CAT/C/62/D/721/2015 notwithstanding his medical problems, is not especially vulnerable and that it will be possible to meet his specific needs after his return to Bulgaria. 4.12 Regarding the complainant’s state of health, the December 2015 medical report he produced attests to a severe depressive episode without symptoms of psychosis and probable post-traumatic stress disorder, requiring intensive outpatient treatment for several months. Furthermore, according to his doctor, there is a risk of suicide in the event of forced repatriation. As stated in the case law of the European Court of Human Rights, article 3 of the European Convention on Human Rights does not confer on an applicant the right to remain in a State party in order to continue to receive medical services in that State. It is only in particular cases and in very exceptional circumstances that the expulsion of an alien may constitute a violation of article 3 of the European Convention on account of the applicant’s state of health.11 Indeed, the forced return of a person with a medical condition may give rise to a violation of article 3 only if his or her illness has reached an advanced or terminal stage and he or she is near to death. 12 In particular, the risk of suicide and/or attempted suicide by a person who has been ordered to be transferred should not preclude a State from carrying out the step envisaged, provided that concrete measures are taken to prevent the threat from being realized. 13 Like the European Court of Human Rights, the Committee has also held that “only in very exceptional circumstances may a removal per se constitute cruel, inhuman or degrading treatment” (within the meaning of article 16 of the Convention) and that psychiatric fragility and severe post-traumatic stress disorder of the author do not constitute such circumstances. 14 The State party maintains that, in view of the medical report produced, no very exceptional circumstances obtain in the present case, within the meaning of the case law cited. The state of health of the complainant does not constitute an obstacle under the Convention to his removal to Bulgaria. 4.13 In addition, the State party considers it appropriate to note that the complainant’s fitness to be transferred will be definitively assessed at the time that his transfer is organized. The State Secretariat for Migration will take into account the complainant’s state of health at that point and will transmit the relevant information to the Bulgarian authorities, so as to ensure that he continues to receive tailored medical care in Bulgaria. Bulgaria has similar health-care infrastructure to that of Switzerland, which is sufficient to treat the conditions diagnosed in the complainant. Furthermore, that State is bound by the Reception Conditions Directive and is therefore required to provide the necessary health care, which includes, at least, emergency care and essential treatment of illness and of serious mental disorders. There is thus no evidence to suggest that the Bulgarian authorities would refuse to provide the complainant with the care he needs or would fail to afford him the required medical support such that his life or health would be seriously endangered. 4.14 The State party maintains that, for all the reasons described, the complainant has not demonstrated that there are substantial grounds for fearing that he would face a specific and personal risk of being subjected to torture or cruel, inhuman or degrading treatment if transferred to Bulgaria. Complainant’s comments on the State party’s submission 5.1 On 14 November 2016, in response to the State party’s observations, the complainant commented that the situation of asylum seekers in Bulgaria had deteriorated since the beginning of the migration crisis in the summer of 2015 and remained a cause for concern. In its most recent analysis on Bulgaria, UNHCR had recommended that European countries should suspend Dublin returns of vulnerable asylum seekers to Bulgaria on account of serious deficiencies in the reception conditions and asylum procedures in that country. UNHCR noted, in particular, the lack of provision for identifying vulnerable persons and for adequately addressing their needs, as well as shortcomings regarding access 11 12 13 14 GE.18-04727 European Court of Human Rights, Tatar v. Switzerland, No. 65692/12, para. 43, 14 April 2015. European Court of Human Rights, N. v. United Kingdom, No. 26565/05, 27 May 2008. European Court of Human Rights, A.S. v. Switzerland, No. 39350/13, 30 June 2015. M.M.K. v. Sweden (CAT/C/34/D/221/2003), paras. 4.13 and 7.2. 7