The Ceseda mentions that medical reports may be taken into account by OFPRA along with other elements of the asylum claim. In practice, such reports are considered in the light of the applicant’s statements. Applicants often present medical certificates from specialised centres. According to some doctors, all too often, their certificates are not taken into account, as OFPRA often dismisses them as evidence, without seeking a second opinion. The medical report is paid for by asylum seekers via the state supported medical insurance: the “protection universelle maladie” (PUMA) or “aide médicale d’Etat” (AME).
A medical certificate to confirm the absence of female genital mutilation (FGM) is requested during the examination of an asylum request presented by a young woman or girl based on that risk in her country of origin. During the OFPRA interview, the woman applying for asylum in her own name will be asked to demonstrate that she has not been subjected to FGM if this is the reason she fears persecution or serious threats in case of return to her country of origin. If the asylum claim is made on behalf of a child, both parents will have to bring such evidence. Once protection has been granted, the requirement of a medical certificate remains. For the renewal of protection and the right to remain, OFPRA requires that a medical certificate be sent to it each year, proving that the person has still not undergone FGM. A Decree of 23 August 2017 specifies the terms of this obligation, the list of authorised doctors, and consequences of refusal for parents.
The consideration of medical certificates at the CNDA can vary a lot. A poorly argued dismissal of a medical certificate by the CNDA was criticised by the European Court of Human Rights (ECtHR) in September 2013. The applicant, of Tamil ethnic origin, had provided a medical certificate from the doctor of the waiting zone in the Paris CDG airport describing several burn injuries. The Court found that the CNDA had failed to effectively rebut the strong presumption raised by the medical certificate of treatment contrary to Article 3 ECHR and therefore that the forced return of the applicant to Sri Lanka would place him at risk of torture or inhuman or degrading treatment.
On 10 April 2015, the Council of State applied the position of the ECtHR for the first time ever since its condemnation in September 2013. It cancelled the CNDA decision, considering it should have duly taken into account the medical report presented by the asylum seeker as it was supporting his story and explaining his fears in case he would be deported back to his country of origin. As from this judgment, the CNDA has to take into consideration documents, such as medical reports, presenting elements relating to alleged risks and fears. The Court also has to justify why it would not consider these elements as serious. This significantly strengthens the consideration for psychological and physical wounds of asylum seekers and balances the power of the CNDA compared to the asylum seeker. Through a decision of 17 October 2016, the Council of State reiterated and reinforced this position.
In November 2016, the organisation Primo Levi published a study on the way medical certificates, stating physical or psychological wounds, are taken into account by asylum decision-makers in France. The report of this organisation highlights several elements, mainly that:
- Physical and psychological wounds are not equally considered by the protection officers or by the judges. The first category seems to have more credibility to them;
- Even when such a certificate is produced to the decision makers, they do not seem to draw the conclusions of the impact of the established wound on the capacity of the asylum seekers to tell their story in a convincing way.
 Article L.723-5 Ceseda.
 Articles L.723-5 and L.752-3 of Ceseda.
 Nicolas Klausser, “Vers un renforcement du « droit » à une procédure équitable des demandeurs d’asile et une meilleure prise en compte de leurs traumatismes ?”, La revue des droits de l’homme, May 2015.
 Council of State, Decision No 393852, 17 October 2016.