“You Don’t Have an Age”
Medical exams to determine the age of asylum seekers are putting minors at risk.
DECEMBER 3, 2024
One fall day in 2022, Ishaaq, a 16-year-old asylum seeker from a conflict zone in the Middle East, was shepherded into a Belgian hospital ward along with 20 others — 18 Afghans, and two Eritreans — apparently of no determinable age. Ishaaq’s passport had been confiscated by Belarussian border guards during his journey across the European continent and the Belgian authorities, who doubted he was a minor, refused to accept his birth certificate. Until Ishaaq could secure a replacement passport, the question of whether he should be treated as an adult or as a child would be decided by a series of medical examinations.
“Stop here! Don’t move! If you don’t stay still and listen, you will be an adult!” Ishaaq says on a video call, recalling the brusque directions from a doctor. He gestures as he describes the three-point test — a scan of his teeth, clavicle and wrist. He squeezes his jaw between his thumb and forefinger, slaps the top of his chest, and raises his hand, as if the experience were imprinted in muscle memory. One week later he received the results. Ishaaq pats the side of his head with an open palm, eyebrows shifting into an expression of helplessness: He was now, officially, 21.
Ishaaq, who asked for his name to be changed along with some identifying details due to concerns about his safety, was assigned a date of birth: 00/00/2000. He lost his right to guardianship and to a high school education and was transferred from a center for young people to a camp that held adults. His home was now a filthy prefab container — thick with the smell of cannabis smoke — shared with three men in their 30s and 40s from Africa and Afghanistan. On his first day, Ishaaq cleaned the room, and one of the men flew into a rage. “‘If you do it again,’ he shouted, ‘I will…’” Ishaaq makes another motion with his hand, this time slicing across his throat.
Methods that governments deem objective and scientific — such as bone scans and physical examinations — can only provide an educated guess.
At night Ishaaq lay awake, afraid. Outside the camp, he faced hostility of the bland, bureaucratic variety. When he tried to register for services at city hall, or open a bank account, he was refused. “You don’t have an age,” they told him, scanning the zeros of his birth date. All he could do was wait and hope that his documents would come; that “things would get better.”
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Across Europe, border authorities frequently turn to medical assessments to determine the age of asylum seekers when their legal documents are missing or not considered valid. Authorities say the assessments are designed to ensure that an asylum seeker receives appropriate care and protection, and the outcome determines whether they will be treated as a minor or as an adult.
But activists, lawyers and those working with the authorities to provide support for young asylum seekers on arrival say the system ends up putting many children at risk. Methods that governments deem objective and scientific — such as bone scans and physical examinations — can only provide an educated guess. In part, that’s because these methods draw primarily on research based on historic datasets of American and European children that are not representative of today’s asylum seekers. In many cases, the margin of error is two years. Considering that around 76 percent of unaccompanied minors who arrive in Europe are aged between 15-17, that imprecision can carry a major toll.
Laurence Bruyneel, a coordinator at Caritas International Belgium, an NGO that assists migrants and asylum seekers, has observed thousands of young people go through age assessments over the past two decades. She described cases in which youngsters have leaped from the car on the way to hospital because they don’t want to do the tests. Others run away. Some end up living on the streets. Once, she found an asylum seeker attempting suicide in their room following an age test that determined them to be an adult. While she accepts that many young asylum seekers may well be over 18, “I see too many mistakes to know these tests are not accurate and hardly human.” As Bruyneel sees it, medical assessments have become a convenient way for the state to simplify its process for asylum applications. “The need to have something scientific, black or white, is very high,” she told me. “But I don't think that exists.”
Data on the use of medical age assessments for asylum seekers is patchy, but what little there is suggests that Ishaaq’s experience is common. In 2023, at least 43,000 unaccompanied children arrived at EU borders and claimed asylum — the most since 2016. In Belgium, authorities raised doubts about the age of around half of the 4,336 young people who registered for asylum last year. Of those tested, a third were determined to be minors and the rest adults. Those who are misidentified often struggle to challenge the results: “They don’t know if they need a lawyer, what they can do,” said Bruyneel. “I think a lot of people don’t appeal because they think it’s totally useless.”
In countries such as France, a medical assessment tends to be a last resort. In many others, such as Belgium, Sweden, Italy and Greece, it is far more routine, ordered due to the absence of papers or a doubtful glance from a border official.
A study published in the International Journal of Legal Medicine suggested that when 10,000 asylum seekers were subjected to X-ray and MRI scans in Sweden in 2017, a child had a 33 percent risk of being classified as an adult. An investigation by the New Humanitarian reported that in Greece, there had been 1,024 age dispute cases between April 2021 and March 2023 — and 37 percent of these cases were later found to be children, not adults. In 2020, the U.N. Committee on the Rights of the Child reviewed 14 cases in which age assessments conducted by Spanish immigration officials violated the rights of the child. One 17-year-old boy, who was judged to be 19 following an X-ray of his wrist, was forced to stay in an adult detention center and was beaten by one of the guards.
A decade ago, the European Academy of Paediatrics strongly recommended that its members “not participate in the process of age determinations in minor asylum seekers,” citing issues with consent and reliability, as well as concerns about doctors becoming arbiters of immigration law. In 2019, the World Medical Association stated that such assessments only be carried out in “exceptional cases and only after all non-medical methods have been exhausted.” Any uncertainty, it said, should be interpreted in favor of the asylum seeker.
Despite these criticisms, medical age assessments remain widely used across Europe. All EU countries, except for Ireland, approve some form of medical age assessment. Usually this involves an X-ray of the wrist, teeth and/or collar bone, as was the case with Ishaaq, and markers of skeletal maturity are matched against a reference dataset. In countries such as France, a medical assessment tends to be a last resort. In many others, such as Belgium, Sweden, Italy and Greece, it is far more routine, ordered due to the absence of papers or a doubtful glance from a border official. In some countries, including Italy, Romania and Austria, an age assessment can include observation of a person’s genitals and sexual maturity.
In September 2023, the U.K. (which left the EU in 2020), approved the use of X-rays and MRI scans for age assessments for the first time. Failure to give consent will result in the applicant automatically being considered over 18. The decision was condemned by leading bodies in health and social care, which described the decision as “appalling” and “pseudo-science.” This followed an expert report by the Age Estimation Science Advisory Committee, commissioned by the U.K. Home Office, which warned there is “no infallible method … that will provide a perfect match to chronological age.”
Human bodies are idiosyncratic. People grow at different rates; markers of maturity will never track perfectly with chronological age and can vary according to ethnicity and socioeconomic factors. The physical development of a child who has grown up in a famine, lived through a conflict, or been forced to work from a young age, will be very different to one raised in a stable, secure society.
Non-medical age assessments can be just as fraught. These consist of a visual assessment, assessing a person's documents and an interview. In most European countries, the interview is conducted by immigration officials — and then confirmed by a medical assessment if needed or challenged. Ideally, the interview would be conducted by independent social workers, an approach that is more objective, less invasive than medical tests and offers a similar degree of accuracy, yet it is far less commonly applied.
In the U.K., if a young person challenges the initial decision made by the Home Office — often the result of a cursory visual assessment by a border officer — they will be referred to a specialized social worker working for local authorities. That person will make a decision following a series of interviews. This procedure has exposed how often immigration officials wrongly assume young asylum seekers to be adults. In 2022, the Helen Bamber Foundation found that out of 1,386 children initially assessed to be adults by the Home Office, 63 percent were later determined to be children by local authorities. The same year the Refugee Council worked with 233 young people declared “certainly” adults by the Home Office. Again, following social worker assessments, 94 percent were found to be children.
It can take months, or years, to challenge the results of an age assessment. During this time, an asylum seeker’s life is put on hold, leaving them to languish as a non-citizen.
However it is conducted, an age assessment is a crude metric by which to determine how someone should be treated. A 19-year-old asylum seeker may still require a great deal of specialized support, for example, even though they are legally an adult. Those working to protect the rights of children — and young people — in the asylum system, say that what the state should be looking to identify is vulnerability.
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Age assessments have become routine in a political context that is increasingly hostile to migrants. In the summer of 2015, the arrival of a large number of asylum seekers prompted strong anti-migration rhetoric across the EU. Since then, a number of countries — including Italy and Hungary — have significantly tightened their asylum policies and their stance of migration.
The medical tests to which asylum seekers like Ishaaq are subjected can be seen as part of a suite of deterrent policies, such as denying migrants the right to work, or forcing them to live in detention centers while their claims are processed. It can take months, or years, to challenge the results of an age assessment. During this time, an asylum seeker’s life is put on hold, leaving them to languish as a non-citizen.
Ishaaq described the feeling of being given a new, inaccurate date of birth and left in legal limbo as disorientating and distressing — a drawn-out punishment. He recalled feeling unsafe in adult accommodation and yearning to continue his education. He dreamed of going to university and contemplated fleeing Belgium.
Experience of the age assessment process can vary dramatically across the continent. A lack of oversight means that in some regions, infringements on the rights of asylum seekers are common. According to Human Rights Watch, many unaccompanied minors who arrived on the Greek island of Lesvos, a common entry point to the EU, were arbitrarily registered as adults. In cases where a migrant who was clearly a child claimed to be older, authorities did not question their testimony. This is especially concerning, they noted, because lying about being an adult is often a sign of human trafficking.
Ozan Balpetek, a lawyer at the Lesvos Legal Centre, described these practices as systemic. The Greek government only accepts age assessments conducted by the Greek state, meaning they cannot be provided by third parties or civil organizations, he told me. On Lesvos, most new arrivals come from Afghanistan and their identity documents are frequently rejected on the basis that they could easily have been fabricated, said Balpetek. They are then funnelled through an age assessment process that Balpetek equated to a form of “mental and physical torture.” Age assessments that should be conducted by a set of psychiatric and medical experts are often conducted “in bad faith” by non-specialist doctors and nurses, he said. He described undignified examinations of genitals and pubic hair, and interrogations that include questions about masturbation and sexual desires. The experience can be traumatic.
Soon after, her asylum claim was rejected on the basis that she had made “false statements” about her date of birth which did not match the findings of the medical tests carried out in Belgium.
Bruyneel, from Caritas, said medical assessments have evolved into a “weapon” — a way to exploit or create discrepancies in an asylum seeker’s application and discredit their story. She connected me to a Somali teenager she recently advocated for, and we arranged a video call. Faduma (not her real name), is a sunny and vivacious 18-year-old, who speaks about her experience with a disarming buoyancy. She fled Somalia five years ago, when she was 14 and a half, to escape a forced marriage with a much older man. Like many asylum seekers, Faduma traveled with a false passport that bore another person’s name and date of birth. When her plane landed in Belgium, she was stopped by immigration officers and taken to a closed detention center. “I thought I was dreaming,” she said, describing being swept into various rooms and offices in a country that was entirely foreign to her. Within days, Faduma was taken to a hospital for an age assessment and a health check-up. The health checks seemed normal, but “it felt intrusive” when she was asked to remove her headscarf and earrings to prepare for the X-ray. She remembers having to go alone into a room for the scan. “I was scared at that moment,” she said, touching her hijab with a hand decorated with curls of henna from a recent celebration.
She was later told that the age test had determined her to be over 18. The authorities took into account a possible deviation of six months and settled on an age of 17 and a half — three years older than her real age. She was initially relieved to be considered a minor and assigned a guardian. This granted her just six months of support. Soon after, her asylum claim was rejected on the basis that she had made “false statements” about her date of birth which did not match the findings of the medical tests carried out in Belgium.
Faduma’s lawyer and the guardianship service mounted a challenge. Her birth certificate (disregarded by virtue of being from Somalia) stated that she was a minor, and her immaturity was evident to those around her. At her school placement in Belgium, for example, her best friends were 12 and 13 years old. But in a matter of months Faduma was deemed an adult and left to navigate the systems of the state as best as she could. The school was sensitive to her situation and allowed her to stay enrolled. (In other cases an age assessment can mean an abrupt end to a young person’s education.) The guardian who had originally been assigned to her continued to offer informal support. Faduma’s sister wrote a letter for her to present to doctors if she ever went to hospital, to ensure that she was given age-appropriate medicine, in spite of her official record.
Faduma was surprised that members of the authorities themselves acknowledged the age assessment methods they used had a wide margin of error. “Like, if you know your machine is lying…” she said, not finishing the sentence. “I was so mad, but I couldn’t do anything.”
It took three years for Faduma to successfully appeal her age test and asylum decision, after finally presenting a new passport and gathering evidence from her teachers and other support workers. By then, she had already turned 18.
More than a year after he arrived in Belgium, Ishaaq was finally able to get a new passport and convince the authorities of his real age and date of birth. One week later he, too, turned 18.
He could not claim the rights and comforts that should have been assigned to him as an unaccompanied minor. But it was nevertheless an important moment. He could finally prove his true identity. He could begin to make plans for his future, enroll in a Dutch language class and prepare to complete his high school education. It was not his birthday, but he bought a cake to celebrate.
✺ Published in “Issue 23: Deadlines” of The Dial
