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Committee proposes “likelihood ratio” approach to refugee age assessments

Yesterday, the interim Age Estimation Science Advisory Committee report on the evaluation methods used to assist in assessing the age of unaccompanied asylum-seeking children was published.

In October 2021, Priti Patel threatened to use x-rays to verify age. The report says that using X-rays to check age could put them at risk of harm from radiation. MRI scans would be a favourable alternative in this respect and there is evidence to support the use of MRIs on the knee and clavicle for age assessments.

But MRIs are not always suitable. Those that have dental or other metal implants cannot undergo MRIs, and the MRI machine is often found to be distressing because of claustrophobia or noise aversion. The report says “[t]he risk of harm from radiography of the teeth or hand/wrist is minimal when compared to the lifelong benefits that could result from a swifter and more accurate age assessment in terms of both safeguarding and wellbeing. However, the interim committee urges a move away from the use of radiography as soon as the research evidence makes it feasible to do so”.

Instead, the report recommended the continued use of existing checks, including the reliance on interviews with social workers in a full ‘Merton-compliant’ age assessment. These could be supported by biological age assessment methods where necessary, though not in all cases.

But combining both methods could also increase distress. The report urges ministers to assess the impact of different and combined age assessment methods on unaccompanied children at a time when these children simply wish to start rebuilding their lives, having often already faced significant trauma. The report proposes a “likelihood ratio” approach which requires the existing Merton-compliant process to be completed, at least to the point of considering the age to assign, before biological assessment results are factored in.

No individual method alone would be able to predict a person’s age with precision. Biological checks, if they are going to be used, should consider whether the age claimed by the asylum-seeking child is at all possible. It should not be used to answer the specific question of how old the child is, and whether they are over or under 18.

Several recommendations were made:

Recommendation 1: If biological age assessment is implemented it should be used to assess whether the age claimed by [unaccompanied asylum-seeking children] is possible.

Recommendation 2: Research into the accuracy and reliability of the Merton-compliant process should be undertaken as a piece of urgent baseline research.

Recommendation 3: Any methodology used for the assessment of age must respect and prioritise the dignity of the individual being assessed and should minimise physical or psychological harm.

Recommendation 4: Biological age assessment can be carried out using an appropriate combination of dental and skeletal methods; assessment of development of the third molar using radiography, radiography of the hand/wrist or MRI of the knee, and MRI of the clavicle.

Recommendation 5: The use of ionising radiation must be limited, with the ultimate aim of eradicating its use. Continuing research into the use of non-ionising imaging, such as MRI, should be supported.

Recommendation 6: Where possible, the radiation dose should be limited through the use of recent pre-existing images, providing consent for the use of these images for age assessment had been freely obtained.

Recommendation 7: Further research into the impact of socioeconomic factors and their effect on growth and maturational timing, particularly those factors likely to be experienced by [unaccompanied asylum-seeking children], should be supported.

Recommendation 8: Dental and bone images should be acquired by those with the relevant training and expertise and reported by those with expertise in interpreting images for age estimation.

Recommendation 9: A guide should be developed on how to deal with those situations where there is a discrepancy between the claimed/suspected age and the biological or social worker-led evaluation outputs which makes clear what weight should be placed on different sources of information.

Recommendation 10: Consider adopting a likelihood ratio approach, using biological evidence of age, to compare the weight of evidence or ‘support’ for the Merton assigned age versus the claimed age.

Recommendation 11: [unaccompanied asylum-seeking children] should be provided with clear information explaining the risks and benefits of biological evaluation in a format that allows the person undergoing the process to give informed consent and no automatic assumptions or consequences should result from refusal to consent.

Recommendation 12: Further research to gauge the differential impact of the proposed age assessment processes on [unaccompanied asylum-seeking children] with respect to the protected characteristics in the Equality Act 2010 should be undertaken.

Recommendation 13: Research into biological age assessment methods based on a wide range of ethnic or geographical sub-groups to confirm and improve accuracy and applicability of these methods should be supported.

Recommendation 14: A watching brief should be maintained over the development of emerging age estimation methods including, but not restricted to, facial images and DNA methylation.

The Home Office have yet to fully consider the recommendations, though they have said that the Nationality and Borders Act will introduce new scientific methods to assess the age of asylum seekers in order to “bring a more consistent and robust approach… in turn, helping prevent safeguarding risks and stopping abuse of the system”.

Working out the true age of young asylum seekers is complex, inexact and time-consuming. Putting increasing weight on current biological methods of assessing age might be quicker, but it is hard to see how it will not lead to inaccuracies, harm to the asylum seeker, and an increase in cost due to the use of precious healthcare resources.

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