Standards › ASF Health Standards v10 › Standard 25
Standard 25
Health and Migration
Health and migration: migration-informed care, patient understanding, interpreters and mediators, social services, surge capacity, evidence, staff support, portable records, service model and legal status.
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.
Why it matters. A person who has fled war or been displaced often carries trauma and mistrust of institutions. Care that does not take this into account can be harmful even when it is technically correct.
How the surveyor verifies this criterion
Sample. Review 10 patient records with a migration history, and the care adaptations recorded.
1. Care is adapted to the patient’s migration and displacement history.
Method. Check each sampled record for the history and the adaptation made.
Evidence to show. Migration history and trauma-aware assessment record (HMG-FRM-001).
Pass when. Every record with a history shows the adaptation made.
2. Trauma-informed practice is applied where signs are found.
Method. Check each record with trauma signs for the trauma-informed step.
Evidence to show. Migration history and trauma-aware assessment record (HMG-FRM-001).
Pass when. Every record with trauma signs shows a trauma-informed step.
3. Barriers from legal status are identified and addressed.
Method. Check each record for the legal-status barrier recorded and the action.
Evidence to show. Migration history and trauma-aware assessment record (HMG-FRM-001).
Pass when. Every barrier found has an action recorded.
Immediate fail (any one means the criterion is not met)
- A traumatised patient is examined in a way that repeats past harm.
Documents
E-learning
References
- World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings, version 2.0. Geneva: WHO; 2019.
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.
Why it matters. A migrant who does not know how the health system works, or how to book a visit, may give up on care. Helping them understand their own care and how to use the system keeps them engaged.
How the surveyor verifies this criterion
Sample. Review the information given and the understanding checks for 10 patients.
1. Each patient is given plain-language information on their care.
Method. Check each sampled record for the information given.
Evidence to show. Understanding check record (HMG-FRM-002).
Pass when. Every sampled patient has the information recorded.
2. Understanding is checked by teach-back.
Method. Check each record for the teach-back result.
Evidence to show. Understanding check record (HMG-FRM-002).
Pass when. At least 90% of records show teach-back checked.
3. Patients are supported to navigate the health system.
Method. Check each record for the health system steps explained.
Evidence to show. Understanding check record (HMG-FRM-002).
Pass when. At least 90% of records show the steps explained.
Immediate fail (any one means the criterion is not met)
- A patient does not return because no one explained the follow-up.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
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.
Why it matters. Children should never be asked to interpret for their parents, and a patient who cannot follow the conversation cannot consent. A trained interpreter or cultural mediator is needed for language barriers.
How the surveyor verifies this criterion
Sample. Review the interpreter and mediator use register for the last 6 months, and the policy.
1. A trained interpreter or cultural mediator is used for language-discordant consultations.
Method. Check each language-discordant consultation for the interpreter recorded.
Evidence to show. Interpreter and mediator use register (HMG-REG-001).
Pass when. Every language-discordant consultation has a trained interpreter or mediator recorded.
2. No child is used to interpret.
Method. Check the register for any child used.
Evidence to show. Interpreter and mediator use register (HMG-REG-001).
Pass when. No child is recorded as interpreter.
3. A family member interprets only where permitted.
Method. Check each family member use for the reason and the risk level.
Evidence to show. Interpreter and mediator use register (HMG-REG-001).
Pass when. Every family member use has a recorded reason and is not high-risk.
Immediate fail (any one means the criterion is not met)
- A child interprets a diagnosis for their parent.
Documents
E-learning
References
- World Health Organization and International Organization for Migration. Global Competency Standards for Refugee and Migrant Health. Geneva: WHO; latest edition.
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.
Why it matters. Health problems in migrant and displaced people are often driven by housing, work, legal status and schooling. A clinic that works with those services can address the cause, not only the symptom.
How the surveyor verifies this criterion
Sample. Review the referral tracking register for the last 12 months, with the handover records for 5 patients.
1. Relevant legal, education, employment, housing and social services are engaged.
Method. Check the register for referrals to each relevant service.
Evidence to show. Referral tracking register (PHC-REG-002).
Pass when. Referrals are made to the relevant services where needed.
2. Each referral is tracked to a result.
Method. Check each referral for the result recorded.
Evidence to show. Referral tracking register (PHC-REG-002).
Pass when. At least 90% of referrals have a result recorded.
3. Handover includes migration and displacement context.
Method. Check each sampled handover for the context included.
Evidence to show. Referral tracking register (PHC-REG-002).
Pass when. At least 90% of handovers include the context.
Immediate fail (any one means the criterion is not met)
- A patient with no housing returns to the same clinic with the same problem.
Documents
E-learning
References
- World Health Organization. Framework on integrated people-centred health services. Geneva: WHO; 2016.
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.
Why it matters. A sudden arrival of many displaced people, such as after a border opens, can overwhelm a clinic within days. A plan that can be activated quickly keeps care running for everyone.
How the surveyor verifies this criterion
Sample. Review the surge response plan, and its last test record.
1. A surge plan exists and can be activated.
Method. Check the plan for the activation route and the staff named.
Evidence to show. Surge response plan for migration-related demand (HMG-PLN-001).
Pass when. The plan names the activation route and the staff on call.
2. The plan sets the extra assessment points and the treatment distribution.
Method. Check the plan for the two elements.
Evidence to show. Surge response plan for migration-related demand (HMG-PLN-001).
Pass when. The plan sets both elements.
3. The plan is tested each year.
Method. Check the test record for the year.
Evidence to show. Surge response plan for migration-related demand (HMG-PLN-001).
Pass when. The plan was tested in the year.
Immediate fail (any one means the criterion is not met)
- A clinic is overwhelmed with no plan and no staff on call.
Documents
E-learning
References
- World Health Organization. Classification and minimum standards for emergency medical teams. Geneva: WHO; 2013.
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.
Why it matters. Some health problems in migrant and refugee populations need specific guidance, such as TB screening or mental health after displacement. Using that guidance where it exists, and saying where it does not, keeps the care evidence-based.
How the surveyor verifies this criterion
Sample. Review the guidance list and 10 records from patients from high-burden countries.
1. Migrant-specific guidance is used where it exists.
Method. Check the guidance list for migrant-specific guidance per condition.
Evidence to show. Evidence for refugee and migrant health (HMG-POL-004).
Pass when. Migrant-specific guidance is used where it exists.
2. Gaps in the evidence are recognised.
Method. Check the list for the gaps recorded.
Evidence to show. Evidence for refugee and migrant health (HMG-POL-004).
Pass when. Every gap found is recorded.
3. Screening is applied as the guidance requires for each population.
Method. Check each sampled record from a high-burden country for the screening.
Evidence to show. Evidence for refugee and migrant health (HMG-POL-004).
Pass when. Every sampled patient from a high-burden country is screened.
Immediate fail (any one means the criterion is not met)
- TB screening is skipped for a patient from a high-burden country.
Documents
E-learning
References
- World Health Organization. WHO consolidated guidelines on tuberculosis: module 2, screening. Geneva: WHO; 2021.
- World Health Organization and International Organization for Migration. Global Competency Standards for Refugee and Migrant Health. Geneva: WHO; latest edition.
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.
Why it matters. Staff bring their own beliefs and sometimes bias into care for migrants and displaced people. Regular reflection and support help staff notice this, and look after themselves in hard work.
How the surveyor verifies this criterion
Sample. Review the reflective practice records and the support offered to staff for the last 12 months.
1. Staff hold structured reflective practice on culture, beliefs and biases.
Method. Check the record for each staff member at the set interval.
Evidence to show. Staff reflective practice record (HMG-FRM-003).
Pass when. Every staff member has the reflective practice recorded at the set interval.
2. Each issue raised has an action.
Method. Check each record for the action agreed.
Evidence to show. Staff reflective practice record (HMG-FRM-003).
Pass when. Every issue raised has an action recorded.
3. Psychological support is available to staff.
Method. Check each record for the support offered.
Evidence to show. Staff reflective practice record (HMG-FRM-003).
Pass when. Psychological support is offered and recorded.
Immediate fail (any one means the criterion is not met)
- A staff member consistently refuses to treat a particular group.
Documents
E-learning
References
- World Health Organization. Healthy workplaces: a model for action. Geneva: WHO; 2010.
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.
Why it matters. Migrants and displaced people often move between countries and services, and cannot carry their records with them. A record the patient can keep and show, in paper or electronic form, keeps care continuous.
How the surveyor verifies this criterion
Sample. Review 10 patient records for the portable health record given.
1. The patient holds their own health information in a portable form.
Method. Check each sampled record for the portable copy given.
Evidence to show. Portable health record (HMG-FRM-004).
Pass when. Every sampled patient has a portable copy recorded.
2. The portable record includes the diagnosis and treatment.
Method. Check each copy for the diagnosis and treatment.
Evidence to show. Portable health record (HMG-FRM-004).
Pass when. Every copy includes the diagnosis and treatment.
3. The patient is shown how to use it at another clinic.
Method. Check each record for the explanation.
Evidence to show. Portable health record (HMG-FRM-004).
Pass when. At least 90% of records show the explanation.
Immediate fail (any one means the criterion is not met)
- A patient cannot show their diagnosis at a new clinic.
Documents
E-learning
References
- World Health Organization and International Organization for Migration. Global Competency Standards for Refugee and Migrant Health. Geneva: WHO; latest edition.
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.
Why it matters. A clinic for displaced people in a formal camp works very differently from one in an urban settlement. Naming the model the facility runs under makes the services fit the population it actually serves.
How the surveyor verifies this criterion
Sample. Review the service model declaration and the practices adapted to it.
1. The facility names its service model.
Method. Check the declaration for the model named.
Evidence to show. Service model declaration (HMG-FRM-005).
Pass when. The declaration names one service model.
2. The practices are fit for that specific context.
Method. Check the adapted practices against the model.
Evidence to show. Service model declaration (HMG-FRM-005).
Pass when. The practices listed match the model.
3. The declaration is reviewed each year.
Method. Check the review date.
Evidence to show. Service model declaration (HMG-FRM-005).
Pass when. The declaration was reviewed in the year.
Immediate fail (any one means the criterion is not met)
- A clinic in an urban area plans services for a camp it does not serve.
Documents
E-learning
References
- World Health Organization and International Organization for Migration. Global Competency Standards for Refugee and Migrant Health. Geneva: WHO; latest edition.
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.
Why it matters. Asylum seekers, recognised refugees and stateless people have different rights to care and different paperwork. A clinic that does not know which group a patient belongs to can refuse care it must give, or give care it cannot.
How the surveyor verifies this criterion
Sample. Review the legal status and access rights register.
1. The legal status categories served are named.
Method. Check the register for each category served.
Evidence to show. Legal status and access rights register (HMG-REG-004).
Pass when. Every category served is named.
2. Access rights are applied per category, not uniformly.
Method. Check the access rights listed for each category.
Evidence to show. Legal status and access rights register (HMG-REG-004).
Pass when. Each category has its own access rights recorded.
3. Staff are briefed on the rights.
Method. Check the briefing record.
Evidence to show. Legal status and access rights register (HMG-REG-004).
Pass when. Staff briefing is recorded.
Immediate fail (any one means the criterion is not met)
- A stateless person is turned away because staff do not know their rights.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
Additional resources: guidelines in the GMJ library
These guidelines are held in the GMJ guideline library (news.gmj.ge). WHO and PAHO are the issuing bodies; MSF guidelines are marked MSF.
- Proposal for Increasing Health Care Coverage for Venezuelan Refugees and Migrants Living with HIV. Update in Response to the COVID-19 Pandemic · PAHO · criteria: Whole standard
Access to HIV prevention, care and treatment for refugees and migrants regardless of immigration status; guidance written for the COVID-19 period.
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