A post-mortem examination found Ahmed Ibrahim, aged 52, died as a result of inhalation of products of combustion at his home on Buckenham Street, Burngreave, on 19 February 2018, after a fire broke out in his bedroom and “spread severe smoke damage through the property,” according to South Yorkshire Fire & Rescue.
The cause of the blaze remains a mystery, however, following a two-day inquest into his death at the Medico-legal centre which concluded on Friday (18 December).
Mr Ibrahim, who was considered to be ‘vulnerable’ by police and care workers following a stroke in 2016, was unable to escape the fire because he was locked inside with no access to keys. His doors were not fitted with latches and poor mobility meant he could not exit through a window.
His front door keys were stored in a key safe which he did not know the code to, and while carers said there was usually a key in the back door, it was not there on the day of the fire.
NHS Stroke Services authorised the safe to be installed after Mr Ibrahim’s care needs increased following his stroke.
Mr Ibrahim’s son, Khalid Mohammed, told the court: “If I knew what happened was going to happen I would never have let that happen in a million years.”
In a witness statement, Ayan Ali, Mr Ibrahim’s ex-wife, said: “We had concerns around the design of the door as it was on a key lock and there was no internal latch to allow Ahmed out in case of emergency [sic] but I do not recall this being discussed with any of the agencies.
"As far as we were concerned he could come and go freely.”
It continued: “ This has had a terrible effect on me and my family. I have become depressed by this and don’t like to outside [sic] as much.
"I hope Ahmed can get some justice from this as I feel he has been failed by those with the responsibility of caring for him.”
Concerns had previously been raised by Mr Ibrahim’s GP about him being locked in the property after he had to speak to him through the letterbox during a visit.
Joanne Pass, social care service manager at Sheffield City Council, told the court: “I don’t know whether naive is an appropriate word but it didn’t enter our consideration that he was being locked in.
"We just didn’t realise the means of evacuation had been taken away.”
When asked whether it would have been more appropriate for Mr Ibrahim to be placed into a care home due to his needs, which included cooking, cleaning and personal care, Ms Pass said: “It was appropriate that he remain living in his own home according to our understanding of what his wishes and feelings were.”
A mental health assessment recommended by a local authority social worker was never completed and the court heard a review of Mr Ibrahim’s care needs was due around the time of his death.
Tim Gollins, head of locality social care at Sheffield City Council said there were challenges to assessing Mr Ibrahim’s mental capacity “because of cultural needs, language barrier [sic] and mental health.”
Ms Pass admitted, however, the local authority should have conducted an assessment.
During the hearing it also emerged some of Mr Ibrahim’s care needs could have been discussed with his son, who was just 16 at the time of his dad’s death.
No criminal proceedings have ever been brought against anyone following Mr Ibrahim’s death, which triggered a change in policy from the Council to safeguard against anyone under their care being trapped in their home in future.
Simon Strelczenie, area manager at South Yorkshire Fire & Rescue, told the court Mr Ibrahim was found unconscious and not breathing in the living room by firefighters, who performed life-saving care but were unable to revive him.
Mr Strelczenie added: “The position of the casualty suggested he may have tried to escape the fire and leave the property.
"Deliberate ignition wasn’t suspected but couldn’t be totally discounted. The property wasn’t secure when the fire service arrived but there was no evidence of it being forced open."
The fire chief agreed with assistant coroner Katy Dickinson’s suggestion the fire was “likely an accident, but there’s nothing there to tell us how it happened.”
Sarah Griffith, a forensic officer, examined a fire-damaged double socket from Mr Ibrahim’s bedroom and found no evidence of an electrical fault. No electrical items were plugged in in the bedroom at the time of the fire and despite Mr Ibrahim being a smoker, his son Khalid Mohammed insisted he would not have known a lighter found between the sofa and cushions in the front room was present in the house. He said his dad always smoked outside and only ever when a family member was present.
Ms Dickinson recorded a verdict of accidental death and said she was satisfied with Sheffield City Council’s response to Mr Ibrahim’s death.
She said: “I can’t see that Mr Ibrahim lit this fire purposely, there was no electrical fault in the property, so on balance I believe it’s an accidental fire.
"It remains unknown about how that fire started. It remains unknown why the keys were not available to Mr Ibrahim. Unfortunately there are some things we may never get the answers to.”