Accréditation Sans Frontières · ASF Health Standards 9.0
Standard 21 · Refugee & Migrant Health
10 criteria · optional module (declare to apply)
Optional module (declare to apply). 10 criteria, of which 8 non-negotiable. Each criterion is numbered 21.Y, with its classification and verification questions.
Criteria
- 21.1 People-Centred Care Adapted to Migration and Displacement Experience (NON-NEGOTIABLE)
- 21.2 Supporting Patient Agency Through Understanding of Care and the Health System (NON-NEGOTIABLE)
- 21.3 Language and Communication Aids — Interpreters and Cultural Mediators (NON-NEGOTIABLE)
- 21.4 Collaborative Practice Across Health and Social Services (CORE)
- 21.5 Surge Capacity for Migration-Related Demand (NON-NEGOTIABLE)
- 21.6 Evidence-Informed Care for Refugee and Migrant Populations (CORE)
- 21.7 Staff Reflective Practice, Bias Awareness, and Self-Care in Migration Contexts (NON-NEGOTIABLE)
- 21.8 Cross-Border Continuity of Care (NON-NEGOTIABLE)
- 21.9 Camp-Based and Non-Camp Service Model Fit (NON-NEGOTIABLE)
- 21.10 Legal Status Diversity Recognition (NON-NEGOTIABLE)
21.1 People-Centred Care Adapted to Migration and Displacement Experience
NON-NEGOTIABLE
Care is adapted to a patient's migration and displacement experience — including trauma-informed practice, awareness of legal-status barriers to access, and support for continuity of care — not delivered identically regardless of that history.
VERIFICATION QUESTIONS
- Are staff trained to adapt their practice based on a patient's migration and displacement experience, not deliver identical care regardless of history?
Adaptation, not a generic cultural-awareness statement. - Is trauma-informed practice applied, including not routinely asking for detailed trauma history at initial visits?
WHO guidance advises against routinely probing for detailed trauma history early in care. - Does the facility support continuity of care regardless of a patient's legal status?
Access not conditioned on documentation the patient may not have or be able to safely provide.
21.2 Supporting Patient Agency Through Understanding of Care and the Health System
NON-NEGOTIABLE
Patients are supported to understand both their own care and how to navigate the health system itself — with understanding actively verified through methods like teach-back, in plain language, not assumed from silence or a nod, and not replaced by general information about the system.
VERIFICATION QUESTIONS
- Is understanding actively checked using a teach-back approach, for both the immediate care plan and how to navigate the system, not assumed from a nod?
Asking the patient to explain both back in their own words, not just asking "do you understand?" - Is concrete, practical guidance provided on navigating this health system specifically
appointments, referrals, emergency versus routine care? — Navigation guidance, not just general encouragement to seek care. - Is information communicated in plain language, avoiding medical jargon, particularly when working through an interpreter?
Complex terminology strains interpretation and comprehension together.
21.3 Language and Communication Aids — Interpreters and Cultural Mediators
NON-NEGOTIABLE
Trained interpreters or cultural mediators are engaged for language-discordant consultations — never minor children, and only family members when no other option exists and the situation is not high-risk.
VERIFICATION QUESTIONS
- Are trained interpreters or cultural mediators engaged for language-discordant consultations?
Not ad hoc bilingual staff or family members as the default. - Is a minor ever used to facilitate interpretation for a family member?
This should never happen — a specific, absolute rule, not a judgement call. - When a family member interprets due to unavailability of a trained interpreter, is this reserved for low-risk situations only?
Not used for informed consent, complex care, competency assessment, or bad news — situations that call for professional language support.
21.4 Collaborative Practice Across Health and Social Services
CORE
The facility actively engages with legal, education, employment, housing, and other social support services relevant to refugee and migrant patients, and conducts effective handover of care that includes migration- and displacement-related context — not treating health care as isolated from these interconnected factors.
VERIFICATION QUESTIONS
- Does the facility have working relationships with relevant legal, housing, or social support services for referral?
Actual working relationships, not just awareness that such services theoretically exist. - Does handover of care to another provider include migration- and displacement-related context, not just clinical facts?
Cultural, language, and migration context specifically included in handover. - Are staff from refugee or migrant backgrounds, where present, utilised for their relevant skills and insight?
Recognising this as a specific asset, not incidental to their role.
21.5 Surge Capacity for Migration-Related Demand
NON-NEGOTIABLE
The facility has an activatable plan for responding flexibly to sudden increases in demand from migration or displacement events — expansion of assessment points, treatment distribution, and focus on critical needs — not an assumption that routine capacity will simply absorb any surge.
VERIFICATION QUESTIONS
- Does the facility have a specific, written plan for surge response to migration-related demand increases?
A specific plan, not a general assumption that staff will manage if it happens. - Has this plan been tested or exercised, not just written and filed?
An untested plan's gaps remain unknown until an actual surge reveals them. - Does the plan address staff wellbeing and burnout risk during a surge, not only operational capacity?
Sustained surge response carries staff mental health risk that a purely operational plan can miss.
21.6 Evidence-Informed Care for Refugee and Migrant Populations
CORE
Staff use evidence-informed guidelines specific to refugee and migrant health where they exist, recognise where evidence gaps remain, and adapt practice accordingly — not applying general population guidelines uncritically to a population with documented, different health needs.
VERIFICATION QUESTIONS
- Do staff have access to and use evidence-informed guidelines specific to refugee and migrant health, where they exist?
Specific guidance, not just general clinical guidelines applied without adaptation. - Can staff describe how refugee and migrant health needs may differ from the general population for conditions they commonly treat?
Awareness of specific, relevant differences, not a general acknowledgment that differences might exist. - Is there a process for identifying and responding to gaps in evidence specific to this population?
Recognising uncertainty is itself part of good practice here, not something to paper over.
21.7 Staff Reflective Practice, Bias Awareness, and Self-Care in Migration Contexts
NON-NEGOTIABLE
Staff maintain active awareness of their own culture, beliefs, and potential biases through structured reflective practice, and the facility actively fosters a supportive team environment with access to psychological support — not left to assumed self-awareness, or to an assumption that staff will manage vicarious trauma alone.
VERIFICATION QUESTIONS
- Does the facility have a structured process for staff reflective practice regarding bias and cultural awareness?
A defined process, not an assumption that staff will naturally self-reflect adequately. - Does the facility provide accessible psychological support and a structured space to debrief difficult cases?
Actual, used support and a regular opportunity, not a theoretical benefit or informal hope. - Can staff describe a specific instance of adapting their practice after recognising a bias, and do they recognise signs of vicarious trauma in themselves or colleagues?
Concrete examples, not general statements of good intentions or awareness.
21.8 Cross-Border Continuity of Care
NON-NEGOTIABLE
Patients are supported to hold their own health information and documentation in a portable form — paper or electronic — that functions when they move across a border or between health systems, recognising the mobility of refugee and migrant populations.
VERIFICATION QUESTIONS
- Are patients given their own portable health record, in a form they can carry with them?
Something the patient physically or digitally holds themselves, not only a record in the facility's internal system. - Is the record kept updated as care continues, not given once and left static?
An outdated record loses much of its value for continuity of care. - Does the record include information
medication history, vaccination record — that would be useful to a different provider in a different country? — Content specifically useful across a border, not just internally relevant notes.
21.9 Camp-Based and Non-Camp Service Model Fit
NON-NEGOTIABLE
The facility explicitly identifies which service model it operates under — formal camp, informal urban settlement, reception or transit centre, or established resettlement context — and demonstrates its practices are fit for that specific context, not a generic approach applied uniformly regardless of setting.
VERIFICATION QUESTIONS
- Can the facility clearly state which service model it operates under, and why that classification fits its actual context?
A specific, considered answer, not an assumption that one generic approach applies everywhere. - Are the facility's specific practices
staffing, scheduling, outreach — adapted to that model, not copied from a different context? — Adaptation, not a generic template applied regardless of actual setting. - Has the facility considered what changes if its population or context shifts between models over time?
Preparedness for a changing situation, not an assumption that the current model is permanent.
21.10 Legal Status Diversity Recognition
NON-NEGOTIABLE
The facility can name which legal status categories it serves — asylum seeker, recognised refugee, stateless person, internally displaced person, and others — and demonstrates it does not apply a single, uniform assumption about access rights across all of them.
VERIFICATION QUESTIONS
- Can staff name the different legal status categories among the patients this facility serves?
Specific awareness of asylum seeker, refugee, stateless, and internally displaced distinctions relevant to this context. - Does the facility apply a single, uniform assumption about access rights, or does it recognise differences by status?
Differentiation where it legally matters, not a one-size-fits-all approach. - Are staff aware of the particular vulnerabilities that can attach to a specific legal status, such as statelessness?
Specific, not generic, awareness of status-linked risk. ————————————————————