Refugee & Migrant Health

10 criteria

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

A refugee or migrant patient's health needs and vulnerabilities are shaped by what happened before they ever reached this facility — in their country of origin, in transit, and on arrival. Care that ignores this context, treating every patient as though their history began at the clinic door, misses real, clinically relevant information and can retraumatise someone who has already experienced significant hardship.

1 Staff are aware of the principle but haven't received specific training on how to apply it practically.

General awareness doesn't reliably translate into consistent practice without concrete training.

2 Trauma-informed care is practised by some staff but not consistently across the whole team.

Individual good practice doesn't guarantee a system-wide standard without deliberate reinforcement.

3 Legal-status access policy exists but front-line staff apply it inconsistently under uncertainty.

A written policy needs active reinforcement to survive contact with real, ambiguous cases.

Week 1 Review current intake practice for trauma-informed care and legal-status access barriers.

Week 2 Train staff specifically on adapting practice to migration and displacement experience, using the WHO Competency Standards as a reference.

Week 3 Confirm and communicate that access is not conditioned on full legal documentation.

Ongoing Reinforce trauma-informed intake practice through periodic case review.

Observe an actual intake if possible, not just review the policy.

Trauma-informed practice shows in how questions are actually asked, not in a written statement.

Ask a staff member to describe a real, specific adaptation they made for a patient.

A concrete example reveals genuine practice better than a general description of awareness.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

For a refugee or migrant patient, understanding an unfamiliar health system can matter as much for long-term health as any single treatment decision, and a patient who nods along without genuinely understanding — particularly through the added layer of interpretation — can leave with a dangerously incomplete picture of both their care and how to access it again.

1 Teach-back is used for major treatment decisions but not extended to system-navigation information.

Understanding how to actually use the system matters as much as understanding the immediate care plan.

2 System literacy support is given verbally but not reinforced with anything the patient can review later.

Complex system information delivered once, verbally, under stress is easily forgotten.

3 Staff assume system literacy for patients who have been in the country longer, missing gaps that may still exist.

Length of stay does not reliably correlate with genuine system understanding.

Week 1 Observe current practice for both understanding-verification and system-navigation support.

Week 2 Train staff on teach-back technique and develop translated navigation guidance.

Week 3 Brief staff to proactively cover system literacy alongside the immediate clinical matter.

Ongoing Spot-check patient understanding of both care and system navigation periodically.

Observe an actual consultation if possible, watching specifically for teach-back covering both care and navigation.

This is a practice that is easy to describe in policy and easy to skip under time pressure.

Ask a patient directly what they understand about accessing care again.

This tests actual system literacy, not just satisfaction with the immediate visit.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

Family members interpreting, especially minors, carries real, well-documented risks — inaccurate interpretation, withheld or distorted information, compromised confidentiality, and trauma to the family member themselves. This is one of the clearest, most specific safeguards in the entire WHO framework, and it exists because the alternative genuinely and measurably harms patients.

1 Trained interpreters are used for major appointments but family members fill in for quick or informal interactions.

Risk doesn't scale down proportionally with how brief or informal an interaction feels.

2 The no-minors rule is understood by senior staff but not consistently reinforced with newer or junior staff.

A critical safeguard needs to be embedded in onboarding, not assumed as common knowledge.

3 Interpreter access exists during business hours but reverts to family members after hours or in emergencies.

Coverage gaps at specific times undermine an otherwise sound policy.

Week 1 Review recent language-discordant consultations for interpreter engagement patterns.

Week 2 Establish or reinforce trained interpreter access, including after-hours and emergency coverage.

Week 3 Brief all staff explicitly and unambiguously that minors are never used to interpret.

Ongoing Audit family-member interpretation instances to confirm they're confined to genuinely low-risk situations.

Ask the minor-interpreter question directly and expect an immediate, confident answer.

Any hesitation on this specific point is a serious signal worth investigating further.

Check after-hours and emergency interpreter coverage specifically.

This is where the policy is most likely to quietly lapse.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

Housing, legal status, and social support don't just sit alongside a refugee or migrant patient's health — they actively shape it. A facility that treats health in isolation from these factors, or that fails to hand over migration-related context to the next provider in a patient's care, misses information a purely clinical view wouldn't capture.

1 Referral relationships exist for the most common needs but not for less frequent ones.

Coverage naturally concentrates where demand is highest, leaving gaps elsewhere.

2 Handover includes some migration context but inconsistently, depending on which staff member completes it.

Individual practice variation without a standard template produces uneven results.

3 Collaboration happens reactively when a crisis emerges, not proactively as part of routine care.

Reactive engagement misses opportunities for earlier, less crisis-driven support.

Week 1 Map current referral relationships with relevant social support services.

Week 2 Build or strengthen relationships with services covering common gaps.

Week 3 Standardise handover documentation to consistently include migration-related context.

Ongoing Review collaborative practice examples periodically to confirm it remains genuine, not nominal.

Ask for a real, specific referral example, not a general description of awareness.

A concrete instance reveals whether relationships are genuinely working, not just theoretically available.

Check handover documentation directly for migration-related content.

This is a specific, checkable detail that reveals whether the practice is systematic or incidental.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

Surges in demand are a predictable, recurring feature of refugee and migrant health services, not a rare exception — driven by seasonal movement, policy changes, or humanitarian crises. A facility without a real, practised surge plan will improvise under exactly the conditions where improvisation is most likely to fail.

1 An operational surge plan exists but hasn't been updated since it was first written.

Staffing, capacity, and context all change over time, and a stale plan may not reflect current reality.

2 The plan addresses capacity expansion well but doesn't name specific triggers for activation.

Without a clear activation threshold, a good plan can be deployed too late to be genuinely useful.

3 Staff support exists informally but isn't written into the plan itself.

Informal good intentions can lapse under the exact pressure a real surge creates.

Week 1 Review the current surge plan, if one exists, for specificity and currency.

Week 2 Define clear activation triggers and update capacity expansion elements.

Week 3 Add explicit staff wellbeing and burnout-prevention provisions to the plan.

Ongoing Exercise the plan periodically, even at small scale, to keep it genuinely actionable.

Ask for the activation trigger specifically, not just the plan's existence.

A plan without a clear trigger risks being deployed too late to matter.

Ask how the facility has handled a real past surge, if one has occurred.

Real experience, or its honest absence, reveals more than a hypothetical plan alone.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

Refugee and migrant health needs genuinely differ from the general population in ways that matter clinically — different disease prevalence patterns, different exposure histories, different care-seeking barriers. Care that ignores this and applies general guidelines uncritically can miss real, evidence-based adjustments this specific population needs.

1 Awareness exists among senior clinical staff but hasn't been systematically shared with the wider team.

Knowledge held by a few doesn't guarantee it shapes practice across the whole facility.

2 Specific guidelines are used for some conditions but general guidelines are applied uncritically for others.

Coverage often concentrates on the most visible or common conditions, leaving others under-adapted.

3 Evidence gaps are recognised informally but never documented or fed back into practice improvement.

An unrecorded recognition doesn't accumulate into genuine organisational learning over time.

Week 1 Review current guideline use for evidence-informed, population-specific content.

Week 2 Identify and distribute relevant refugee and migrant health guidelines where they exist.

Week 3 Brief staff on documented population-specific health need differences relevant to common conditions.

Ongoing Track identified evidence gaps and revisit guidance as new evidence emerges.

Ask about a specific, common condition, not a general question about awareness.

Specificity reveals genuine knowledge better than a general question would.

Ask what happens when evidence for this population genuinely doesn't exist.

A thoughtful answer to genuine uncertainty is itself a sign of good practice here.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

Unacknowledged bias shapes clinical judgement in ways that are genuinely hard to see from the inside, and staff providing this care are regularly exposed, secondhand, to accounts of hardship and trauma — both are real, documented occupational realities of this work, and both require structured, deliberate support rather than being left to individual capacity alone.

1 Reflective practice happens informally among some staff but is not structured or facility-wide.

Individual good practice does not reliably generalise without a defined, shared process.

2 Support exists but staff are unaware it is available or feel discouraged from using it.

A benefit's existence does not guarantee genuine, comfortable access to it.

3 Debriefs happen after major incidents but not as a routine practice for cumulative, everyday difficulty.

Vicarious trauma often builds cumulatively, not only from single major events.

Week 1 Review current training content and support access for genuine coverage of bias and staff wellbeing.

Week 2 Establish a structured reflective practice process and strengthen debrief structure.

Week 3 Deliver specific training on institutional discrimination and normalise use of available psychological support.

Ongoing Revisit reflective practice and staff wellbeing periodically, using real case examples where appropriate.

Ask for a specific personal example, not a general statement of awareness.

A concrete instance distinguishes genuine reflective practice from familiarity with the concept.

Ask staff directly whether they have used available support, not just whether it exists.

Genuine uptake, not nominal availability, is the real test.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

A refugee or migrant patient's mobility isn't a hypothetical edge case — it's a defining feature of the population this standard exists to serve. A record that only exists inside one facility's own system provides no protection the moment that patient needs care somewhere else, which for this population is often exactly when it matters most.

1 A patient-held record exists but isn't consistently offered to every relevant patient.

A good practice that depends on individual staff remembering to offer it isn't yet a reliable system.

2 Records are given but patients aren't clearly told how or why to keep and use them.

A document without explanation of its purpose is less likely to be genuinely used.

3 Updates happen for major changes but not consistently for smaller, cumulative ones.

Gradual changes can leave a real gap between the record and the patient's actual current status.

Week 1 Review current practice for providing patients their own portable health records.

Week 2 Establish a standard patient-held record format and consistent offering practice.

Week 3 Brief patients clearly on the purpose and use of their own portable record.

Ongoing Build record updates into routine care so they don't become static over time.

Ask a patient directly whether they have and understand their own record.

Patient-side confirmation reveals whether this is genuinely functioning, not just policy.

Check record content for genuine cross-border usefulness, not just facility-internal notes.

Content specificity is what determines whether this actually helps continuity of care elsewhere.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

A facility serving a protracted encampment, an informal urban refugee population, an active transit and reception context, and an established resettlement population are facing genuinely different operational realities — different infrastructure, different population turnover, different legal and logistical constraints. A standard that assumes one model fits everywhere isn't actually usable everywhere it claims to apply.

1 The model is understood by leadership but not reflected consistently in front-line practice.

Strategic awareness doesn't automatically translate into operational adaptation without deliberate effort.

2 Practices are well adapted for the primary population served but not for a secondary group also present.

Facilities serving mixed populations can default to their majority context and under-serve others.

3 The classification was accurate when first made but hasn't been revisited as the context evolved.

Refugee and migrant contexts can shift meaningfully over time, and a stale classification may no longer fit.

Week 1 Have leadership explicitly classify and document the facility's actual service model.

Week 2 Review current practices for genuine fit against that specific model.

Week 3 Adjust any practices found to be generically applied rather than context-adapted.

Ongoing Revisit the model classification periodically as population or context may shift.

Ask the classification question directly and expect a specific, considered answer.

Hesitation or vagueness here often signals the facility hasn't genuinely thought through its own context.

Check for evidence of real adaptation, not just a template with the local name inserted.

Superficial customisation can look like adaptation without functioning as it.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

Asylum seeker, recognised refugee, stateless person, and internally displaced person are not interchangeable categories — they carry genuinely different legal access rights in different countries, and treating them as one undifferentiated group risks either wrongly denying care someone is entitled to, or missing a specific vulnerability tied to a particular status.

1 Awareness exists for the most common status category served but not for less frequent ones.

Familiarity naturally concentrates on the majority population, leaving smaller groups under-recognised.

2 Access policy differentiates on paper but front-line staff apply it inconsistently in practice.

A correct written policy still needs active reinforcement to hold under real, ambiguous cases.

3 General awareness of legal status differences exists without specific knowledge of this context's relevant distinctions.

Abstract awareness of the concept doesn't guarantee it's been applied to this facility's actual population.

Week 1 Identify which legal status categories are actually present among the facility's patient population.

Week 2 Review and correct access policy to genuinely differentiate by status where legally relevant.

Week 3 Brief staff specifically on status-linked vulnerabilities relevant to this population.

Ongoing Revisit legal status awareness as the facility's population composition may shift over time.

Ask staff to name the specific categories, not just confirm general awareness that differences exist.

Specificity reveals whether this understanding is genuinely operational.

Ask about a less common status category present in this population.

This is where recognition gaps are most likely to concentrate.