Health and social workers urge Home Office to reconsider unethical age assessments for children seeking asylum

Leading paediatricians, dentists and social care workers have written to the Home Secretary urging him to reconsider the use of x-rays as methods of age assessments for children seeking asylum in the UK.
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Royal College of Paediatrics and Child Health (RCPCH), the British Dental Association (BDA) and the British Association of Social Workers (BASW) have jointly written to Home Secretary, James Cleverly to express concerns with plans laid out by the Government to use “scientific methods” to determine a young person’s age. These “scientific methods” include the use of x-ray and MRI scanning of teeth and bones. The government has not yet laid out how these tests will interact with the currently used Merton-compliant social work assessments. The organisations are deeply disturbed by these plans due to their unethical and inaccurate nature. 

RCPCH, BDA and BASW have persistently spoken out against the use of x-rays and other biological methods of age assessment for this group of young people. It is RCPCH’s position that exposure to radiation through x-ray imaging for a non-medical purpose is not ethical, and that there is insufficient evidence to make accurate conclusions about the age of this population of children from the methods currently available and proposed by the Government. The Government’s own Scientific Advisory Committee has advised against these proposals. 

There are additionally concerns about stipulations made in the Illegal Migration Act 2023 which suggest that refusal to undertake a biological age assessment will be held against vulnerable children as a part of the decision-making process with regard to their asylum claim. It is the organisations’ view that the consequences of this refusal undermine the principles of informed consent, which should apply to any medical procedure or test, as the potential consequences of deportation result in duress to consent. RCPCH is clear that this is both a children’s rights and medical ethics issue. 

Furthermore, there is considerable confusion over who will conduct the medical investigations, how requests are going to be raised, and who will bear the cost. There are also wider issues to take into account, such as the impact these unethical assessments could have on the NHS at a time when we are already seeing major delays in offering x-ray and MRI appointments for patients. The Secondary Legislation Committee in the House of Lords has itself called out the poor process that has been followed in developing this hugely consequential legislation. 

RCPCH Officer for Child Protection, Professor Andrew Rowland, said:

It is appalling to see that the Government is persisting with these plans, which hinge life-changing decisions for some of the most vulnerable young people in our society on unspecific scientific outcomes and includes exposing them to radiation, despite the evidence showing that these methods produce a wide range of outcomes, often straddling the age of 18, and are unable to produce a specific measure of age. Many of these children have faced significant trauma on their journey to the UK, and should be met with compassion and care, not unnecessary, imprecise and potentially damaging medical procedures.

Furthermore, informed consent is fundamental to all medical practice, and by its very definition must be free from duress. This atrocious policy enforces a slide away from that core principle as it places such significant consequences on the refusal of biological age assessments, even when the child in question might not have the capacity or competence to consent. To charge forth blindly with these plans would be a direct violation of children’s rights. 

British Dental Association Chair, Eddie Crouch, said:

Dentists are health professionals, not border guards, and we want no part in age checks that fail basic tests on ethics and accuracy.

These x-rays can never deliver the precision required to draw a line between vulnerable young people and adults.

The Home Office have been reaching for silver bullets and come back with pseudo-science.

British Association of Social Workers Chief Executive, Dr Ruth Allen, said:

Age assessments are a complex, specialist piece of work, which needs to be done holistically, fairly and objectively by a social worker, not a machine. There is no evidence provided that biological methods deliver greater certainty on age determination than the currently used Merton process. We are also conscious that the government has not explained what shortfalls have been identified in the Merton process to warrant a change nor how it could be improved. We are also deeply concerned that if a young person is to refuse a biological method, then they would be considered to be over 18. This is coercion. 

In short, the adoption of biological methods violates long-standing rights in relation to informed medical consent, offer no real advantages in assessing age and produce a procedural quagmire of unallocated responsibilities. We need to ditch these plans immediately.


Notes to Editors

  1. On 12 September 2023, the Government confirmed its plans to authorise the use of x-rays in the age assessment of children and young people seeking asylum in the UK.
  2. Secondary legislation has been laid by the Ministry of Justice, will authorise the use of x-rays in the age assessment processes, and by the Home Office taking forward powers under the Nationality and Borders Act 2022. The legislation is available here:
  3. The interim Age Estimation Science Advisory Committee (AESAC) was commissioned to provide advice to the Home Office Chief Scientific Adviser on scientifically based methodologies that might assist with assessing the age of unaccompanied asylum-seeking children (UASC) whose claimed age is disputed and supplement the existing, Merton-compliant method of age assessment. You can read their assessment.
  4. The Secondary Legislation Scrutiny Committee's Report on the proposed statutory instruments for age assessment, which responds directly to evidence supplied by the RCPCH, can be found here.