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By cutting open Tom's mouth, she had contravened a central principle of medicine to "do no harm".

The ombudsman told BBC News NI she had referred her report to the Nursing and Midwifery Council as she felt the falsification of records contravened the professional code of conduct.

But, as courts have now held, it is at best questionable whether the president can undo the appropriations passed by Congress, contravening the power given Congress under the Constitution.

Critics say this undermines EU law, contravenes the German constitution and would be logistically impossible to police.

"Any move towards recognising Somaliland's independence would not only contravene Somalia's sovereignty but also destabilise the region by setting a dangerous precedent," says Somali State Minister for Foreign Affairs Ali Omar Balcad.