CURIOUS Special Ed. – International Day of Peace 2023: AAAQ Framework as a Tool for Assessing Right to Health of Refugees

An article by Erlangga Lazuardi Ramadhan (NORP 2019-2020)

The global refugee crisis is one of the most pressing humanitarian challenges of our time. Displaced individuals, fleeing conflict, persecution, and hardship, often find themselves in precarious conditions, struggling to access basic necessities, including healthcare. The right to health is a fundamental human right, yet refugees frequently face barriers in realizing this right. 

The AAAQ Framework: An Overview

The AAAQ Framework, which stands for Availability, Accessibility, Acceptability, and Quality, is a human rights-based tool used to assess the right to health. Developed by the United Nations, this framework originally served as an assessment tool for the healthcare sector but now can be used for any other types of services. It serves as a guideline for evaluating whether health services and healthcare systems meet international standards, with a focus on vulnerable populations such as refugees.

Case Percentage

The dire need for the AAAQ Framework becomes evident when we consider the percentage of refugees worldwide who lack adequate access to healthcare. According to the United Nations High Commissioner for Refugees (UNHCR), there are 117.2 million refugees expected to be in 2023. Around 76% of them live in low- and middle-income countries with overcrowded camps or urban slums, facing limited access to clean water, sanitation, and healthcare services. In Indonesia, there are over 13.000 refugees spread from Aceh to Kupang of whom 27% of them are children. Ensuring the right to health for this population is not only a moral imperative but also crucial for global public health.

Key Information

Availability: This component assesses whether healthcare services, infrastructure, and healthcare workers are present whether in types or quantities. In refugee settings, inadequate funding, shortages of medical staff, and limited medical facilities can significantly hinder healthcare availability.

Accessibility: Accessibility evaluates physical, financial, administrative, social, and information-related barriers to healthcare. Refugees often face obstacles such as language barriers, lack of transportation, financial constraints, stigma and discrimination, minimum information on said services, and long-winded bureaucracy  when seeking medical care.

Acceptability: Acceptability refers to the cultural appropriateness of healthcare services. Whether healthcare provides services respectful of the culture of individuals, minorities, peoples and communities; and respect confidentiality and informed consent. Tailoring healthcare to meet the diverse cultural and ethnic needs of refugees is essential to ensure that services are acceptable and effective.

Quality: Quality involves assessing the standard of healthcare services, including the competence of healthcare providers, the safety and sanitary of medical facilities, and the availability of essential medicines. Ensuring that healthcare meets international quality standards is vital to protect the health of refugees. Quality also extends to the way people are treated before, during and after accessing services.

Contributions of Medical Students

Medical students play a pivotal role in addressing the right to health of refugees. They can contribute by:

Advocacy: Medical students can engage in advocacy efforts to raise awareness about the healthcare needs of refugees. They can participate in campaigns, lobby for policy changes, and collaborate with humanitarian organizations to promote refugee’s health rights.

Education: Medical students can educate themselves and their peers about the unique health challenges faced by refugees. This includes cultural competency training, understanding trauma-informed care, and learning to work in resource-constrained settings. With more people being aware of the problems and working together, more solutions can be produced.

Direct Care: By volunteering with medical organizations working with refugees, medical students can provide direct medical care, offering essential services to those in need.

Research: Conducting research on refugee health issues can contribute valuable data and insights that inform evidence-based policies and interventions.

Take-Home Message

The AAAQ Framework serves as an invaluable tool in assessing and addressing the right to health of refugees. As the global community tackles the challenges of the refugee crisis, it is imperative that we prioritize the health and well-being of those who have been forcibly displaced. Medical students have a unique role to play in advocating for and contributing to the realization of this fundamental human right. By applying the principles of the AAAQ Framework and working collaboratively, we can strive to ensure that refugees receive the healthcare they deserve, reaffirming our commitment to the principles of compassion, justice, and human rights.


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The AAAQ manual and the right to water – contextualising indicators (2014) The Danish Institute
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The AAAQ toolbox (2023) The Danish Institute for Human Rights. Available at: (Accessed: 04 September 2023). 

UNHCR (2023) Global appeal 2023, Global Focus. Available at:,an%20unprecedented%20spike%20in%20numbers. (Accessed: 04 September 2023). 

UNICEF (2023) ‘Availability, Accessibility, Acceptability and Quality framework: A tool to identify
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