Bride flown over from Pakistan for arranged marriage was force-fed diabetes pills

A woman who has been lying in a vegetative state for eight years was mistreated by her relatives, a court heard as her family stand trial for allowing her to suffer serious physical harm.

Ambreen Fatima Sheikh has not woken up since she fell unconscious in July 2015.

When she was rushed to hospital after her relatives called an ambulance saying she had stopped breathing, medics found a severe burn on her lower back 'caused by a caustic substance', a Leeds Crown Court jury was told.

The prosecution also said it was likely that she had 'ingested antidiabetic medication' that 'she did not ingest voluntarily.'

She had been left lying unconscious for up to three days before her family called for the ambulance, it was claimed.

Ambreen had flown to the UK from Pakistan for an arranged marriage in 2014.

Her husband, Asgar Sheikh, 30, father-in-law Khalid Sheikh, 55, mother-in-law Shabnam Sheikh, 53, and brother and sister-in-law Shakalayne, 24, and Shagufa Sheikh, 29, are all standing trial charged with causing or allowing a vulnerable adult to suffer serious physical harm.

Shagufa, Shabnam and Asgar Sheikh are also accused of acting to pervert the course of justice. All five defendants are accused of conspiracy to pervert the course of justice. They deny all of the offences.

On Tuesday, as he opened the trial, Robert Steen Smith told the court Ambreen - who was then in her 30s - arrived in the UK from Pakistan in 2014 after entering an arranged marriage with Asgar. She moved into the family home - where she lived with all five defendants - in Clara Street, Huddersfield.

Mr Smith said to the jury: 'At first the marriage appears to be one without any apparent problems. The evidence you're going to hear establishes that within months of her arrival she wasn't meeting the expectations of her husband or family. She eventually became socially isolated. The prosecution contend that she had been - by the end of July 2015 - a vulnerable person.'

The court was told that at around 1.12am on August 1, 2015, a call was made to the ambulance service from Shagufa Sheikh who 'reported that her sister-in law couldn't breathe properly'. It was said the ambulance arrived at 1.31am and paramedics were taken to Shagufa's bedroom where Ambreen lay unconscious.

Mr Smith said: 'Staff asked what had happened and they were told by Shagufa that she [Ambreen] had stopped talking to them at midnight and had become unresponsive. They were asked why the call hadn't been made sooner. Shagufa changed her account and said it had been 1am when she had stopped talking to them. She told them she had been suffering from headaches for at least three days and had been unwell and spent most of that day in bed.'

Ambreen was taken to Huddersfield Royal Infirmary and was put onto the intensive care ward and intubated. A CT scan found swelling on her brain and staff 'took the necessary steps to try and discover the cause', the court heard. It was the next day when a lumbar puncture - or spinal tap - was going to be performed that it was discovered she had a 'severe' burn to her lower back. The spinal tap showed no evidence of infection to the brain.

Mr Smith explained that medical professionals say the burn pre-dated Ambreen's admission to hospital and had taken place five to seven days before. The prosecutor said: 'It was likely to have been caused by some form of caustic substance.'

Dr Jones spoke to Asgar Sheikh, the court heard, and was told Ambreen had been 'going to bed with headaches for at least two days.' Mr Smith said: 'He told them he couldn't think of any reason why she would have damage in that location [her lower back]. Dr Jones asked if she had an electric blanket and he [Asgar] said she didn't. The decision was made the next day to inform the police.

'It is quite obvious - you may think - her husband or any other responsible person living in that house hold who became aware of that burn could be expected to arrange medical treatment for her or to ask members of the family do so do...It would have been painful at some stage and it is inconceivable that the household were unaware of it.'

The court was told that despite Ambreen being at risk of losing her life, she did survive, but has not yet woken up. Mr Smith described her as being in a 'vegetative state' and unable to speak or communicate. He added that she is still receiving care and said: 'She will never recover and is at risk of death as a result.'

It was said the prosecution's case is that 'one or more of the defendants was responsible for causing her to enter a state of unconsciousness well before the ambulance was called and that she was likely unconscious in that property for at least 24 hours - and possibly two to three days before it arrived.

'She had been vomiting and had been incontinent of urine and steps were taken by one or more of the defendants to try and conceal that fact. It is also almost more than probable that she had ingested antidiabetic medication, causing her to suffer hypoglycemia and she did not ingest that voluntarily.'

Mr Smith said that in Ambreen's unconscious condition she 'would have been incontinent but when staff [from the ambulance service] arrived she was in a clean condition wearing clean clothes in a clean bed in her sister-in-law's bedroom rather than her own.'

He added: 'At some stage, one or more of the defendants had removed her soiled clothing, cleaned her body and dressed her and carried her into the other bedroom. The ambulance staff were then presented with a false account that she was suddenly suffering breathing difficulties having been unwell with a headache for three days.

'Ambreen's soiled clothing and bedding on which she had been lying before she was moved was disposed of by one of more members of the household by depositing those items in a wheelie bin outside the house. Police removed the items and they were analysed. There were some stains or urine and vomit and evidence a pair of trousers had been worn after she had sustained the burn.'

The court heard that further examination of Ambreen's body found a number of other injuries including an injury to her right ear and 'signs on her back which appeared to be areas of caustic burning'. Mr Smith added: 'She also showed signs of marks on her toes which may have been consistent with a period of prolonged immobility.'

Mr Smith said that medical experts identified an explanation consistent with Ambreen's presentation which is that 'she had suffered from an episode of profound hypoglycemia which results in the swelling of her brain and loss of consciousness.'

He said: 'She was not suffering from diabetes - which could have caused it - and had no reason to take any form of medication which could result in that. Shabnam [Ambreen's mother-in-law] suffered from diabetes and at the time of the events was taking a drug which had been prescribed by her GP.'

The court heard that when she called 999, Shagufa told the operator: 'We have been checking her sugar and her blood pressure as well.'

Mr Smith said: 'She told them she [Ambreen] wasn't diabetic but said: "Her sugar has been low and then normal." She told the operator that Ambreen had taken paracetamol.'

Speaking to the jury, Mr Smith said: 'You will want to consider why - if this was a truthful account - any person in that household would want to check the blood sugar of her when she was not diabetic and chose to do so without getting medical help.'

The trial continues.