9,000 unaccompanied children have applied for asylum in the UK since 2016. By definition1 a refugee is someone who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country". Following that experience, all unaccompanied asylum-seeking children have to navigate the UK legal system and their new surroundings alone.
In terms of health care and access to NHS services, refugee and unaccompanied asylum-seeking children and young people have the same rights to care as UK nationals. Age will have implications for the outcome of an asylum claim and for ability to access health services, education and welfare support. This is why determining asylum-seeking children’s age is currently under discussion as part of the Nationality and Borders Bill.
As the updated RCPCH position statement on age assessments outlines, many asylum-seekers will have no documentary evidence of their birth date and therefore other methods of age assessment are currently being undertaken within the UK to establish whether they are under the age of 18 years. The two main factors to consider regarding age assessment of young people are the accuracy of age assessments and the ethics of undertaking these assessments.
The key points in this position statement include:
Paediatricians should not be involved in age assessments since the scientific evidence shows that pubertal assessment and bone age assessment are unreliable indicators of age and therefore cannot be used.
The RCPCH considers it unethical to expose anyone to radiation from x-rays unnecessarily for non-clinical purposes
Age assessments require informed consent, which has to be freely given, and it is difficult to ensure this is taking place if vulnerable young people are assessed under duress: consent is not valid if coerced.
- 1Article one of the 1951 European Convention on Human Rights