Most people arrive for this appointment having told their story more times than they ever wanted to. To an official, to a solicitor, sometimes through an interpreter they had never met before. What they are bracing for is telling it again, and then undressing in front of a stranger who will look closely at the marks left behind. The examination has to be built around that, or it is not worth doing.
The question behind a scarring report asylum solicitors ask for is precise: what is on the skin, described exactly, and whether in a doctor's opinion each mark fits the account given or could have another cause. Applicants usually want to know something simpler first, which is what will actually happen in the room.
Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction or symptoms of sepsis need 999 or A&E immediately. For urgent advice that cannot wait, call NHS 111.
What happens at the examination for a scarring report?
Before we meet, I read the instruction and the account the person has already given, usually their statement. That way the time together can go on the injuries themselves, and nobody has to start again from the beginning.
Consent, at every stage
I explain what the examination involves before anything starts, and again as we go. The person decides what is examined and can stop at any point, for a break or altogether. If a scar is in an intimate area, we talk about that first, and nothing is examined without consent. If something would make the appointment easier to bear, I would rather hear it at the start than notice it halfway through. Where an interpreter is present, I check that the person is comfortable with them before we begin.
The account, one mark at a time
For each scar, I ask how it was caused, when, what happened immediately afterwards, whether it was treated and how it healed. Some details are remembered clearly and others not at all, and that is common. Where someone does not know or cannot remember, the report records that plainly. An honest gap is worth more than a filled one.
What is examined and recorded
Each scar is examined in good light and described in plain terms: where it is, its length and width, its shape, its colour against the surrounding skin, whether it is raised, flat or sunken, how the edges look, and whether it is tethered to the tissue beneath. I describe each location against fixed landmarks, so that another doctor could find the same scar again. The pattern matters more than the single mark, so I note how scars sit in relation to each other. Marks the person does not link to the account, such as an old operation scar or a childhood injury, are recorded too. Leaving them out would make the report less complete, not more persuasive.
The opinion, and where it stops
For each scar, the report gives an opinion on how far its appearance fits the cause described, and what else could produce a similar mark. That opinion comes with its reasoning, not as a bare conclusion. Dating a scar is rarely precise. Colour and texture change over months and settle at different rates in different skin, so I give a range only where the evidence allows one. Some injuries leave nothing visible at all, and the report says so where it matters. Psychological effects need their own assessment, covered in mental health evidence in an asylum or human rights claim.
Will the doctor decide whether the account is true?
No, and it matters that the report does not try. Credibility is for the Home Office and the tribunal. My part is narrower: to describe what I see, to say how far the physical findings fit what is described, and to set out what else could explain them. A doctor who writes as though deciding the claim is less useful to everyone, including the person being examined. Many scars could have more than one cause, and a careful report says so openly rather than leaving the reader to wonder.
What should be sent or brought beforehand?
- The letter of instruction, with the questions and any deadline.
- The person's statement or interview record, so the account does not have to be repeated in full.
- Any medical records from the UK, and from before arrival if they exist, especially treatment for the injuries.
- Earlier medical or psychological reports.
- Whether an interpreter is needed, for which language and dialect, and who is arranging one.
Some things should not wait for a report. A wound that has not healed, a scar that has become red, hot, painful or is discharging, or new numbness or weakness in a limb needs a doctor now, through the NHS GP or NHS 111. So does distress that is becoming unmanageable: for urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any hour.
How does Clinique Alpa approach scarring reports?
The examination takes place in person at 466 Green Lanes in Palmers Green, without hurry, and if travel is not realistic, a home visit examination can be arranged. Solicitors can instruct directly. Scope, fixed fee and timescale are agreed first. Any report is written where clinically appropriate after assessment.
Which package fits depends on the number of scars and the questions asked, and is agreed at quotation. A short immigration medical letter is £550 (2 to 4 pages), a standard immigration medical report £1,000 (5 to 8 pages), a comprehensive immigration medico legal report £1,250 (8 to 15 pages) and a complex asylum or immigration expert report £1,500 (up to about 20 pages). Legal aid work is done at the authorised rate only, with prior authority. The detail is on our medical report fees page, and there is more on how I approach this kind of work in medico legal reports from a GP in London.
Reports are usually ready 48 to 72 hours after the assessment, once all records and instructions are in. A priority 24 hour service is available for 25 per cent more, subject to the diary. Complex reports, such as those covering many scars, may need a longer window, and that is stated at quotation.
This is an independent clinical opinion. It cannot be written to a required conclusion and does not guarantee the outcome of any claim, application, exemption or hearing.
All medico-legal assessments and expert reports are independent professional opinions. No particular diagnosis, conclusion, causation opinion, prognosis, consistency assessment, recommendation or outcome can be promised or guaranteed.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP and Clinical Director at Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.