The “forensic paradox” of aging unaccompanied minors in the migration crisis: Why medicine and forensics are a must

only between 2014 and 2017 the European Migration Network (EMN) recorded 268,348 unaccompanied minors entering Europe1, hence in the past years the European Union has intervened in order to guarantee special protective measures for minors. Yet only a few weeks ago news concerning incidents in Greece have once again drawn attention to the need to protect migrant children2. Particularly when dealing with adolescents, protection derives, for those without documents, from properly ascertaining that they are minors. Adequate verification of age is therefore fundamental, yet in Europe it is still badly managed. Italy is a perfect example of such mismanagement, but not the only one. Our country is one of the main doors to Western Europe and on May 6th 2017, the Italian Parliament enacted the “Provision on protective measures for unaccompanied foreign minors”, known as the “Zampa law” (n°47/17), which aims at guaranteeing the protection of unaccompanied minors. However, as reflected in the whole of Europe, within the lines of this law, the paradox of the lacking, restricted and somewhat maligned role of medical and forensic sciences in age assessment emerges, which is dangerously leading to a sloppy administration of the rights of minors. Proof of this is the amount of resources spent in appeals which follow inadequate aging procedures which in turn can lead to minors being judged as adults (the most alarming risk since what is most at heart is the protection of true minors), or to judging adults as minors, leading to an excessive burden on administrations which can severely challenge the system in the long run. According to principles of medical ethics and human rights assessed in the practical guide recommended by the European Asylum Support Office (EASO) as well as other sources, the age assessment procedure, when necessary, recommends that a multidisciplinary holistic approach be applied. This approach involves an interview with a social worker, a neuropsychiatric or psychological evaluation, and a pediatric auxological examination, (all in this order), preferably performed together with an intercultural-linguistics mediator; medical procedures should come last, favour those methods that are less intrusive for the minor leaving the most invasive ones (including radiological examination) as a last resort (though one wonders which reliable medical age assessment for this purpose is at the moment non radiological). Here the double paradox emerges: first that of the secondary role of medical evaluation, then that of the omitted role of forensics. Age assessments by psychosocial tests and non-medical methods can measure behavior and cognitive ability but they are highly influenced by environmental and cultural factors. Furthermore child and adolescent interviews and psychological evaluations do not provide any validated margin of error (let alone referred to specific ethnic groups) as requested by most administrative or judicial agencies, and the assessment of mental maturity is very difficult in individuals who have little or no education, come from different cultural backgrounds and who may have experienced trauma. On the other hand, medical radiological methods (which are far less invasive than usually proclaimed8) have fairly large error ranges but these are better known and quantifiable than those of psychosocial assessments.9 Hence it is unreasonable and counterproductive to proceed to verify age in adolescents without medical and radiological tests. Furthermore, one wonders why the world of forensic experts is frequently left aside in guidelines and laws, since these are the scientists best trained to discuss “error ranges” in administrative and judicial (not “only - clinical”) scenarios. Age assessment based on dental and/or skeletal maturity has since decades been the object of research by forensic experts. In the last years several forensic groups and societies10 have dealt with this issue and provided a plethora of publications relating to this topic as well as appropriate scientific methodology with which to present the strength of evidence. It is our opinion that the recommended holistic approach in the age estimation process must always include, when dealing with minors (particularly post pubertal minors) with no valid documents, medical and radiological evaluation, and that it cannot be considered multidisciplinary and complete without the involvement of forensic expertise