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X-Rays: Child Refugees

Volume 826: debated on Tuesday 6 December 2022


Asked by

To ask His Majesty’s Government what assessment they have made of the ethical considerations of the use of X-rays to determine the age of child refugees seeking asylum in the United Kingdom.

The Home Office Chief Scientific Adviser convened an independent age estimation science advisory committee to provide the department with independent advice on the ethics and implementation of different scientific approaches to age assessment. No official decisions have been made on the use of scientific methods, and the use of X-rays specifically would need to be independently justified and approved under the Justification of Practices Involving Ionising Radiation Regulations 2004.

I thank the Minister for that Answer, but can he say when the report will be completed and published?

The report is still under evaluation. I am afraid there is no estimate at the moment for the production of the report.

My Lords, I have twice recently through Written Questions tried to find out whether the Government will publish the report of the advisory committee. Both answers—which were almost identical—avoided answering the question. Could the Minister therefore tell us now whether the Government will publish this key report and, if not, why not?

My Lords, the British Dental Association is opposed to dental X-rays being used because of their inaccuracy. Other organisations such as the BMA agree. During the passage of what became Nationalities and Borders Act, the noble and learned Lord, Lord Stewart of Dirleton, the Minister at the time, acknowledged this lack of accuracy by saying that

“assessments are not of themselves accurate”.—[Official Report, 8/3/22; col. 1280.]

There was no dentist on the age estimation science advisory committee. Do the Government understand that both their own Minister and dentists disagree that this should be one of the methods used to assess age?

The answer is no. By way of background, I remind the noble Baroness that, between 2016 and September 2022, there were 7,357 asylum cases where age was disputed and subsequently resolved, in which half the individuals—3,696—were found to be adults. At least 27 other European countries use scientific or medical methods as part of their age assessment process. The most common method by far internationally is the use of one or more X-rays, usually dental, wrist, clavicle or knee, although MRI scans, CT scans and physical or psychological examination by a doctor are also reported. The implementation of SAA across Europe varies enormously, with different methods or combinations of methods, data outputs and timing, and the use of negative interference.

My Lords, given that 12 EU countries do not allow any asylum applications from Albania on the grounds that Albania is a democratic and aspirational country, why do we not do the same?

Although I am tempted to address my noble friend’s topic, which is slightly off the topic of this Question, I will say only that the response to the problem of Albanian young men crossing the channel is being considered speedily by the department, and policies will be formulated shortly.

My Lords, it is an understatement to say that the use of X-rays to assess the age of children is like using a sledgehammer to crack a very small nut: it not only exposes children to harmful radiation but damages our image in the wider world. Would the Minister agree that traumatic events such as seeing near and dear ones killed and homes destroyed can visibly age people, including children, and that a country that is not even in the top 10 of those giving asylum per head of population should eschew this demeaning practice?

I disagree with the noble Lord. As I have already said, there is clear evidence that many people claim to be a minor when they are not. Clear safeguarding issues arise if a child is inadvertently treated as adult and, equally, if an adult is wrongly accepted as a child and placed in accommodation with younger children to whom they could present a risk.

My Lords, the Minister has just told us that the Government are assessing the evidence. Can he tell us what assessment they have made of the Royal College of Paediatrics and Child Health? Its members are experts in this area and it has said that the use of X-rays for age assessment does not work and is unethical.

The international experience would tend to suggest that that is not the case. The position adopted by the department is that age assessment is one option on a menu of options available for the assessment of age; there is no suggestion that the assessment of age will be undertaken, at this stage and in the present state of the science, simply on a scientific assessment.

Would my noble friend the Minister not agree with me that this has been a problem for a considerable period of time? When I was in the Home Office, we also had difficulties with this matter, but the rules are quite clear: minors are entitled to support in a way that those who are overage are not. So, although it is regarded as being rather unfair to use X-rays, and maybe even dangerous, does my noble friend not agree that at least we have to apply those rules and find ways of applying them that are as fair as possible?

I entirely agree with my noble friend. I can assure the House that we will ensure that scientific methods are implemented in such a way as to be compliant with the existing regulatory and statutory frameworks governing safety. I entirely agree with the sentiment of my noble friend’s question.

My Lords, further to that answer, in determining what constitutes an appropriate scientific method of age assessment, can the Minister assure us that any future methods will be formally approved by the relevant medical body before they come into use?

Plainly they will be formally approved by the advisory committee to the Home Secretary, and one suggests that the views of relevant professional bodies will be of great weight in making such a decision.

My Lords, as a sitting magistrate I occasionally have to do age deeming, both in youth court and in adult court. Sometimes we have reports from social workers and sometimes—although rarely—we get expert reports. In the training I received, maybe 10 or 12 years ago, the central message I got was that it was ultimately a judicial decision and that all forms of report, be they from social workers or scientific reports, have quite large elements of doubt within them and the decision is ultimately a judicial one. Does the noble Lord agree?

In the context of decisions made in magistrates’ courts, I agree that it is a judicial decision. In the context of asylum-seeking people who say that they are minors, the question then falls to the Secretary of State to determine whether they should be treated as a minor—and sadly, as I say, experience suggests that a large number of people have suggested that they are minors in order to take advantage of the perhaps more beneficial regime. It is very important that those people, for the reasons that I have already given the House, are weeded out by such a fair system as we can determine.

My Lords, in response to the noble Baroness, Lady Lister, I think I heard the Minister say about a report that a decision on publication will be made in due course. Can he tell the House whether that is a decision on whether to publish or when to publish?

My Lords, the British Dental Association has written to all of us saying that X-rays carry a small risk of possible long-term physical harm and that the risk is cumulative and successive exposures increase the risk, which means that each exposure over a lifetime must be clinically justified. Over my lifetime I have had more than 20 X-rays from dentists and have never been warned of this cumulative risk. Can my noble friend explain why the BDA is so worried about a single X-ray of someone claiming asylum who looks 22, especially when the BDA says that it can tell the age to within four years with 95% accuracy? So it might well show that someone was younger than they looked and be to their benefit.