In its judgment Sahiti v. Belgium (no. 24421/20) delivered on 9 October 2025, the European Court of Human Rights (ECtHR) found a violation of Article 8 of the Convention due to the absence of a final decision — since 2010 — on an application for residence on medical grounds lodged by a seriously ill Kosovar national.
The Court deplored the “procedural ping-pong” between the Immigration Office and the Council for Alien Law Litigation (CALL), marked by successive annulments and withdrawals, and underlined the impact of prolonged uncertainty on the applicant’s private life. The complaint under Article 3 (risk upon removal) was declared inadmissible, as no effective removal measure had been taken. Finally, under Article 46, Belgium was invited to take, within a reasonable time, all necessary measures to ensure that a final decision is issued on the application. No just satisfaction was awarded (the Court cannot order the issuance of a residence permit).
This ruling follows directly from Paposhvili v. Belgium (Grand Chamber, 13 December 2016, no. 41738/10), which laid down key principles protecting seriously ill foreign nationals against removal.
Facts and procedure
The applicant, a Kosovar national residing in Verviers, suffers from a serious medical condition and presents a suicidal risk.
On 27 September 2010, he applied for residence for more than three months under Article 9ter of the Law of 15 December 1980, invoking the lack of access to adequate medical care in his country of origin.
Between 2012 and 2024, the Immigration Office issued nine decisions on the merits (six annulled by the CALL, three withdrawn by the Immigration Office), and several orders to leave the territory were also withdrawn or annulled. As of September 2024, no final decision had yet been made.
The application was lodged with the ECtHR on 17 June 2020. The judgment was delivered on 9 October 2025.
The Strasbourg decision
The Court held that the persistent absence of a final decision, despite numerous back-and-forth exchanges between domestic authorities, amounted to a failure by the State to conduct the proceedings with due diligence. By living in prolonged uncertainty about his situation, the applicant’s private life was undermined, particularly regarding access to healthcare, social stability, and a peaceful family life — thus violating his right to respect for private life.
The Court ordered Belgium to take all necessary measures within a reasonable time to ensure that a final decision is reached on the applicant’s 9ter request. It cannot, however, compel the authorities to issue the residence permit or award compensation for costs or expenses.
The link with Paposhvili
In Paposhvili v. Belgium, the Court held that a State may not remove a seriously ill foreign national when there are substantial grounds for believing that his or her health would deteriorate seriously, rapidly, and irreversibly due to the absence of adequate treatment in the country of destination. This threshold — broader than the mere risk of imminent death — must be rigorously assessed by national authorities.
The Paposhvili judgment thus reinforced the responsibility of domestic authorities to conduct a thorough and evidence-based assessment of medical risks associated with removal, guided by proportionality and subject to ECtHR oversight.
The Sahiti judgment, which concerns prolonged procedural stagnation, confirms that Belgium cannot tolerate excessively lengthy procedures without reaching a decision on medical stay requests, as this violates the procedural obligations arising from Article 8 of the European Convention on Human Rights. It further recalls that the mere existence of procedures (via the Immigration Office or the CALL) does not exempt authorities from the obligation to reach a decision within a reasonable timeframe.
Implications for residence permit requests on medical grounds in Belgium (Article 9ter)
This judgment requires the Belgian State to review its practices (and possibly its legislation) to prevent unjustified procedural deadlocks in the handling of 9ter applications.
Belgian judges will play an increasingly important role in requiring reasoned decisions based on relevant medical evidence and in sanctioning procedural abuses. Seriously ill foreign nationals cannot be subjected to prolonged uncertainty — their vulnerability calls for enhanced protection.
It is therefore increasingly urgent to assess whether the current framework complies with the Convention’s requirements and ECtHR case-law.
A need for structural reform through greater coordination.
In our view, a structural overhaul is needed to break down the silos between procedures.
Today, the paths followed by ill foreign nationals collide with a patchwork of authorities and jurisdictions — the Immigration Office, the CALL, labour courts, and medical authorities — with no coordination or overall vision. This fragmentation fuels delays, inconsistencies, and, too often, the practical denial of fundamental rights.
The two distinct regimes — asylum law on the one hand, and residence on medical grounds on the other — although both aimed at protecting individuals facing serious risks, remain treated in isolation: one concerns fear of persecution or inhuman treatment; the other, the severity of illness and the lack of adequate care.
This artificial separation often leads to double vulnerability: a seriously ill asylum seeker may be denied international protection because his risk is deemed “medical,” while his 9ter application is examined (sometimes years later) without any connection to the prior asylum assessment or its procedural safeguards.
However, Paposhvili precisely called for a holistic approach to risk assessment, requiring a convergent reading of Articles 3 and 8 of the Convention.
An effective removal of these procedural barriers would require legislative reform enabling asylum authorities, the Immigration Office, and the CALL to coordinate their evaluations, share medical expertise, and recognise the continuity of protection between asylum law and medical stay law.
This would be, in our view, the only way to restore the unified meaning of the principle of non-refoulement, which should not depend on the procedural doorway used but on the human gravity of the risk faced.
As several European networks of practitioners and organisations (such as the Equality Law Clinic and the Refugee Law Clinic of the Université Libre de Bruxelles) advocate, it is time to move beyond a purely vertical logic where each actor operates in isolation, without considering the cumulative effects of their decisions. The rights to private life, health, and dignity require an integrated and cross-cutting approach.
Through its judgment of 9 October 2025, the ECtHR reminds us that the effectiveness of rights cannot be decreed — it must be built through coherence and cooperation. Belgium must now draw inspiration from this standard to guarantee seriously ill foreign nationals not only the right to be heard, but above all the right to finally obtain a fair, swift, and humane decision.
Céline Verbrouck
Specialist in Immigration Law and Private International Family Law
+32 2 894 45 70
www.altea.be