When a person lacking legal documentation indicating their age applies for asylum in Sweden, age determination may be used to verify or refute the age-statement made by the asylum-seeker. According to the United Nations Convention on the Rights of the Child, everyone under the age of eighteen has extended rights to social services and protection, including a right to good quality health care, and the right to primary education . In addition, unaccompanied minors seeking asylum in the EU have the right to a legal guardian, cannot be detained unless it is for their own safety, and cannot be deported to their country of origin unless it is deemed to be in the best interest of the child and a safe reintegration process is in place  (ref - see note). Thus an asylum-seekers status as a minor may have a significant impact on their application for asylum in Sweden.
What is the scientific evidence regarding the reliability of non-radiological age assessment techniques?
SBU’s Enquiry service was unable to find any systematic reviews or primary studies that reliably address the accuracy of non-radiological age assessment techniques. In general, the literature indicates that the variation between individuals is too large to allow an individual’s age to be estimated based on physical traits (i.e. height or stage of puberty). Neither were any studies identified that assessed psychosocial methods for assessing an individual’s age.
SBU has taken no position in this issue. We present only the conclusions as interpreted by the authors of the individual studies included.
The Swedish Migration Agency currently has the responsibility to conduct an initial age assessments when a person lacking legal documentation indicating their age applies for asylum in Sweden. The case officer may alter an applicant’s age in the Swedish Migration Agency database if he or she does not accept the applicant’s age-claim. The applicant may then choose to have a medical age assessment. The Swedish Migration Agency can change an age assessment if presented with approved documentation of age .
Medical age assessments are usually based on a thorough analysis of the individual’s medical history combined with height and weight measurements, and an assessment of maturity based on a physical examination. These measurements may be supplemented with radiological exams that estimate the degree of maturity of a person’s bones or teeth [4,5]. Medical age assessment is regarded as controversial and ethically unacceptable by some medical professionals [6,7].
SBU’s Enquiry Service has only focused on non-radiological methods for age assessment in its Response.
We searched PubMed, SocIndex, PsycInfo, Scopus, ProQuest (Social Services Abstracts, Sociological Abstracts, ERIC) as well as Campbell Collaboration.
The search strategy was done in two steps. First we conducted a broad search for systematic reviews assessing any kind of age assessment technique (Search I). Subsequently, the search was altered to include any study type, but narrowed to exclude radiological methods (Search II). The complete search strategy is presented in the section “Literature search.”
Identified abstracts and articles were largely read by only one person. No attempt was made to assess the quality of the identified articles.
The search strategy identified 16,234 records (15,347 from Search I, and 887 from Search II) (See Figures 1 and 2). The abstracts of all of the articles identified by the literature search were read. Of these, 73 articles (32 from Search I, and 41 from search II) were judged to be potentially assessing the accuracy of non-radiological age assessment methods, and were read in full text.
After all of the potentially relevant studies were read, no systematic reviews or scientific studies were identified that assessed the accuracy of non-radiological age assessment techniques. Only studies that discussed or described certain aspects of non-radiological age assessments such as height or puberty status were identified.
Neither were any scientific studies identified that assessed any psychosocial method for assessing the age of refugees.
* All methods that do not include a radiological examination, e.g. examining physical features such as height and puberty, psychosocial methods etc.
SBU Enquiry response consists of systematic literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed. The quality of the studies identified is not systematically reviewed.
This response from SBU’s Enquiry Service was formulated by Jessica Dagerhamn, Laura Lintamo och Jan Liliemark, SBU. This response was translated by Rebecca Silverstein, SBU.