Child refugees are subjected to genital tests to prove their age—and they may not even work

How old are you?
How old are you?
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A young boy—let’s call him H—arrived in the UK in 2011. He had hoped his life would finally start to get better after fleeing Afghanistan. He was wrong.

Based on his physical appearance and demeanor, the UK decided H was “significantly” over the age of 18. Two social workers claimed H was “deliberately making himself look younger in his behavior” and was, in fact, in his early 20s. H was forced to live in adult housing and his mental health deteriorated. He was threatened with deportation.

Like so many people under the age of 18 seeking asylum, H was unable to produce documentary evidence of his age. Many simply don’t have time to grab these documents while fleeing, and others come from countries where births are not registered.  The sheer number of children traveling alone makes Europe’s current refugee crisis quite different to previous ones. In a recent report, the OECD described the 24,000 unaccompanied minors applying for asylum in Europe last year as “a particularly striking and worrying characteristic of the current refugee crisis.”

Child asylum seekers pose a particular problem for European governments. There are advantages to being a minor in the asylum system as they’re entitled to housing, health, and educational support—and minors are much more likely to be given asylum. But that’s not the case for adults. Authorities therefore have an interest to ensure children are processed as children, and get the support they need, while adults are treated as such.

How do they do it? With no paper trail, several European governments undertake an age assessment to try and determine whether an asylum seeker is under 18.

These age assessments can vary widely across Europe, with some countries determining age just based on an applicant’s appearance or a series of interviews to see if they behave like a child. This is how it works in the UK, where age is disputed in 22% of young people’s asylum claims.

In the case of H, it wasn’t until a children’s legal center stepped in and ordered another assessment that H was finally declared to be 16—the age he claimed to be. H is just one case study (pdf) among many in the UK, where children as young as 14 (pdf) have been placed in adult detention centers.

The alternative is a medical age assessment.

Examining the sexual organs of children

This is common in many European countries, including Germany and Sweden, which have seen some of the highest numbers of asylum claims—with unaccompanied minors filing a large amount of these applications.

It’s not always pleasant. Many unaccompanied minors undertake a dangerous journey when trying to reach Europe—often, they have to fit into small, uncomfortable spaces. Some become quite claustrophobic as a result. “These scans require people to go into a hole, which can be particularly traumatizing for asylum seekers,” says Juana Remus, a professor of law at Humboldt University in Berlin. “We had one case in Berlin where a minor threatened to kill himself if he was forced to undergo a MRI scan.”

In the majority of cases in Germany, an asylum seeker’s age is based on physical appearance and an interview. Then, if there’s any doubt, medical tests are also carried out. The consequence of refusing the age assessment in some cities, including Berlin and Hamburg, is that the asylum seeker will be treated as an adult.

A sample age assessment report from Saarbrücken, the capital of the German state of Saarland, shows how complex the process can be:

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An asylum seeker’s sexual organs, pubic hair, body hair, facial hair, body type, their voice, and developmental disorders were all thoroughly examined. In the report, the youth officers note that the stage of development of the outer genitals was around that of someone aged 14.9 years, whereas the pubic hair was about an average of 15.2 years. The youth officers also examined the applicant’s penis, looking at the pigmentation, as well as his glans and testicles.

The report then goes on to detail a bone and dental age assessment, which included wrists and dental X-rays.

Some of the techniques used to determine age, such as radiographic imaging and physical examination to establish sexual maturity, are particularly distressing to minors who have already undergone a number of traumatizing experiences. According to a study published in the British Medical Bulletin in 2012, some minors considered intimate genital examination as abuse. This was particularly true for asylum seekers who have experienced sexual violence or female genital mutilation.

The UN’s Committee on the Rights of the Child released a damning report in 2014, where Germany’s age assessment process was criticized for involving “degrading and humiliating practices,” which didn’t necessarily produce accurate results.

A spokesman for the city of Hamburg said that the medical age assessment is voluntary and only conducted if there are doubts about age—but if a migrant doesn’t do it, then he is considered an adult. ”Looking at genitals is a common procedure when visiting a doctor,” he added. Quartz also has reached out to the cities of Berlin and Saarbrücken and will update this post with any response.

In 2012, the British Home Office announced it would trial dental X-rays on child asylum seekers, but there was a significant backlash from many NGOs, medical bodies, and statutory agencies, who were concerned with the accuracy, legality, and ethical justification. The Home Office—which didn’t respond to repeated requests for comment from Quartz—later quietly dropped the plans.

Do the tests even work?

The medical tests themselves are a source of dispute, in any case. After deciding to conduct dental and wrist X-rays and pediatric examinations, for example, the Swedish Migration Board ran into a problem. “No doctors really wanted to do this,” Carl Bexelius, a spokesperson for the Board, tells Quartz. “They felt it was an ethical issue.”

Gunilla Klingberg, professor of pediatric dentistry at Malmö University in Sweden, tells Quartz that the reason she and her colleagues wouldn’t carry out the tests was simple. “Nobody wanted to do it because we as doctors take an oath that we should not harm our patients,” she explains.

Dental X-rays are used because, as with other skeletal changes, teeth develop throughout childhood growth. All of the teeth—except the third molars, or wisdom teeth—are fully formed by the age of 14-18 years. It’s the wisdom teeth that dentists examine when estimating age.

Klingberg says that while dental X-rays can estimate the age of children from three to 13 as they have more teeth developing, the room for mistakes increases significantly for young adults.

The margin of error for dental X-rays is estimated to be someone’s age is between 2-3 years, while for wrist X-rays the margin is between 3-4 years, she says. This margin of error can be particularly problematic for asylum seekers claiming to be 15 or 16. ”You would never judge the age of someone by measuring their height, so why ignore the same biological variations that exist for teeth?” Klingberg says.

The medical age assessments also fails to take into account the particular variations due to ethnicity and socioeconomic backgrounds. For example, a young Somali asylum seeker may have significant developmental differences to their British, Swedish, or German counterparts, of which they’re being compared to.

Anna Bärtås, the vice-president of the Swedish Pediatric Society, tells Quartz that it asks all its members not to carry out age assessments for the time being. There’s a particular worry that the Swedish Migration Board would put too much emphasis on the X-ray results, as they demanded radiological results that clearly stated the skeletal age, while not making enough of an effort to ensure the process is more holistic.

“Since age highly influences the outcome of the asylum process, we think that it’s ethically and humanitarianly wrong to base the assessment on insufficient facts,” Bärtås says.

The standoff between the Board and Swedish doctors means the Board is now forced to tell asylum seekers to arrange their own age assessments and then hand in the results. “The Swedish Migration Board cannot advise them where to go because we’ve not been able to close any agreements with medical performers,” Bexelius says. This only harms the asylum seekers, he adds.

He says the Board is less concerned about the exact biological age, and more interested in deciphering if an applicant is 18 or under. If an applicant is unable to provide an age assessment, the Board has to decide on their whole case with the fact that the asylum seeker has not been able to meet the standard of proof to show their under 18.

When science is brought into legal proceedings like the age of an asylum seeker, it’s often seen as the arbiter of the truth—but there are limits to what medical assessments can achieve.

Gregor Noll, a professor of international law at Lund University, believes the asylum system is for erecting a boundary between a group of insiders and outsiders—a system that is enforced by violence. “We’re sending police in, we’re putting people on planes even if they resist their deportation,” Noll says. “So don’t expect it to transform itself to something objective and scientifically clean.”