Migration and Integration Fund (AMIF) 2021-2027.

...”

55 . The non-governmental organisations Refugee Support Aegean (RSA) and Stiftung PRO ASYL published a report in March 2024 entitled “Beneficiaries of international protection in Greece: Access to documents and socio ‑ economic rights”, which set out, among other things (footnotes and case ‑ studies omitted):

“ Introduction

Refugees in Greece face chronic legal and practical obstacles to access to documents and socio-economic rights. These barriers, coupled with a policy expecting immediate autonomy and self-sufficiency, expose many holders of international protection to situations of homelessness and destitution. Beneficiaries of international protection in Greece have no effective remedy against violations related to deprivation of socio-economic rights and to destitution.

These conditions continue to create potent risks of breach of the minimum standards set by Article 3 of the [Convention] and Article 4 of the Charter of Fundamental Rights of the European Union according to jurisdictions throughout Europe. Against this backdrop, the European Commission has launched infringement proceedings against Greece under Letter of Formal Notice INFR(2022)2044 for poor implementation of the Qualification Directive as regards the content of international protection granted.

Yet, whereas countries such as Germany or the Netherlands have adopted policies opposing deportations of beneficiaries of international protection to Greece apart from exceptional cases, European states still pursue returns of recognised refugees to Greece on the ground that they can enjoy the rights attached to their granted status.

As a rule, readmission of beneficiaries of international protection from other European countries takes place via Athens International Airport. Upon arrival at the airport, beneficiaries receive no information on housing options or on procedures for access to their rights in Greece. They may be issued a police note ... in Greek, instructing them to appear before the Asylum Service if they do not hold documentation. In recent cases supported by Refugee Support Aegean (RSA), however, returnees have not received a police note or any other document.

...

The present report provides up-to-date information on the conditions facing persons who receive international protection in Greece, including those returned in the context of readmissions from other European countries, based on cases legally supported by RSA. It tracks the grant and renewal of necessary documents for their access to socio ‑ economic rights such as employment, housing, health care, education and social assistance. The report focuses in particular on access to residence permits and other documents, to the HELIOS programme and to the risk of homelessness and destitution. Issues relating to refugees’ access to other rights are documented in detail in our previous reports.

...

Social Security Number (AMKA)

...

The requirement of a ‘valid’ residence permit creates substantial obstacles, given that AMKA is deactivated upon interruption of lawful residence in the country. ‘Specifically as regards deactivation due to non-legal residence in the country, [deactivation] shall automatically take place on the day following the expiry of validity of the residence title, in the absence of renewal, extension or withdrawal of the status of international or temporary protection’.

Therefore, the systematic protracted delays in the [residence permit] renewal procedure carry risks of deactivation of AMKA for beneficiaries of international protection through no fault of their own. This has serious repercussions on their access even to acquired rights and benefits such as employment or health care.

Housing

HELIOS and housing programmes

The ‘Hellenic Integration Support for Beneficiaries of International Protection and Beneficiaries of Temporary Protection’ (HELIOS) is implemented by the International Organisation for Migration (IOM) in partnership with several non-governmental organisations. From 2022 onwards, the programme is temporarily funded by the national budget pending its inclusion in the European Social Fund +, and is ‘implemented through successive extensions’, the latest – ninth – prolonging its implementation until end of June 2024.

The need to secure extensions of the programme under national funding through successive amendments to the framework agreement has resulted in interruption of HELIOS for a significant period of time, especially during the last months of 2023. Specifically, the programme was abruptly halted as of 1 October 2023, resumed for a brief period and was interrupted again in November. As a result, the programme did not accept new enrolments of recognised refugees, as highlighted in responses to enrolment requests by RSA clients. Indicatively, only 30 people enrolled on the programme in the last quarter of 2023 according to IOM statistics.

Enrolment on HELIOS has to be done within one year of the notification of a positive asylum decision. Eligibility for enrolment on HELIOS is subject to the following criteria: (a) recognition as a refugee or beneficiary of subsidiary protection after 1 January 2018; and (b) official registration and residence in the reception system, i.e. in camps such as Reception and Identification Centres (RIC), Closed Controlled Access Centres (CCAC) or Controlled Temporary Reception Facilities (CTRF), or official municipality shelters or other housing programmes e.g. for victims of trafficking, or a pre ‑ removal detention centre at the time of notification of a positive decision on their asylum claim. In light of this, beneficiaries of international protection who were not in Greece upon the approval of their asylum application or who have held international protection for over one year are not eligible for enrolment on the HELIOS programme.

According to IOM statistics, 45,688 beneficiaries of international and temporary protection had been registered on the HELIOS programme from its launch to 29 February 2024. 14% of the total enrolments concern Ukrainian nationals covered by temporary protection.

HELIOS does not offer accommodation per se . It offers rental subsidies to assist beneficiaries in finding an accommodation place, upon condition they already hold a rental agreement of a duration exceeding six months and a bank account. Assistance under HELIOS is offered for a period of six to twelve months, depending on the date of submission or the necessary documents. The level of the rental subsidy ranges from 230 € for a single adult to 800 € for a six-member family. In addition to a monthly subsidy, beneficiaries receive retroactively a one-off sum ranging from 350 € to 1,150 € to cover the rental deposit and cover settling-in expenses they need in order to rent property.

Beyond the precondition of possession of AFM [a Tax Identification Number] and a bank account, access to housing is marred by severe barriers as described in previous reports, including discrimination and a lack of affordable housing. In 2024 too, constantly rising rent prices are reported due to high demand, particularly in the Attica region. In addition to rent, beneficiaries have to cover utility bills and other expenses such as food on their own means. Therefore, the HELIOS rent subsidy alone is often insufficient to ensure their subsistence.

From its launch to 29 February 2024, HELIOS has provided rental subsidies to 10,133 households, totalling 23,459 beneficiaries. There is no available breakdown of rental subsidies by duration. Rental subsidies under HELIOS are available for a maximum of twelve months, as described above. Over 20,000 beneficiaries who had previously been included in the programme have stopped receiving rental subsidies, since the number of households currently benefitting from HELIOS subsidies is 1,612, corresponding to 2,961 persons. Importantly, Greece granted international protection to 25,813 people in 2023 alone and had 26,848 registered beneficiaries of temporary protection at the end of the year.”

56 . The two NGOs published a report in March 2025 entitled “Recognised Refugees 2025: Access to documents and socio ‑ economic rights”, stating, among other things (footnotes and case ‑ studies omitted):

“ Issuance of AMKA

According to the [Joint Ministerial Decision no. F80320/109864/14-12-2023], as of 2025 the Ministry of Migration and Asylum is responsible for granting AMKA to third ‑ country nationals and stateless persons falling within its competence, including beneficiaries of international protection. The regulations thereby exclude KEP [Citizens Service Centres] and EFKA [National Social Insurance Institution] from the process as far as beneficiaries of international protection are concerned.

However, the Ministry of Migration and Asylum has not yet started issuing AMKA to beneficiaries of international protection, to our knowledge. The Asylum Service noted in February 2025 that ‘the responsible Informatics Directorate of the [Ministry of Migration and Asylum] has planned technical-level activities with the responsible service of IDIKA for the implementation of Article 1 § 5 (d) of [Joint Ministerial Decision no. F80320/109864/14-12-2023]’.

...

Crucially, the responsible authorities do not proceed to AMKA issuance if the activation conditions are not met, as described below.

Activation of AMKA

Under [Joint Ministerial Decision no. F80320/109864/14-12-2023], beneficiaries of international protection can only activate their AMKA by producing proof of residence and an employment contract or a recruitment certificate uploaded on the Ministry of Labour information system (‘ERGANI’), as proof of address. Greek law therefore treats beneficiaries of international protection differently from Greek and EU citizens, to whom the above requirements are set alternatively and not cumulatively. As a result, refugees who have not secured lawful employment are unable to obtain an active AMKA and are thereby completely excluded from health care and social welfare.

The Greek Ombudsman has expressed severe concerns against the policy of the state. For its part, the European Commission has informed civil society organisations that it has repeatedly raised the issue with the responsible authorities, with a view to addressing the exclusion of beneficiaries of international protection from AMKA and their adverse differential treatment compared to Greek citizens. The Ministry of Migration and Asylum has conceded that legislative reform is necessary to overcome this barrier. Yet, the issue remains unresolved to date and no amendment has been made to the regulations in question.

Given the absolute necessity of an active AMKA for any meaningful exercise of rights attached to international protection status and for engagement with all main branches of the Greek public and private sector, we deem it clear that the prerequisite of an uploaded employment contract or a recruitment certificate on the ERGANI information system for access to AMKA deprives beneficiaries of international protection of their fundamental rights to health care, social support and shelter. Greek law maintains a circular logic whereby access to basic rights as a minimum precondition for integration into the host society and for search of employment is in fact conditioned upon already secured employment. As stated by the Greek Ombudsman, this ‘runs counter to any sense of integration policy.’

Finally, the requirement of a ‘valid’ residence permit for an active AMKA under [Joint Ministerial Decision no. F80320/109864/14-12-2023] creates substantial obstacles for people in practice, given that AMKA is deactivated upon interruption of lawful residence in the country. ‘Specifically as regards deactivation due to non ‑ legal residence in the country, [deactivation] shall automatically take place on the day following the expiry of validity of the residence title, in the absence of renewal, extension or withdrawal of the status of international or temporary protection’. This means that the Protracted Delays in [residence permit] renewal inevitably impact on the activation status of AMKA.

...

Guaranteed minimum income

Contrary to the benefits described above, no minimum residence is required for eligibility for the guaranteed minimum income (... [the] EEE), a 216 € monthly allowance per household, plus 108 € per additional adult and 54 € per additional child.

...

Health care

Barriers to accessing AMKA have direct repercussions on access of beneficiaries of international protection to health care in Greece, as they exclude them from any essential treatment that is not considered emergency health care. In addition, persons who have AMKA but are not insured can no longer be prescribed medication or examinations from private doctors.

We reiterate our previous observations in relation to severe limitations posed by the language barrier ...

...

... Appointments in the public health system are scheduled through a telephone line (1535) available only to Greek and English speakers and at a cost. Persons who do not speak these languages therefore have no means of direct access to public health institutions. Furthermore, hospitals in the Attica region continue to face critical gaps in interpretation services to communicate with patients. ...”

57 . In March 2026 RSA issued a policy note “Recognised refugee statistics in Greece in 2025: Deportations from EU Countries, constant barriers to integration”. The accompanying press release set out, among other things (emphasis in original):

“ European countries are ramping up deportations of recognised refugees to Greece according to latest official statistics for 2025, processed and published today, while persisting legal and practical barriers to people’s access to documents and to dignified living conditions in the country persist unresolved .

The latest data supplied by the Hellenic Police in response to parliamentary questions refer to 9,179 requests for readmission of recognised refugees from other European states in 2025. This is more than a fourfold increase from 2,468 requests in 2024. The overwhelming majority of requests came from Germany (7,467), whose requests rose by 555% from 2024 to 2025. Most requests for readmission of recognised refugees from Germany (5,469) had not been processed yet by the Hellenic Police at the end of last year.

Throughout 2025, the Hellenic Police examined 3,710 readmission requests, corresponding to a total of 5,437 people. More than 80% of those cases came from two countries alone: Switzerland (2,513) and Germany (2,192).

94% of requests for readmission of recognised refugees back to Greece were granted (5,088 out of 5,437 cases).

As for actual deportations to Greece , the number of people (forcibly) readmitted in 2025 reached 725 , a marked increase compared to 390 in 2024. These readmissions exclude cases of people who voluntarily departed from other countries and returned to Greece after receiving a negative asylum decision and/or a return decision in those countries.

Returns of recognised refugees to Greece are therefore steadily increasing, in spite of chronic, unresolved legal and practical barriers to people’s access to essential documents and to core socio-economic rights, not least housing and health care .

Official statistics of the Greek authorities for 2025 reveal chronic issues that are steadily deteriorating , which are summarised in this note. These include protracted delays in the renewal of identity documents of beneficiaries of international protection, barriers and chronic deficiencies across the different steps of the family reunification process , as well as withdrawals of protection status .”

COMPLAINTS

58 The applicants complained that they would face treatment contrary to Article 3 of the Convention if they were to be removed to Greece, owing to their health situation, their dependence on their adult children, the alleged lack of medical care in Greece and the living conditions there, including the risk of extreme material deprivation and lack of accommodation. They also complained that the decision to remove them to Greece violated Article 8 of the Convention, in view of their strong dependency on their children in Sweden.

THE LAW

59 The Court observes that the present case concerns the rejection of the applicants’ claims for asylum in Sweden because they had already been granted asylum in Greece. It is not about the domestic authorities’ decision of 22 November 2018 not to grant the applicants’ request for family reunification (see paragraph 5 above). Moreover, in the three sets of impediments proceedings which followed the deportation orders, when relying on Chapter 12, section 18, of the Aliens Act – under which the new circumstances proffered as impediments to enforcement can be among those referred to in Chapter 12, sections 1 or 2 (see paragraph 38 above), or can consist of “medical or other special reasons” (see paragraph 39 above) – the applicants cited medical certificates (see paragraphs 20, 25 and 27). Therefore, the applicants’ main argument against their deportation was their health and, only in that connection, their alleged dependence on their children. The Court, being the master of the characterisation to be given in law to the facts complained of ( see Radomilja and Others v. Croatia [GC], nos. 37685/10 and 22768/12, §§ 114 and 126, 20 March 2018), considers that in the specific circumstances of the present case, it is appropriate to examine the applicants’ complaints under Article 3 of the Convention alone.

60 Article 3 of the Convention reads as follows:

“No one shall be subjected to torture or to inhuman or degrading treatment or punishment.”

61 The Government submitted that the applicants had failed to substantiate that their medical conditions had reached the threshold under Article 3 of the Convention, as defined by the Court’s case-law.

62 In any event, as the returning State, Sweden had fulfilled its obligations under Article 3. Based on the evidence submitted, relevant country information and the receiving country’s obligation under EU law, the domestic authorities had thoroughly assessed the general situation for migrants in Greece and the applicants’ individual circumstances, including, in particular, whether they, as beneficiaries of international protection, would have access to healthcare and medication upon return to Greece.

63 The applicants had not adduced any evidence substantiating their claim that they would not have access to healthcare in Greece or to any specific treatment or medication for their health issues. Nor had they demonstrated that they, in the absence of assistance or other welfare benefits, would not be able to finance accommodation or necessary healthcare and other services.

64 The Government observed that the case was not about the hardship encountered by the applicants when they were living in Greece from March 2020 until January 2022 as asylum seekers, allegedly unaware that they had been granted asylum there. Nonetheless, the available country information confirmed that the general situation for asylum seekers and those granted international protection had improved substantially in recent years.

65 The applicants would be deported together, and the first applicant would therefore have assistance from the second applicant in accessing sufficient and appropriate treatment and appropriate accommodation, and with other factors of relevance for the applicants’ living conditions. However, Article 3 could not be interpreted as obliging the member States to provide everyone with a home or to grant refugees financial assistance to provide them with a certain standard of living.

66 Further, there were no obstacles to the applicants continuing to receive assistance and support from their four adult children living in Sweden, even if the applicants were living in a different country.

67 The Government also emphasised that, when the deportation orders are carried out, the authorities will ensure that the applicants’ health, medical status, and specific needs are taken into account and communicated to the receiving country, and that the mode of expulsion will be chosen accordingly.

68 Lastly, the medical evidence of 21 July 2025 submitted to the Court, which stated that the first applicant now also suffers from a subcortical vascular dementia, had not been assessed by the domestic authorities in the present case, even though safeguards were in place under Swedish law enabling the domestic authorities to consider new circumstances such as a deteriorated medical condition arising after an expulsion order is issued, namely Chapter 12, section 18, of the Aliens Act. They reiterated that the evidentiary burden lay with the applicants, who had not yet shown substantial grounds for believing that, if the measure complained of were to be carried out, they would be exposed to a real risk of being subjected to treatment contrary to Article 3 of the Convention.

69 . The applicants contended that deporting them to Greece would amount to treatment contrary to Article 3 of the Convention, in view of their current poor health and their dependency on their adult children in Sweden. They observed that the first applicant’s medical condition and acquired disabilities, and the risk that he could experience another, potentially fatal, cerebral haemorrhage owing to stress, had formed the essential basis of their repeated submissions regarding impediments to the enforcement of the expulsion orders, but that the said risks should also be seen in the light of the consequences of their being separated from their children, who were the first applicant’s primary caregivers and thus provided daily and irreplaceable support crucial to his ability to function and maintain medical stability. They also referred to the second applicant’s mental health difficulties and the harsh living conditions for refugees in Greece, including the risk of extreme material deprivation and lack of accommodation. In their view “the Paposhvili -test” had been fulfilled.

70 The applicants further referred to a recent medical certificate of 21 July 2025 concerning the first applicant (see paragraph 32 above).

71 The applicants, who had already experienced the living conditions in Greece, claimed that the lack of access to appropriate healthcare there had been the cause of the severe deterioration of the first applicant’s health that had culminated in his life-altering medical crisis, and submitted that those conditions were such as to be covered by Article 3 of the Convention.

72 The applicants also pointed out that they were elderly and vulnerable, that they would face linguistic barriers in Greece, and that they were wholly unable to navigate administrative or medical systems autonomously. The first applicant was more dependent on access to a structured and accessible healthcare system than he had been during their previous stay in Greece.

73 Lastly, in the applicants’ view, the Swedish authorities had failed to carry out a proper risk assessment of the treatment that they risked being subjected to upon return to Greece. The authorities had merely relied on Greece’s obligation to adhere to EU law on access to healthcare for beneficiaries of international protection, and on the existence of theoretical support structures.

74 . The third-party interveners, the NGOs RSA and Stiftung PRO ASYL, referred to and reiterated the conclusions set out in their reports from March 2024 and 2025 entitled, respectively, “Beneficiaries of international protection in Greece: Access to documents and socio-economic rights” and “Recognised Refugees 2025: Access to documents and socio ‑ economic rights” (see paragraph 55 and 56 above), and to RSA’s policy note “Recognised refugee statistics in Greece in 2025” (see paragraph 57 above), concerning, in particular, the obstacles faced by recognised refugees in obtaining essential documents such as renewed residence permits (ADET) and activated social security numbers (AMKA), both of which were required to access healthcare, shelter, and social welfare, including disability benefits. They emphasised that the possession of an activated AMKA was impossible to obtain for recognised refugees in Greece who could not work.

75 The relevant general principles have been summarised in, among other authorities, the cases of F.G. v. Sweden ([GC], no. 43611/11, §§ 111 ‑ 27, 23 March 2016), J.K. and Others v. Sweden ([GC], no. 59166/12, §§ 77-105, 23 August 2016) and Khasanov and Rakhmanov v. Russia ([GC], nos. 28492/15 and 49975/15, §§ 93-116, 29 April 2022). The Court, in particular, reiterates the following.

76 Contracting States have the right, as a matter of well ‑ established international law and subject to their treaty obligations, including the Convention, to control the entry, residence, removal and deportation of aliens. However, the removal or deportation of an alien by a Contracting State may give rise to an issue under Article 3 of the Convention, and hence engage the responsibility of that State under the Convention, where substantial grounds have been shown for believing that the person in question, if removed or deported, would face a real risk of being subjected to treatment contrary to Article 3 of the Convention in the destination country. In these circumstances, Article 3 of the Convention implies an obligation not to remove or deport the person in question to that country (see F.G. v. Sweden , § 111, and Khasanov and Rakhmanov , § 93, both cited above, with further references).

77 . The assessment of the existence of a real risk must necessarily be a rigorous one and must focus on the foreseeable consequences of the applicant’s removal to the country of destination, in the light of the general situation there and of his or her personal circumstances (see F.G. v. Sweden , §§ 113 and 114, and Khasanov and Rakhmanov , §§ 95 and 109, both cited above, with further references).

78 . Where domestic proceedings have taken place, it is not the Court’s task to substitute its own assessment of the facts for that of the domestic courts and, as a general rule, it is for those courts to assess the evidence before them. As a general principle, the national authorities are best placed to assess not just the facts but, more particularly, the credibility of witnesses since it is they who have had an opportunity to see, hear and assess the demeanour of the individual concerned. This should not lead, however, to an abdication of the Court’s responsibility and a renunciation of all supervision of the result obtained from using domestic remedies, otherwise the rights guaranteed by the Convention would be devoid of any substance (see F.G. v. Sweden , § 118, and Khasanov and Rakhmanov , §§ 104-05, both cited above).

79 . If an applicant has not already been deported, the material point in time for the assessment must be that of the Court’s consideration of the case (see F.G. v. Sweden , § 115; J.K. and Others v. Sweden , §§ 106-07; and Khasanov and Rakhmanov , § 106, all cited above, with further references). When carrying out the risk assessment, it is a firmly established principle that the Court may obtain relevant materials of its own motion (see J.K. and Others v. Sweden , § 90, and Khasanov and Rakhmanov , § 116, both cited above).

80 . In respect of the deportation of seriously ill foreigners, the applicable principles were set out in the case of Paposhvili v. Belgium ([GC], no. 41738/10, §§ 172 ‑ 93, 13 December 2016), and confirmed in that of Savran v. Denmark ([GC], no. 57467/15, §§ 121 ‑ 32, 7 December 2021). The Court found that Article 3 may be applicable to situations in which death is imminent, and to “other very exceptional cases”, which in Paposhvili (cited above, § 183) was clarified as follows:

“The Court considers that the ‘other very exceptional cases’ ... which may raise an issue under Article 3 should be understood to refer to situations involving the removal of a seriously ill person in which substantial grounds have been shown for believing that he or she, although not at imminent risk of dying, would face a real risk, on account of the absence of appropriate treatment in the receiving country or the lack of access to such treatment, of being exposed to a serious, rapid and irreversible decline in his or her state of health resulting in intense suffering or to a significant reduction in life expectancy. The Court points out that these situations correspond to a high threshold for the application of Article 3 of the Convention in cases concerning the removal of aliens suffering from serious illness.”

81 . It is only after this threshold has been reached, and thus Article 3 is applicable, that the returning State’s obligations as laid out in paragraphs 187 ‑ 91 of the Paposhvili judgment and described in paragraph 82 b) to e) below become of relevance (see Savran , cited above, § 135).

82 . As to whether those conditions are satisfied in a given situation, the national authorities are under an obligation under Article 3 to establish appropriate procedures allowing an examination of applicants’ fears to be carried out, as well as an assessment of the risks they would face if removed to the receiving country (see Paposhvili , cited above, §§ 184-85). In the context of those procedures:

(a) it is for applicants to adduce evidence capable of demonstrating that there are substantial grounds for believing that, if the measure complained of were to be implemented, they would be exposed to a real risk of being subjected to treatment contrary to Article 3 (ibid., § 186);

(b) where such evidence is adduced, it is for the returning State to dispel any doubts raised by it, and to subject the alleged risk to close scrutiny by considering the foreseeable consequences of removal for the individuals concerned in the receiving State, in the light of the general situation there and the individuals’ personal circumstances – such an assessment must take into consideration general sources such as reports of the World Health Organization or of reputable non-governmental organisations as well as medical certificates concerning the individuals in question (ibid., § 187), and the impact of removal must be assessed by comparing applicants’ health prior to removal and how their health would evolve after transfer to the receiving State (ibid., § 188);

(c) the returning State must verify on a case-by-case basis whether the care generally available in the receiving State is sufficient and appropriate in practice for the treatment of applicants’ illnesses so as to prevent them being exposed to treatment contrary to Article 3 (ibid., § 189);

(d) the returning State must also consider the extent to which applicants will actually have access to treatment, including with reference to its cost, the existence of social and family networks, and the distance to be travelled in order to have access to the required care in any given case (ibid., § 190);

(e) where, after the relevant information has been examined, serious doubts persist regarding the impact of removal on applicants – on account of the general situation in the receiving country and/or their individual situations – the returning State must obtain individual and sufficient assurances from the receiving State, as a precondition for removal, that appropriate treatment will be available and accessible to the persons concerned so that they do not find themselves in a situation contrary to Article 3 (ibid., § 191).

83 In the present case the applicants, in support of their applications for asylum in Sweden, referred to the first applicant’s cerebral haemorrhage, owing to which he had been hospitalised until 14 March 2022 and which had resulted in, inter alia , aphasia, affecting his ability to understand and express information. He had been prescribed several medicines to prevent another cerebral haemorrhage from occurring (see paragraph 8 above). Subsequently, they also referred to the second applicant’s mental-health difficulties (see paragraph 69 above). Those conditions and developments were described in various medical certificates (see paragraphs 12, 16, 20 and 27) and submitted to the immigration authorities and the courts in support of their asylum applications and subsequent applications to do with alleged impediments to the enforcement of the deportation orders.

84 The applicants’ asylum applications were dismissed by the Migration Agency on 15 May 2023 under Chapter 5, section 1b(1)(i), of the Aliens Act, on the basis that they had already been granted refugee status in Greece. The Migration Agency assessed the question of whether an interruption of the first applicant’s ongoing care in Sweden would be harmful. It had before it the medical certificate of 24 March 2023 from consultant H.D. (see paragraph 12 above), which stated that removing the first applicant from Sweden to Greece would risk decreasing his chances of making a successful rehabilitation and recuperation, and of receiving medical follow-ups. The Migration Agency observed that the certificate did not state that the first applicant’s health would deteriorate if he had to travel to Greece. Moreover, the Migration Agency could ensure that the Greek authorities received the necessary information regarding his health before deporting him.

85 As part of their appeal to the Migration Court the applicants submitted the medical certificate of 17 June 2023 from consultant H.D. (see paragraph 16 above), who found it “unacceptable from a humanitarian perspective to refuse the applicants’ applications for asylum in Sweden”, given in particular that the first applicant had communication difficulties and was in need of his children’s support, and given that the second applicant only spoke Arabic.

86 On 19 October 2023, the Migration Court upheld the Migration Agency’s decision finding that it could not be considered unacceptable from a humanitarian perspective, nor in breach of Chapter 12, section 1 or 2, of the Aliens Act or of the Convention, to deport the applicants to Greece. That decision became final on 19 December 2023 (see paragraph 17 and 18 above).

87 Based on those medical assessments of the first applicant’s health, the Court fully accepts that the stroke suffered by him in January 2022 was very serious and could have been fatal, and that the medical consequences thereof were difficult and devastating for him and his family. It further accepts that the risk of a cerebral haemorrhage recurring is increased by stress and by the absence or lack of access to hypertension medication.

88 The Court notes, however, that the applicants did not claim that they would not have access in Greece to any specific medication or treatment or care. Rather, and without referring to any concrete evidence, they maintained that there was, in general, no healthcare available to them in Greece. They referred to their past experience in Greece as asylum seekers in the period from March 2020 to January 2022. They also claimed that they were not aware that the Greek authorities had granted them refugee status on 23 March 2021 (see paragraph 13 above). It must therefore be assumed that the applicants only had personal experience of the Greek healthcare as asylum seekers, not as beneficiaries of international protection.

89 Subsequently, in the ensuing impediments proceedings, the applicants submitted the medical certificate of 18 January 2024 written by the consultant H.D. (see paragraph 20 above), which stated that the first applicant still had aphasia and some loss of use of his right hand, reduced balance, and cognitive effects such as memory difficulties and passiveness. He was taking medicine for depression and anxiety, symptoms which had recently worsened, probably owing to the risk of being deported. In H.D.’s opinion, the after ‑ effects of the cerebral haemorrhage prevented the first applicant from managing independently. She added that “to deport [the first applicant] in his current state would be directly harmful and have nothing but damaging consequences, and would in no way be defensible from a medical or ethical point of view”. A medical certificate of 22 April 2024 (see paragraph 25 above) was submitted directly by a consultant to the Migration Agency, in which the consultant apparently stated that allowing the first applicant to travel by aeroplane could have serious adverse consequences because his brain had been damaged and his skull was very fragile. The applicants also submitted the medical certificate of 28 May 2024 from consultant H.D. regarding the first applicant, which stated that even if he followed his treatment and medication, external circumstances could give rise to another stroke, which could be fatal. Lastly, they submitted the medical certificate of 29 May 2024 regarding the second applicant, which stated that she suffered from depression (see paragraph 27 above).

90 The Court reiterates its findings in, among others, the case of Savran (cited above, § 131), and in particular:

“the benchmark was not the level of care existing in the returning State; it was not a question of ascertaining whether the care in the receiving State would be equivalent or inferior to that provided by the healthcare system in the returning State. Nor was it possible to derive from Article 3 a right to receive specific treatment in the receiving State which was not available to the rest of the population ([see Paposhvili , cited above], § 189). In cases concerning the removal of seriously ill persons, the event which triggered the inhuman and degrading treatment, and which engaged the responsibility of the returning State under Article 3, was not the lack of medical infrastructure in the receiving State. Likewise, the issue was not one of any obligation for the returning State to alleviate the disparities between its healthcare system and the level of treatment existing in the receiving State through the provision of free and unlimited healthcare to all aliens without a right to stay within its jurisdiction. The responsibility that was engaged under the Convention in cases of this type was that of the returning State, on account of an act – in this instance, expulsion – which would result in an individual being exposed to a risk of treatment prohibited by Article 3 (ibid., § 192).”

Moreover, the Court pointed out that whether the receiving State was a Contracting Party to the Convention was not decisive.

91 In the present case, the Court notes that Greek legislation secures beneficiaries of international protection free healthcare upon activation of a social security number, AMKA, which requires documents demonstrating an individual’s legal stay and actual residence in the country, including a valid residence permit, and, as quoted in paragraph 49 above:

“a letter of employment from an employer or an employment contract registered with ERGANI, or a certificate of commencement of business issued by the Tax Administration. In the specific case of an adult family member who wishes to be insured as a dependent, instead of the supporting documents listed in the preceding paragraph, a valid social security number (AMKA) of the primary insured is required.”

92 As pointed out by, for example, the Greek Council for Refugees and ECRE in their Country Report on Greece published in September 2025 (see paragraph 54 above), that excludes beneficiaries of international protection who are not yet working or are not able to work because of their health or age.

93 The Court is fully aware, as pointed out by the third-party interveners (see paragraphs 55 and 74 above), that there have been significant administrative problems hindering recognised refugees in obtaining essential documents, such as renewed residence permits and activated social security numbers.

94 It notes, however, the following statements in the communication of 4 April 2025 issued by the EU Commission to the Council and the European Parliament (see paragraph 52 above):

“EU Agencies have worked particularly intensively with the Greek authorities. This work has supported the establishment of a comprehensive migration management system and has been underpinned by significant financial, operational, and technical support to help the responsible ministries and services involved.

...

As a result of this continuous cooperation and support and the significant efforts of the Greek authorities in the last years, migration management in Greece has been significantly improved.

...

Beneficiaries of international protection have free access to healthcare in the same way as Greek citizens. Some have faced challenges due to administrative obstacles concerning the initial issuance or conversion of AMKA ... following the granting of status, or lack of information on the procedures and the required supporting documents. These challenges have been brought to the attention of the Task Force on Integration, instituted by the Ministry of Migration and Asylum ...”

95 Turning to the present case, it must be assumed that when the Greek authorities accepted the applicants’ return to Greece, they implied that they were also willing to provide the applicants with renewed residence permits, as the previous ones had expired (see paragraph 13 above).

96 . However, it appears to be out of the question that the applicants – the first of whom suffers from acquired disabilities and the second of whom is 71 years old – would be able to join the labour force in Greece and thus activate their AMKAs. Nevertheless, the Court notes that even if the applicants were unable to activate their AMKAs, they would, in accordance with section 33(1) of Law 4368/2016, belong to the “uninsured and vulnerable social groups”, as defined in section 33(2), and have a right to free access to public health facilities and be entitled to hospital and medical care. Among the groups referred to are beneficiaries of international protection, whether they hold a valid residence permit or not (see paragraph 50 above).

97 Further, there is no indication that in relation to the applicants, any specific treatments required – such as hypertension and anti ‑ depression medication – would be unavailable or inaccessible to them in Greece, even if they had to pay for them.

98 The Court also notes that the Swedish Migration Agency gave assurances that the Greek authorities would receive the necessary information regarding the applicants’ health before deporting them, that the applicants would not be separated (see paragraph 15 above), and that an escort could be arranged if needed from a practical or security perspective (see paragraph 26 above). Furthermore, the Court sees no obstacle to other measures being taken, such as, for example, the furnishing of the applicants, before the deportation orders are implemented, with a stock of the medications prescribed by their current doctor in Sweden.

99 In these circumstances, the Court is not convinced that the applicants provided the national authorities, whether in the asylum proceedings or the subsequent impediments proceedings, with evidence capable of demonstrating that there were substantial grounds to believe that there was an absence of appropriate treatment available for their health issues in Greece, or a lack of access to such treatment, or that the first applicant (or second applicant) would face a real risk – in the alleged absence of “any” healthcare – of being exposed to a serious, rapid and irreversible decline in his or her health resulting in intense suffering or a significant reduction in life expectancy (see paragraph 80-82).

100 In other words, the Court is not satisfied that the high threshold under Article 3 has been reached (see paragraph 80 above).

101 The Court notes that the consultant H.D. submitted to the Swedish immigration authorities that deporting the first applicant would be “harmful” and “damaging”, and even “unacceptable from a humanitarian perspective”, but it sees no reason to criticise the domestic administrative and judicial authorities for making their own legal assessment based on the concrete medical evidence available to them.

102 The Court also observes that, in the proceedings before it, the applicants submitted a medical certificate of 21 July 2025, written by the consultant H.D., which stated that the first applicant’s condition had worsened over the preceding 18 months, and that “he now meets the diagnostic criteria for subcortical vascular dementia” (see paragraph 32 above). The applicants did not submit that certificate to the Migration Agency, nor did they request a new impediments procedure based on those new circumstances, which they could have done. Further, they did not explain whether the new medical certificate means that the first applicant was now in need of supplementary treatment and care. Therefore, although the assessment of the applicants’ Article 3 complaint must be made ex nunc (see paragraph 79 above), the Court cannot attach decisive weight to the said certificate.

103 The Court will proceed to examine whether the high threshold under Article 3 was reached with regard to the applicants’ submissions to the Swedish authorities that, in view of their health and their dependence on their adult children, deporting them to Greece would subject them, as beneficiaries of international protection, to harsh living conditions, including the risk of extreme material deprivation and lack of accommodation (see paragraph 69 above).

104 The Court accepts that, after their arrival in Sweden, the applicants were supported financially and administratively by their adult children and that they lived with their son, a nurse, who assisted with the daily care of the first applicant.

105 The Court also acknowledges that the situation of beneficiaries of international protection, in any country, unavoidably entails hardship, loss, difficulties and challenges, be they financial, linguistic, administrative or practical, including in finding appropriate housing.

106 Nevertheless, the evidentiary burden still lies with the applicants to show substantial grounds for believing that, if the deportation orders were to be implemented, they would be exposed to a real risk of being subjected to treatment contrary to Article 3 of the Convention (see Paposhvili, § 186, and Savran § 130, both cited above).

107 Moreover, according to the Court’s established case ‑ law, Article 3 cannot be interpreted as obliging the Contracting Parties to provide everyone within their jurisdiction with a home (see Chapman v. the United Kingdom [GC], no. 27238/95, § 99, ECHR 2001‑I) or to give refugees financial assistance to enable them to maintain a certain standard of living (see Müslim v. Turkey , no. 53566/99, § 85, 26 April 2005; M.S.S. v. Belgium and Greece [GC], no. 30696/09, § 249, ECHR 2011; Tarakhel v. Switzerland [GC], no. 29217/12, § 95, ECHR 2014 (extracts); and A.S. v. Switzerland , no. 39350/13, § 27, 30 June 2015).

108 The Court also notes that numerous initiatives have been taken by the Greek Government, with the assistance of EU agencies, specific member States, NGOs and others, with a view to facilitating the successful integration of the many beneficiaries of international protection in Greece, including by securing rental subsidies, guaranteed minimum income, language training and integration classes (see paragraph 52 above).

109 The Court agrees with the Migration Agency’s assessment in its decision of 15 May 2023 that the applicants’ children could still assist the applicants even if they were living in different countries (see paragraph 15 above).

110 The foregoing considerations are sufficient to enable the Court to conclude that the circumstances of the present case do not reach the threshold set by Article 3 of the Convention to bring the applicants’ complaint within its scope. As already indicated, the threshold should remain high for this type of case ( Paposhvili , cited above, § 183). Against this background, there is no call to address the question of the returning State’s obligations under this Article in the circumstances of the present case (see paragraphs 81-82 above). Moreover, as the applicants are to be returned to Greece, another Contracting Party to the Convention, they can lodge an application against that country should they find in the future that their Convention rights have been breached.

111 It follows that the applicant’s complaints are incompatible ratione materiae with Article 3 of the Convention within the meaning of Article 35 § 3 (a) and must be rejected pursuant to Article 35 § 4.

112 In view of the above, it is appropriate to discontinue the application of Rule 39 of the Rules of Court.

For these reasons, the Court, unanimously,

Declares inadmissible the application.

Done in English and notified in writing on 3 September 2026.

Ilse Freiwirth Ivana Jelić Registrar President