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International Accreditation of Healthcare Facilities

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ASF Standards · Hospital · Standard 9

Standard 9 — Refugee & Migrant Health

10 criteria · 8 non-negotiable · 2 core · Version 3.0

Criteria in this standard

9.1 — People-Centred Care Adapted to Migration and Displacement Experience
9.2 — Supporting Patient Agency Through Genuine Understanding of Care and the Health System
9.3 — Language and Communication Aids — Interpreters and Cultural Mediators
9.4 — Collaborative Practice Across Health and Social Services
9.5 — Surge Capacity for Migration-Related Demand
9.6 — Evidence-Informed Care for Refugee and Migrant Populations
9.7 — Staff Reflective Practice, Bias Awareness, and Self-Care in Migration Contexts
9.8 — Cross-Border Continuity of Care
9.9 — Camp-Based and Non-Camp Service Model Fit
9.10 — Legal Status Diversity Recognition
9.1

People-Centred Care Adapted to Migration and Displacement Experience

Non-Negotiable

Care is genuinely 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.

In plain terms: Care is genuinely adapted for refugee and migrant patients — recognising trauma, legal-status fears, and the barriers they face — not just delivered the same way as for everyone else.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

A refugee who has crossed a border on foot, lost family, and now fears deportation does not arrive at the hospital as an ordinary patient. They may not disclose symptoms that could mark them as a burden. They may not return for follow-up because they moved or because the last clinic reported them. They may react to a physical examination with terror rooted in what was done to them before. Trauma-informed care means staff understand this, explain before touching, ask permission, avoid triggering procedures where possible, and never threaten legal consequences. It means the hospital has decided that a person's migration status does not change their right to care — and staff know it.

What good looks like

  • Staff can describe specific, genuine adaptations made for patients with migration and displacement histories.
  • Trauma-informed practice is evident — safety, choice, and non-judgemental listening, not routine probing for detailed trauma history.
  • Care access is not conditioned on legal status documentation.

Common failure modes

  • Care is delivered identically regardless of stated migration or displacement history.
  • Staff routinely ask for detailed trauma or torture history at first contact.
  • Patients without full legal documentation are turned away or deprioritised.

Worked example

In practice
A 170-bed hospital in a city with a large refugee population.
BeforeRefugee patients were treated identically to others. Staff had no training on trauma or migration. The Coordinator observed a nurse insisting a woman remove her headscarf for a routine examination, and a receptionist asking for immigration documents at registration. Refugee patients reported avoiding the hospital because 'they ask questions.'
ActionA half-day trauma-informed care module was delivered to all patient-facing staff, developed with a refugee support NGO. A written policy stated that immigration status is not asked and does not affect care. Registration was simplified to name, date of birth, and contact. Examination consent scripts were adapted. A refugee liaison worker was engaged part-time through the NGO.
AfterThe Monitor reviewed the policy, training records (94% of staff), and interviewed the liaison worker and two refugee patients who described feeling safe. Observed a consultation where the clinician explained each step before touching. Verified.

If you are starting from zero — do this first

  1. Ask refugee-serving organisations in your area what their clients say about your hospital.
  2. Write one sentence: 'We do not ask immigration status and it does not affect care.' Post it.
  3. Arrange trauma-informed care training with an NGO that knows the population.
  4. Remove immigration document requests from registration.
The most common mistake: Believing that treating everyone 'the same' is equity — for a traumatised patient, the same treatment is a different experience.

Self-assessment questions

1. Are staff trained to adapt their practice based on a patient's migration and displacement experience, not deliver identical care regardless of history? — Genuine adaptation, not a generic cultural-awareness statement.
Evidence: Training record on migration-adapted care
2. Is trauma-informed practice applied, including not routinely asking for detailed trauma history at initial visits? — WHO specifically advises against probing for detailed trauma history early in care.
Evidence: N/A — tested directly
3. 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.
Evidence: Access policy regarding legal status

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
ASK Staff practice interview Asks clinical staff how they adapt care for a patient with a known migration or displacement history.
OBSERVE Trauma-informed practice check Reviews intake practice for evidence that detailed trauma history isn't routinely and inappropriately probed at first contact.
DOCUMENT Legal-status access policy review Reviews whether access to care is genuinely not conditioned on legal status documentation.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standard 1 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) requires health workers to adapt practice to migration and displacement experiences, address trauma-informed care and psychosocial needs, and support continuity of care regardless of legal status.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.2

Supporting Patient Agency Through Genuine Understanding of Care and the Health System

Non-Negotiable

Patients are supported to genuinely 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, a nod, or general goodwill information about the system.

In plain terms: Refugee and migrant patients are helped to understand not just their own care but how the health system works — and you check that they actually understood.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

A patient who does not know that the hospital has an outpatient department, that a referral means an appointment somewhere else, that a prescription must be filled at a pharmacy, or that emergency care is free regardless of status — that patient cannot navigate the system. Migrants often come from health systems with entirely different structures and assumptions. Explaining the system is as important as explaining the diagnosis. And explanation is not enough: teach-back, in the patient's language, is the only way to know it landed. The consequence of failure is missed follow-up, untreated conditions, and emergency presentations that could have been prevented.

What good looks like

  • Teach-back genuinely verifies understanding of both the care plan and system navigation.
  • Concrete, translated navigation guidance is provided, not just general encouragement.
  • Plain language is used consistently, especially when working through an interpreter.

Common failure modes

  • Understanding is assumed from a nod or silence, with no active verification.
  • Patients leave understanding their specific treatment but not how to access the system again.
  • Medical jargon is used routinely, straining both interpretation and comprehension.

Worked example

In practice
A 140-bed hospital serving newly arrived migrants from several countries.
BeforeMigrant patients were given standard discharge information. A high proportion did not attend follow-up. When interviewed by a liaison worker, patients said they did not understand what a 'referral' was, did not know where the outpatient clinic was, and assumed all care cost money they could not pay. Some had returned to the emergency department for routine issues.
ActionA one-page 'How this hospital works' guide was produced in the six most common languages: what each department does, how referrals work, what is free, who to ask. It is given at registration and explained by the liaison worker or interpreter. Discharge includes a teach-back on the next step: 'Where will you go for your follow-up, and when?' Answers are recorded.
AfterThe Monitor reviewed 15 migrant patient records with documented teach-back; follow-up attendance had risen from 40% to 72%. Interviewed two patients who described the system correctly. Verified.

If you are starting from zero — do this first

  1. Ask five migrant patients what a 'referral' means and where the outpatient clinic is.
  2. Write a one-page system guide in your most common languages.
  3. Give it at registration and explain it.
  4. Add teach-back on the next step at discharge.
The most common mistake: Explaining the diagnosis carefully and assuming the patient knows how to get the follow-up you have arranged.

Self-assessment questions

1. 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?"
Evidence: N/A — tested directly
2. Is concrete, practical guidance provided on navigating this health system specifically — appointments, referrals, emergency versus routine care? — Real navigation guidance, not just general encouragement to seek care.
Evidence: Navigation guidance material
3. Is information communicated in plain language, avoiding medical jargon, particularly when working through an interpreter? — Complex terminology strains interpretation and comprehension together.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
OBSERVE Teach-back practice observation Observes a consultation, or a simulated scenario, to check whether teach-back genuinely verifies understanding of both care and system navigation.
DOCUMENT Navigation material review Reviews any materials or guidance provided on navigating the local health system, in relevant languages.
ASK Patient understanding check Asks a recent refugee or migrant patient to explain back their care plan and how they would access this facility again.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standards 2 and 4 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to assess and support health system literacy as distinct from condition-specific understanding, and to actively verify genuine understanding through methods such as teach-back rather than assuming comprehension from silence.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.3

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 genuinely no other option exists and the situation is not high-risk.

In plain terms: Trained interpreters or cultural mediators are used for language-discordant consultations — never children, and family members only when there is truly no alternative.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

This is the refugee-specific counterpart of 8.3, and the stakes are higher. Refugee patients may be discussing torture, sexual violence, or mental illness — topics a family member cannot interpret and should not hear. A cultural mediator adds what an interpreter cannot: understanding of why a patient from a particular background may refuse a male examiner, may not disclose a symptom, or may interpret a question as a threat. Children must never interpret for parents: it exposes them to adult content, it distorts the information, and it places the child in an impossible position. Where the hospital serves a refugee population, interpreter and mediator access is a core service, not an extra.

What good looks like

  • Trained interpreters or cultural mediators are the default for language-discordant consultations.
  • Staff confirm, without hesitation, that minors are never used to interpret.
  • Family-member interpretation, when it happens, is reserved for genuinely low-risk situations only.

Common failure modes

  • Ad hoc bilingual staff or family members are the default, with trained interpreters rarely engaged.
  • A minor has been used to interpret, even occasionally.
  • Family members interpret for high-risk situations like informed consent or bad news.

Worked example

In practice
A 160-bed hospital serving a refugee settlement of 30,000 people.
BeforeInterpretation was by family members or other patients from the same language group. A ten-year-old was observed interpreting her mother's gynaecological consultation. A man was asked to interpret for a woman describing sexual violence. There was no interpreter budget and no mediator role.
ActionWith NGO support, four cultural mediators from the main refugee language groups were recruited and trained. A phone interpretation service covered other languages. A written rule prohibited children interpreting and required same-gender interpreters for sensitive consultations. Interpreter and mediator use was documented. Staff were briefed on why family interpretation is unsafe.
AfterThe Monitor reviewed 20 refugee patient records: interpreter or mediator documented in all language-discordant consultations. Observed a mediator-supported consultation. Interviewed a mediator who described the same-gender rule in practice. Verified.

If you are starting from zero — do this first

  1. Ask how the last ten refugee consultations were interpreted. Count how many used a child or a family member.
  2. Write the rule today: no children; family only as a last resort and never for sensitive topics.
  3. Recruit mediators from the main language groups — NGOs can help.
  4. Contract a phone service for other languages.
The most common mistake: Using the patient's child to interpret because they speak the language best — the child is harmed and the information is distorted.

Self-assessment questions

1. Are trained interpreters or cultural mediators engaged for language-discordant consultations? — Not ad hoc bilingual staff or family members as the default.
Evidence: Interpreter engagement record
2. Is a minor ever used to facilitate interpretation for a family member? — This should never happen — a specific, absolute rule, not a judgement call.
Evidence: N/A — tested directly
3. When a family member interprets due to genuine 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 WHO specifically flags as requiring professional language support.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
DOCUMENT Interpreter engagement review Reviews records for evidence of trained interpreter or cultural mediator engagement in language-discordant consultations.
ASK Minor-interpreter policy check Asks staff directly whether minors are ever used to interpret, and confirms understanding that this is never acceptable.
OBSERVE High-risk situation check Checks whether family-member interpretation, where it occurs, is confined to genuinely low-risk situations, never consent or bad news.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standard 3 explicitly states health workers have a responsibility not to engage minors to facilitate interpretation, given the associated significant risk, and identifies inaccuracy, information distortion, and compromised confidentiality as documented risks of family-member interpretation generally.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.4

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.

In plain terms: The hospital works with legal, housing, education, and social services relevant to refugee patients — because their health depends on more than what happens in the hospital.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Adapted Full

Why this matters

A refugee child with malnutrition needs food, not just a prescription. A woman with chronic pain and a pending asylum claim needs legal support to reduce the stress that worsens the pain. A man with TB living in an overcrowded shelter needs housing to complete treatment. The hospital cannot solve these problems, but it can connect patients to those who can — if it knows who they are. Collaborative practice means a directory of local services, referral pathways that actually work, and periodic contact between the hospital and those services. It is the difference between treating symptoms and addressing causes.

What good looks like

  • Real, working referral relationships exist with relevant legal, housing, and social support services.
  • Handover documentation consistently includes migration- and displacement-related context.
  • Staff can describe genuine, specific examples of collaborative practice across services.

Common failure modes

  • No real working relationships exist with social support services beyond general awareness they exist.
  • Handover documentation covers clinical facts only, omitting migration-related context entirely.
  • Staff cannot describe any specific instance of collaborative, cross-service practice.

Worked example

In practice
A 150-bed hospital in a region hosting refugees with no established links to social services.
BeforeClinicians saw refugee patients with problems rooted in housing, legal status, and food insecurity, and had no one to refer to. A child with recurrent chest infections lived in a damp shelter; the paediatrician prescribed antibiotics repeatedly. No directory of services existed; no one had met the local refugee legal aid organisation.
ActionThe Coordinator and the refugee liaison worker mapped local services: legal aid, housing support, food assistance, education, mental health. A one-page directory was created for clinicians. A quarterly meeting with the three main NGOs was established. Referral forms were created and tracked. The child's family was referred to housing support and rehoused.
AfterThe Monitor reviewed the directory, meeting minutes from three quarters, and 25 tracked referrals with outcomes. Interviewed an NGO partner who described the working relationship. Verified.

If you are starting from zero — do this first

  1. List the non-medical problems you see in refugee patients: housing, legal, food, education.
  2. Find the organisations in your area that address each. Meet them.
  3. Create a one-page directory for clinicians.
  4. Track referrals and meet the organisations quarterly.
The most common mistake: Treating the medical consequence of a social problem repeatedly because no one has connected the patient to the service that could fix the cause.

Self-assessment questions

1. 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.
Evidence: Referral relationship record
2. 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.
Evidence: Handover documentation sample
3. Are staff from refugee or migrant backgrounds, where present, genuinely utilised for their relevant skills and insight? — Recognising this as a specific asset, not incidental to their role.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

  • Referral relationships exist for the most common needs but not for less frequent ones. — Coverage naturally concentrates where demand is highest, leaving gaps elsewhere.
  • Handover includes some migration context but inconsistently, depending on which staff member completes it. — Individual practice variation without a standard template produces uneven results.
  • Collaboration happens reactively when a crisis emerges, not proactively as part of routine care.

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
DOCUMENT Referral relationship review Reviews evidence of actual working relationships with relevant social support services, not just theoretical awareness.
DOCUMENT Handover content review Reviews handover documentation for inclusion of migration- and displacement-related context, not clinical facts alone.
ASK Collaborative practice interview Asks staff to describe a real instance of engaging social support services for a refugee or migrant patient.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standard 5 requires engagement with broader social and community support services and effective handover of care that specifically includes cultural, language, and migration- and displacement-related considerations.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.5

Surge Capacity for Migration-Related Demand

Non-Negotiable

The facility has a real, 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.

In plain terms: The hospital has a real, tested plan for a sudden surge in patients from a migration or displacement event — where they will be assessed, who will do it, and what supplies are needed.

Facility category Crisis Transition Small Standard
Applicability Full Full Adapted Full

Why this matters

A border opens, a camp is evacuated, a conflict displaces a town — and 500 people arrive at the nearest hospital in 48 hours. Most need assessment, some need urgent care, many need vaccination, all need food and water. A hospital with no plan is overwhelmed and turns people away or delivers chaotic care. Surge capacity planning means: a designated assessment area that can be opened rapidly, a triage protocol for mass arrivals, a call-in list, a stockpile of the basics (rehydration, vaccines, wound care), and agreements with health authorities and NGOs about who does what. It should be tested — at least on paper — before it is needed.

What good looks like

  • A specific, written surge response plan exists covering key operational elements.
  • The plan has been tested through drill or actual surge experience, with lessons incorporated.
  • Staff wellbeing and burnout risk during a surge are explicitly addressed.

Common failure modes

  • No specific surge plan exists beyond an assumption that staff will manage.
  • The plan, if it exists, has never been tested or exercised.
  • Staff wellbeing during a surge is not addressed anywhere in the plan.

Worked example

In practice
A 180-bed hospital 40 km from a border that has seen two displacement events in five years.
BeforeThe disaster plan (5.3) covered mass casualty events but not migration surges. When 300 displaced people arrived in one weekend two years earlier, the hospital had no assessment area, no interpreters, and ran out of oral rehydration solution. Staff described it as 'chaos.'
ActionA migration surge annex was added to the disaster plan: a covered outdoor area designated for rapid assessment; a five-minute screening protocol (acute illness, injury, pregnancy, vaccination, malnutrition); an activation trigger; a call-in list including interpreters and NGO partners; a stockpile list for 500 people for 72 hours; an agreement with the regional health authority on referral and reporting. A tabletop exercise was run with NGO partners.
AfterThe Monitor reviewed the annex, the stockpile inventory, the health authority agreement, and the tabletop exercise report with actions. Verified.

If you are starting from zero — do this first

  1. Ask: if 300 people arrived this weekend, where would you assess them and who would do it?
  2. Write a one-page surge annex: area, trigger, screening protocol, call-in list.
  3. Stockpile the basics for 500 people for 72 hours.
  4. Run a tabletop exercise with local NGOs and the health authority.
The most common mistake: Assuming the mass casualty plan covers a migration surge — a surge is hundreds of mostly well people needing assessment, not dozens of injured.

Self-assessment questions

1. 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.
Evidence: Surge response plan document
2. Has this plan actually been tested or exercised, not just written and filed? — An untested plan's real gaps remain unknown until an actual surge reveals them.
Evidence: Drill or exercise record
3. Does the plan address staff wellbeing and burnout risk during a surge, not only operational capacity? — Sustained surge response carries real staff mental health risk that a purely operational plan can miss.
Evidence: Staff support provisions within the plan

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
DOCUMENT Surge plan review Reviews the surge response plan for specificity covering assessment expansion, treatment distribution, and critical-needs focus.
DOCUMENT Exercise record check Checks for evidence the plan has been tested through drill or exercise, not only written.
ASK Staff wellbeing provision interview Asks whether the plan addresses staff support and burnout risk during a sustained surge.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standard 6 specifically requires health workers to respond flexibly and collaboratively to migration- and displacement-related surges in demand, identifying expansion of assessment points, treatment distribution, and focus on critical needs as key response elements.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.6

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.

In plain terms: Staff use clinical guidelines specific to refugee and migrant health where they exist, know where evidence is thin, and adapt sensibly.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

Refugee health has specific evidence: screening for TB, hepatitis B, and parasites by region of origin; vaccination catch-up schedules; recognition of conditions rare in the host country; management of trauma-related mental illness. Applying host-country guidelines without adaptation means missing conditions the host population does not have and over-testing for ones the refugee population does not. Where evidence exists — WHO, UNHCR, national refugee health guidelines — staff should use it. Where it does not, they should know that, and adapt with judgment rather than guess.

What good looks like

  • Staff have genuine access to and use guidelines specific to refugee and migrant health where they exist.
  • Staff can describe specific, relevant differences in health needs for conditions they commonly treat.
  • A real process exists for identifying and responding to evidence gaps.

Common failure modes

  • General population guidelines are applied uncritically with no adaptation for this population's documented differences.
  • Staff cannot describe any specific way refugee and migrant health needs differ from the general population.
  • No process exists for identifying where evidence for this population is genuinely lacking.

Worked example

In practice
A 140-bed hospital that had started receiving refugees from a region with high hepatitis B and TB prevalence.
BeforeRefugee patients were assessed using standard domestic protocols. Hepatitis B screening was not routine. Two cases of active TB were diagnosed late after multiple presentations. Clinicians were unaware of the WHO and national refugee health screening recommendations.
ActionThe Coordinator obtained the national refugee health guideline and the WHO recommendations for the relevant region. A refugee health screening protocol was written: TB screening, hepatitis B and C, HIV with consent, parasitic infection screening, vaccination status, mental health screen. Clinicians received a one-hour briefing. The guideline was reviewed annually with an infectious diseases specialist.
AfterThe Monitor reviewed the protocol with its sources, training records, and 20 refugee patient records showing protocol-based screening. Two hepatitis B cases identified and treated. Verified.

If you are starting from zero — do this first

  1. Find your national refugee health guideline, or the WHO/UNHCR one for your region.
  2. Compare it to what you currently do for refugee patients.
  3. Write a screening protocol based on the guideline.
  4. Brief clinicians and review annually.
The most common mistake: Applying the domestic screening protocol to refugee patients from regions with a completely different disease burden.

Self-assessment questions

1. 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.
Evidence: Guideline access and reference record
2. Can staff describe how refugee and migrant health needs may differ from the general population for conditions they commonly treat? — Genuine awareness of specific, relevant differences, not a general acknowledgment that differences might exist.
Evidence: N/A — tested directly
3. 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.
Evidence: Evidence gap identification process

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
DOCUMENT Guideline access review Checks whether staff have access to evidence-informed guidelines specific to refugee and migrant health.
ASK Population-difference awareness interview Asks staff to describe specific ways refugee and migrant health needs differ from the general population for conditions they commonly see.
DOCUMENT Evidence gap process review Reviews any process for identifying and responding to evidence gaps specific to this population.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standard 7 requires health workers to use evidence-informed guidelines specific to refugee and migrant health where they exist, recognise where the health needs of this population differ from the general population, and identify where evidence gaps remain.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.7

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 genuine access to psychological support — not assumed self-awareness or an assumption that staff will manage vicarious trauma exposure on their own.

In plain terms: Staff actively reflect on their own biases and culture, the hospital supports this through structured practice, and staff working with traumatised patients are looked after.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

Every clinician has assumptions about people from other cultures, and most are unaware of them. The nurse who assumes a refugee is exaggerating pain, the doctor who is impatient with a patient who will not make eye contact, the receptionist who is curt with someone who does not understand the form — each is acting on bias, and each affects care. Reflective practice — structured time to examine one's reactions — reduces this. The second element is staff wellbeing: hearing accounts of torture and loss every day takes a toll, and staff who are burned out become staff who withdraw. Supervision, peer support, and access to counselling are not luxuries in a hospital serving refugees.

What good looks like

  • A structured reflective practice process genuinely exists and is used, not just assumed.
  • Genuine, accessible psychological support and debrief structure exist and staff actually use them.
  • Staff can describe specific, real examples of both bias adaptation and vicarious trauma awareness.

Common failure modes

  • No structured reflective practice process exists beyond an assumption of individual self-awareness.
  • Psychological support exists only nominally, with no evidence staff actually access it.
  • Staff cannot describe any specific example of adapting practice or recognising vicarious trauma.

Worked example

In practice
A 150-bed hospital where a third of patients are refugees.
BeforeNo reflective practice existed. Staff complained about refugee patients in the break room; some described them as 'demanding.' A nurse who had heard multiple accounts of sexual violence had started avoiding female refugee patients. There was no supervision or support for staff exposed to trauma narratives.
ActionMonthly facilitated reflective practice sessions were introduced for clinical teams, led by a psychologist from a partner NGO, using real (anonymised) cases. An implicit bias workshop was run once for all staff. A peer support scheme was set up. Confidential counselling access was arranged through the NGO. Attendance was tracked.
AfterThe Monitor reviewed session records (10 sessions, average 70% attendance), workshop records, and the counselling access agreement. Interviewed three staff who described the sessions as valuable and gave examples of changed practice. Verified.

If you are starting from zero — do this first

  1. Listen in the break room. What do staff say about refugee patients when they think no one is listening?
  2. Arrange one implicit bias workshop with an NGO or university.
  3. Start monthly reflective practice sessions with a facilitator.
  4. Arrange confidential counselling access for staff.
The most common mistake: Training staff in cultural competence once and assuming bias is fixed — it is a practice, not a certificate.

Self-assessment questions

1. 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.
Evidence: Reflective practice process description
2. Does the facility provide genuine, accessible psychological support and a structured space to debrief difficult cases? — Actual, used support and a real, regular opportunity, not a theoretical benefit or informal hope.
Evidence: Psychological support and debrief process record
3. 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? — Genuine, concrete examples, not general statements of good intentions or awareness.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
DOCUMENT Reflective practice process review Reviews the facility's structured process, if any, for staff reflective practice on bias and cultural awareness.
DOCUMENT Support and debrief access review Reviews what psychological support and debrief structure genuinely exist and whether they are actually used.
ASK Staff example interview Asks a staff member for a specific instance of recognising and adapting for their own bias, and how they or the team handled a recent difficult case.

Supervisor tips

  • 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.

Evidence base

[37] WHO Competency Standards 8 and 9 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to maintain structured awareness of their own biases and institutional discrimination's impact, and to engage in self-care within a supportive team environment addressing the wellbeing impacts of migration-context care.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.8

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 genuine mobility of refugee and migrant populations.

In plain terms: Refugee and migrant patients are given their own health record in a form they can carry — paper or digital — so it works wherever they go next.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

A refugee may be in three countries in a year. Each hospital that treats them starts from zero: no history, no medication list, no vaccination record, no knowledge of the TB treatment started two countries ago. A portable record — a printed summary the patient keeps, a vaccination card, a QR code linking to a secure online summary — means the next clinician knows what was done. It must be in a form the patient can hold and use: a hospital number in a system the next country cannot access is not portable. The record is the patient's; the hospital's job is to give them a copy that works.

What good looks like

  • Patients are consistently given a genuine, portable health record they hold themselves.
  • Records are updated as care continues, not static from a single point in time.
  • Record content — medication, vaccination history — is genuinely useful across a border.

Common failure modes

  • No patient-held record exists beyond what stays in the facility's own internal system.
  • Records are given once and never updated as care continues.
  • Record content is too facility-specific to be genuinely useful elsewhere.

Worked example

In practice
A 160-bed hospital near a transit route used by refugees moving onward.
BeforeRefugees received no record on departure. The hospital's electronic system was inaccessible from anywhere else. A patient started on TB treatment moved on after two weeks with no documentation; the next hospital restarted treatment from scratch, and resistance developed. Vaccinations given were not recorded anywhere the patient could show.
ActionA portable health summary was created: one page in English and the patient's language — diagnoses, medications with duration, vaccinations with dates, allergies, pending results, and the hospital's contact. It is printed for every refugee patient at discharge and, where the patient has a phone, also sent as a PDF. A vaccination card is issued. The summary is explained by an interpreter.
AfterThe Monitor reviewed 15 refugee discharges, all with portable summaries and vaccination cards. Interviewed a patient who showed the summary on her phone and explained its contents. Verified.

If you are starting from zero — do this first

  1. Ask a refugee patient at discharge: 'What will you show the next doctor?' If the answer is nothing, that is the gap.
  2. Create a one-page portable summary template in English and your main refugee languages.
  3. Print it for every refugee patient and send as PDF where possible.
  4. Issue a physical vaccination card.
The most common mistake: Keeping excellent records in a system the patient will never be able to access from the next country.

Self-assessment questions

1. 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.
Evidence: Patient-held record sample
2. 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.
Evidence: Record update practice
3. Does the record include information — medication history, vaccination record — that would be genuinely useful to a different provider in a different country? — Content specifically useful across a border, not just internally relevant notes.
Evidence: Record content sample

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
DOCUMENT Patient-held record review Reviews whether patients are provided a genuine, portable health record, and its actual content.
OBSERVE Update practice check Checks whether patient-held records are updated as care continues, not issued once and left static.
ASK Patient practice interview Asks a refugee or migrant patient whether they were given and understand how to use their own portable record.

Supervisor tips

  • 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.

Evidence base

[37] WHO's explanatory notes for Competency Standard 1 specifically identify patient-held records — paper or electronic — updated regularly, as a key strategy for improving continuity of care given the mobility of refugee and migrant populations.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.9

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 genuinely fit for that specific context, not a generic approach applied uniformly regardless of setting.

In plain terms: The hospital knows exactly which refugee service model it operates in — camp, urban settlement, transit centre, established community — and has designed its services to fit that reality.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

A hospital serving a formal camp with 50,000 residents faces different demands from one serving refugees dispersed in urban apartments, or a transit centre where people stay 48 hours. The camp needs outreach, mass screening, and coordination with camp health services. The urban setting needs accessibility, cultural mediation, and links to community organisations. The transit centre needs rapid assessment and portable records. A hospital that has not named its model has not thought about what its refugee population actually needs. Naming it is the first step to designing services that fit.

What good looks like

  • The facility can clearly state and justify its specific service model.
  • Practices are genuinely adapted to that model, not a generic template.
  • There's real awareness of how the facility would adapt if its context shifted.

Common failure modes

  • The facility cannot articulate which service model it actually operates under.
  • Practices are generic, apparently copied from an unrelated context, without adaptation.
  • No consideration has been given to what would change if the population or context shifted.

Worked example

In practice
A 140-bed hospital 15 km from a formal refugee camp and also serving refugees living in the nearby city.
BeforeThe hospital treated refugee patients as they arrived, with no distinction between camp residents and urban refugees. Camp residents often could not reach the hospital; urban refugees did not know it existed. No one had asked what each group actually needed. Services were the same for both.
ActionThe Coordinator worked with the camp management agency and an urban refugee NGO to map both populations. The hospital documented its dual model. For the camp: a weekly outreach clinic and a transport arrangement for referrals. For urban refugees: a cultural mediator, multilingual signage, and a partnership with the NGO for outreach. Different pathways were written for each.
AfterThe Monitor reviewed the service model document, the outreach clinic records, the transport log, and the NGO partnership agreement. Interviewed the camp health coordinator who described the working relationship. Verified.

If you are starting from zero — do this first

  1. Write one sentence: 'The refugees we serve live in [camp / urban / transit / established community].'
  2. For each setting you serve, ask the relevant agency what those refugees need from a hospital.
  3. Design one pathway per setting.
  4. Document it and share with partners.
The most common mistake: Delivering one undifferentiated service to refugee populations whose circumstances and needs are entirely different.

Self-assessment questions

1. 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.
Evidence: Service model self-classification
2. Are the facility's specific practices — staffing, scheduling, outreach — genuinely adapted to that model, not copied from a different context? — Real adaptation, not a generic template applied regardless of actual setting.
Evidence: Model-specific practice adaptation record
3. Has the facility considered what changes if its population or context shifts between models over time? — Genuine preparedness for a changing situation, not an assumption the current model is permanent.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
ASK Model self-classification interview Asks facility leadership to state and justify which service model the facility actually operates under.
DOCUMENT Practice adaptation review Reviews whether specific practices are genuinely adapted to the stated model, not generically applied.
ASK Context-shift preparedness interview Asks how the facility would adapt if its population or operating context shifted between models.

Supervisor tips

  • 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.

Evidence base

[37] WHO's multicountry review underpinning the Global Competency Standards identified four broad models of care for refugee and migrant populations — mainstream, specialised-focus, gateway, and limited/external-actor — and found that service delivery approaches vary meaningfully across them.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

9.10

Legal Status Diversity Recognition

Non-Negotiable

The facility can name which legal status categories it actually serves — asylum seeker, recognised refugee, stateless person, internally displaced person, and others — and demonstrates it doesn't apply a single, uniform assumption about access rights across all of them.

In plain terms: The hospital can name which legal status groups it serves — asylum seekers, recognised refugees, stateless people, internally displaced, undocumented — and knows what each group is entitled to.

Facility category Crisis Transition Small Standard
Applicability Full Full Full Full

Why this matters

An asylum seeker in many countries is entitled to emergency care only. A recognised refugee has the same entitlements as citizens. A stateless person may have no entitlement at all under the letter of the law. An undocumented migrant may be entitled to nothing — or to everything, depending on the jurisdiction and the type of care. A hospital that does not know these distinctions either turns away people who are entitled to care or treats people it cannot be reimbursed for without knowing it. Knowing the categories, the entitlements, and — critically — the hospital's own policy on treating people regardless of entitlement is the foundation for consistent, fair, and legally defensible practice.

What good looks like

  • Staff can specifically name and describe the legal status categories among patients they serve.
  • Access policy genuinely differentiates by status where legally relevant, not applied uniformly.
  • Staff demonstrate specific awareness of vulnerabilities linked to particular legal statuses.

Common failure modes

  • Staff cannot distinguish between different legal status categories among their own patient population.
  • A single, uniform assumption about access rights is applied regardless of actual legal status.
  • No awareness exists of status-specific vulnerabilities, such as those facing stateless persons.

Worked example

In practice
A 150-bed hospital in a country with five legal categories for displaced people and different entitlements for each.
BeforeRegistration staff did not know the categories. Patients were sometimes turned away because 'refugees are not covered' when in fact they were. Others were treated and the hospital could not claim reimbursement because the correct category was not recorded. The hospital had no written position on treating people outside any entitlement.
ActionThe Coordinator obtained the legal entitlements for each category from the Ministry and UNHCR. A one-page reference was created for registration staff. A hospital policy stated: emergency care for everyone regardless of status; other care per entitlement; and a defined charity fund for those with no entitlement. Registration records the category (with the patient's consent) for reimbursement purposes only — it does not affect clinical care.
AfterThe Monitor reviewed the entitlement reference, the policy, and 20 registration records with category correctly recorded. Interviewed two registration staff who correctly described entitlements for three categories. Verified.

If you are starting from zero — do this first

  1. List the legal status categories that exist in your country for displaced people.
  2. Find out what each is entitled to — ask the Ministry or UNHCR.
  3. Write a one-page reference for registration staff.
  4. Decide and write down what you will do for people with no entitlement.
The most common mistake: Treating all displaced people as one category — 'refugees' — when the law treats them differently and the hospital's obligations differ.

Self-assessment questions

1. Can staff name the different legal status categories among the patients this facility actually serves? — Specific awareness of asylum seeker, refugee, stateless, and internally displaced distinctions relevant to this context.
Evidence: Staff knowledge of legal status categories served
2. Does the facility apply a single, uniform assumption about access rights, or does it recognise genuine differences by status? — Genuine differentiation where it legally matters, not a one-size-fits-all approach.
Evidence: Access policy by legal status category
3. 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.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

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

Implementation plan

When What
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.

How the Monitor verifies this

Method What Detail
ASK Legal status awareness interview Asks staff to name and describe the legal status categories among patients they actually serve.
DOCUMENT Access policy review Reviews whether access policy genuinely differentiates by legal status category where legally relevant, rather than applying one assumption uniformly.
ASK Status-specific vulnerability interview Asks staff about specific vulnerabilities linked to a particular legal status relevant to this facility's population.

Supervisor tips

  • 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.

Evidence base

[37] WHO's Competency Standards explicitly distinguish these legal status categories throughout, noting that access to health care and legal entitlements vary meaningfully by status and by country, and that health workers need specific awareness of this rather than a single generalised assumption.

Train your team: H-09 · Refugee & Migrant Health on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

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