RCPCH responds to UK Government plans to authorise the use of x-rays in age assessments of children seeking refuge and asylum

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.

Secondary legislation, laid by the Ministry of Justice, will authorise the use of x-rays in the age assessment processes, before further legislation is laid by the Home Office taking forward powers under the Nationality and Borders Act 2022. This will specify that x-rays of teeth and bones of the hands and wrists and Magnetic Resonance Imaging (MRIs) of knees and collar bones can be used as part of the age assessment process.

RCPCH has 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. 

We are additionally concerned by stipulations made by the Illegal Migration Act which suggest that refusal to undertake a biological age assessment will be held against children as a part of the decision-making process with regard to their asylum claim. It is RCPCH’s 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.

The committee commissioned to examine biological age assessments, the Age Estimation Scientific Advisory Committee (AESAC), did not conduct their investigation in the context of this new policy, and we feel that the acceptance threshold for inaccuracy of large result ranges, which often straddle the age of 18 years, would be reduced when considering that a child or young person is likely have their asylum claim refused as a consequence of an inaccurate result. This may result in the child being deported. Additionally, the AESAC’s report specifies in its recommendations that ‘no automatic assumptions or consequences should result from refusal to consent’.

Professor Andrew Rowland, Officer for Child Protection, said:

Evidence shows that using x-rays to determine age can be widely inaccurate and the practice is ultimately unethical. 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.

Children have a right to seek asylum in the UK under the United Nations Convention on the Rights of the Child and it is our legal duty to uphold this. Many of these children have faced significant trauma on their journey to the UK, and should be met with compassion and care, not unnecessary medical procedures.

Furthermore, informed consent is fundamental to all medical practice, and by definition must be free from duress. This Government policy enforces a slide away from that core principle as it places such significant consequences on the refusal of biological age assessments. This directly opposes both the principles of informed consent and the recommendations set out by the independent body commissioned to look at the policy - the Age Estimation Scientific Advisory Committee (AESAC),with regard to assumptions or consequences stemming from refusal to consent. 

As a College we will continue to work with our members to engage with the Government on this issue and help ensure that children’s rights are given the weighting, in parliament and beyond, that children need; that children deserve; and that children are entitled to.