G.K. [Ghana, Medical Evidence, Memory] v The International Protection Appeals Tribunal and Anor

THE HIGH COURT 2025/377 JR [2026] IEHC 229 BETWEEN: G.K. (GHANA, MEDICAL EVIDENCE, MEMORY) APPLICANT AND THE INTERNATIONAL PROTECTION APPEALS TRIBUNAL and THE MINISTER FOR JUSTICE RESPONDENTS JUDGMENT of Ms. Justice Mary Rose Gearty delivered on the 22nd of April 2026 1. Introduction 1.1 This Applicant came to Ireland from Ghana. He was refused refugee status and subsidiary protection on the basis that his account of repeated homophobic assaults was not credible. He submits that his medical evidence, supporting a diagnosis of post-traumatic stress disorder, was not afforded sufficient weight. 1.2 While all medical reports are referred to in the impugned decision, the medical reports were discounted in their entirety without sufficient explanation and memory issues were ignored. The Tribunal was aware of the relevant law insofar as the reports were listed, but the contents were not engaged with in a meaningful way. Deciding on the basis of the medic’s methodology or because the diagnosis is highly dependent on the Applicant’s account is not sufficient. 2. Credibility and Medical Evidence: the Law 2.1 The law in this regard is well settled and has been restated recently by Ms. Justice Siobhán Phelan in A.S. v. IPAT [2023] IEHC 53 where she quoted from Ms. Justice Faherty giving judgment in M.M. v. RAT [2015] IECA 158. The facts in both cases were similar to those arising here: both were cases in which credibility concerns were weighed against medical evidence. In A.S., the Court found that the Tribunal had failed to weigh and consider the medical evidence before finding that the narrative given by the applicant was implausible. Having initially drawn a conclusion on credibility, the Tribunal then held that the medical evidence did not outweigh the finding that the applicant lacked credibility. This approach was held to be incorrect, and Phelan J. emphasised the importance of considering all the evidence in the round. 2.2 The nine factors set out by Faherty J. in M.M., and quoted in A.S., are as follows: (i) In considering any assessment of an applicant's credibility, decision makers are obliged to consider the medical evidence in total before them; (ii) The medical evidence must be put into the totality of the evidence to be assessed and must not be tangential or peripheral to such assessment; (iii) It is always a matter for the decision maker to assess the probative value of the contents of such reports; (iv) Where an applicant provides a story which might be true and the medical evidence tends to confirm his or her story then it is axiomatic that an overall assessment of the evidence should weigh in the applicant's favour; (v) If medical evidence is to be rejected, it is incumbent on the decision maker to give reasons; (vi) A summary consideration of medical evidence by a decision maker may be upheld where the medical evidence uses phrases of low probative value: (vii) Where an examining physician reports on objective findings and uses phrases which attach a higher probative value to those findings, the medical evidence should be treated as providing potentially objective corroboration of the claim; (viii) If such evidence is to be rejected, the reasons for rejecting the reports must be more fully addressed in the decision; (ix) The requirement to more fully address reasons for rejecting medical reports which attach a higher probative value to clinical findings may be less where the balance of the evidence is overwhelmingly in favour of a finding of a lack of credibility. 2.3 Both parties agree that this case hinges on the last three factors. In brief summary, the Applicant claimed an objective corroboration of his claim due to two clinical diagnoses of PTSD and the Respondents submitted that the medical evidence was considered in full and, if not engaged with fully, this was because the requirement to address the reports in more depth did not arise as the balance of the evidence was overwhelmingly that his claim lacked credibility. 3. Procedural History, Account of Assaults and Credibility Concerns 3.1 The Applicant arrived in Ireland in Autumn of 2022, applied for asylum in October and had his preliminary interview with the International Protection Office [IPO] on the same date. His questionnaire was submitted in February 2023 and his interview was in July, 2023. The IPO refused his application on credibility grounds, and he appealed that decision, submitting grounds in November 2023. The Applicant also submitted a medical report from a psychologist dated November 2023 and, the following year, a Spirasi report dated November 2024. Further medical documents and a letter from a group working with the Applicant in the context of the group’s support for gay, lesbian and transexual citizens in rural communities. Detailed submissions were made by the Applicant and there was a (video-link) oral hearing on 10th February 2025. His appeal was refused in a decision dated 19th February. 3.2 The Applicant claims to be bisexual and gave evidence, at interview and subsequently to IPAT, that he had been married with two daughters when he met a man and began a relationship with him. He described three alleged assaults on him, all resulting in physical injuries, and in each case his sexuality was expressly referred to as the reason for the attack. In Ghana, there is little tolerance for homosexuality or bisexuality and there is no issue arising as to this “country of origin information” [COI]. The issue is whether the Applicant’s claims were true, that is, his claims as to his sexuality, his relationship with another man, and that this relationship led to repeated assaults on him. 3.3 The Applicant described being in pain after the assaults he describes and there was a focus on two particular injuries: one arising from a burn and another from being thrown to the floor. There were physical signs of injury which were consistent with these accounts but that could have been caused in other ways. 3.4 The credibility issues which arise are evident from the interview notes and the account of the Applicant’s evidence. Briefly stated, the primary concerns of the decision maker were that the Applicant was unable to recall the date of birth of his second child correctly. One date, which was nominated by the Applicant, would mean that this child was conceived when the man was, according to his own account, now living in a different part of Ghana with a new male partner. The Applicant described arranging meetings with his male partner at his work premises only, but the first assault on him apparently took place at his home, at a time when this man was also there. 3.5 In respect of a later assault in a different town, he explained that local people must have seen the two men holding hands, which the Tribunal found was unlikely given the hostility to homosexuality in the country and the fact that the Applicant had already been attacked for his relationship with this man, if his version of events was true. Finally, the Applicant did not describe his male partner in much detail, other than his name and date of birth. There were other discrepancies, including whether he had told his wife of the relationship. 4. The Medical Evidence 4.1 The Irish Centre for the Care of Survivors of Torture, Spirasi, provides expert training for doctors working in this field in examining those who claim to be survivors of torture and producing impartial medico-legal reports. Dr. Hugh O’Sullivan, who provided a report on the Applicant, has received that training and is a general practitioner with qualifications in surgery and psychiatry. In the Spirasi Report he makes a clinical finding that the Applicant is suffering from post-traumatic stress disorder [PTSD]. Dr. O’Sullivan notes the physical injuries which are consistent with assault and notes injuries that the Applicant confirms were not relevant to his claim. His report makes specific references to the difficulties that victims of trauma generally, and this Applicant in particular, suffer with memory, including disclosure and recall of events. 4.2 A second medic, a consultant psychologist, treated the Applicant over the course of 6 months. He attended Dr. Christine O’Connell on 20 occasions, and she made the same diagnosis, namely, that he suffered from PTSD. While she expressed the opinion that the trauma in question was the torture and threats that he described, this is properly a matter for the decision maker, not for her. 4.3 A third document, a letter from a local LGBTQ support group noted that the Applicant had engaged with its services since his arrival in the relevant county. 5. The Impugned Decision 5.1 The Tribunal member is clearly familiar with the case of A.S. and has carefully and appropriately referred to the Spirasi report, the psychological report and the letter from the local support group. 5.2 The findings of the Tribunal in this regard (at para. 47) should be set out in full: “The tribunal notes that the submitted Spirasi report evidences signs of physical injury. The tribunal notes that the appellant attributed a number of injuries, including back pain and a triangular shaped scar on his left thigh, to attacks which he claims to have suffered because of his sexuality. The Spirasi report makes a finding that the identified injuries are, as per the Istanbul Protocol, consistent with the Appellant’s account of torture. The finding of “consistent” is the lowest possible level and of the least probative value, meaning that while the injuries could have been caused in the manner claimed, there are numerous other possible causes. The report also arrives at a finding in relation to PTSD and categorizes same as being highly consistent with having been caused by torture, but this is a finding on a non-physical injury which is, when coupled with the findings made regarding the physical injuries, highly dependent on the account given by the Appellant to the examining physician. The examining physician does not, as is proper, assess the credibility of the Appellant’s claims”. 5.3 Regarding the report of the psychologist, the Tribunal stated at para 67: “The Tribunal has also considered the additional medical documents submitted by the appellant in relation to treatment he is receiving here in Ireland, including the letter of Dr Christine O'Connell, Senior Clinical Psychologist, dated 8th November 2023, who opines that the appellant has been diagnosed with severe PTSD as a result of the traumatic experiences he had in Ghana. However, the Appellant’s symptoms have not been assessed by Dr O'Connell in line with the Istanbul protocol and furthermore the Appellant’s diagnosis of severe PTSD is entirely reliant on the account provided by the Appellant. Thus, it is of limited probative value. The other medical documents relate to orthopedic appointments or treatments. While supportive of the fact that the appellant is suffering with back slash joint pain, the causation of the injury giving rise to the pain is entirely reliant on the account given by the Appellant.” 5.4 This medical evidence, therefore, issues from two sources, and both provide a clinical diagnosis of PTSD. Both are dismissed on the basis that they are reliant on the Applicant’s account. In respect of the second report, it is noted that the doctor is not listed as an approved doctor to provide Spirasi reports. This is simply insufficient. The detail contained in the medical reports and the engagement by both experts with the Applicant were such that the diagnosis is highly consistent with the account he has given. There is nothing else in the Applicant’s history that explains his condition. 5.5 While the diagnosis is not binding on the Tribunal member, who is of course entitled to reject it, the medical evidence must be addressed fully in the decision. That has not been done here. If there is overwhelming evidence of inconsistency, that is sufficient to dispense with the requirement to fully address the medical evidence. If that is the case, it should be expressly set out. 5.6 The Tribunal member should also incorporate some consideration of the memory issues that have been set out in detail both in the Spirasi report and in the report from the treating psychologist. As was pointed out at the hearing, it is clear from his interview that this Applicant had memory difficulties. In the Spirasi report, he scored 14 out of 28 on a scale measuring cognitive impairment, where any score over 8 (out of 28) shows significant impairment. The effect of PTSD on memory and ability to recall and to disclose events and is specifically referred to in the report and paragraph 343 of the Istanbul Protocol is quoted: The normal variability of memory, in which successive accounts may contain more and different details each time with the omission of other details, is likely to be exacerbated by torture or ill-treatment. Finally, paragraph 543 of the Protocol is also cited to the effect that PTSD is relatively rare in the general population, and a very traumatic experience is required to lead to such a diagnosis. 5.7 Finally, in this regard, while the Spirasi report is the more persuasive evidence given the rigorous methodology used, it is nonetheless important to engage with any expert medical report, even if the expert has not used the required methodology or is not registered as an approved doctor for these purposes. This is particularly so when the opinion has been formed, as here, over a long period of time by a medical expert. Dr. O’Connell’s opinion should not be discarded on the basis that she is not listed as an approved doctor for the production of Spirasi reports. The weight of her evidence, and indeed that of the Spirasi report, is for the Tribunal member but the diagnoses, including the memory issues identified, must be engaged with in a meaningful way. 6. Community Support Group 6.1 The Tribunal considered correspondence with LGBTQ Ireland and notes the contents of the letter provided by a local LGBTQ group, as follows: “One letter in particular is more relevant in that it refers to the appellant as being involved in the group. However while the latter refers to a “growing openness regarding his sexual orientation” the letter does not identify what that orientation is. [The group's] website sets out that it is an LGBTQ social support group and that there are many ways to get involved with the group with the “simplest of them [being] just to show up.” There does not appear therefrom to be any specific requirement on an individual to identify as LGBTQ in order to participate. As such, while the Tribunal notes that the Appellant participates in events as stated in the correspondence, the submission is considered to be of limited probative value in supporting the appellant’s claim regarding his sexual identity.” 6.2 This finding ignores the email correspondence with the Applicant in which he identifies himself as a bisexual, and it does not address the fact that the history of the Applicant’s involvement with the group and their letter in support of his application both provide corroboration, however weak, for the Applicant’s claim to be bisexual. This is a less significant point that those made above. 7. Conclusions 7.1 The decision of the Tribunal must be quashed in order to ensure that the evidence, and the medical evidence in particular, is considered appropriately. 7.2 The weight of the evidence is for the Tribunal but if a medical diagnosis is to be rejected, the reasons for doing so must be logical, must take memory issues into account and must be set out fully. If the credibility issues are overwhelmingly against the Applicant such as to justify discounting the medical evidence, this must be set out clearly and must include a decision as to what weight, if any, is attached to the memory issues identified, and why. 7.3 The case will be remitted to a different Tribunal member for a new determination on the application. 7.4 My provisional view is that the Applicant, having been successful, is entitled to his costs. If the Respondents wish to argue otherwise, please contact the Registrar within the next 14 days. Appearances Michael Conlon S.C. and Garry O’Halloran B.L. appeared for the Applicant instructed by Trayers & Co. Solicitors Maeve Brennan B.L. appeared for the Respondents instructed by the Chief State Solicitor’s Office