Submission under this category
For a refugee to be prioritized for resettlement consideration by UNHCR under this submission category, the following four conditions must be met:
Diagnosis
- The health condition and/or disability is life-threatening without proper treatment; or
- There is a risk of irreversible loss of functions without proper treatment; or
- The particular situation/environment in the country of asylum is the reason for or significantly worsens the health condition.
Treatment
- Adequate treatment is not available, e.g. due to lack of medical facilities or expertise, or is inaccessible, e.g. due to restrictions or financial barriers in the country of asylum.
Prognosis
- The health condition and/or disability puts the individual and/or dependent family member(s) at risk in the country of asylum; or
- The particular situation/environment in the country of asylum significantly worsens the health condition and/or disability; and
- There is a favourable prognosis that treatment (including supportive rehabilitation and healthcare) and permanent residence in the country of resettlement would significantly improve the health condition and/or disability or lead to an improvement in daily functioning and quality of life.
Informed Consent
- It is the expressed wish of the individual to be permanently resettled in the third country for the purposes of undergoing medical treatment and also as a durable solution for their protection needs.
The resettlement of persons under this submission category is reserved for individuals with serious medical needs that meet all four conditions in this submission category. Opportunities for resettlement based on medical needs are extremely limited, and it is important to identify and prioritize the most serious and compelling cases that can only be addressed through resettlement under this submission category.
Given the challenges involved in the resettlement of refugees with life-threatening medical needs, it is advisable that country offices establish standard operating procedures for the referral, clinical assessment, processing and submission of medical needs cases under this category.
Most refugees with medical needs, for example, those relating to old age, disability or mental health, are unlikely to meet the high threshold to qualify for resettlement under this submission category. Refugees with medical needs that are not eligible under this submission category may still be in need of resettlement under another submission category. Consider, for example, whether such refugees are exposed to protection risks on account of their health condition and related protection needs – in which case 3.3 Legal and/or Physical Protection Needs may be a more appropriate category. In that case, relevant information as to medical needs should be carefully documented in Section 6 “Specific Needs” of the RRF, preferably endorsed by a medical assessment outlining clinical observations, treatment provided, and the availability of required treatment and/or counselling in the country of asylum.
Refugees with medical needs not considered life-threatening but, according to independent medical advice, are at risk of becoming life-threatening without adequate treatment, may be submitted under this category as normal priority.
Medical needs may be used as a secondary submission category only when the above conditions are satisfied. This may be the case where, for example, an individual requires emergency resettlement due to immediate risk of refoulement and who has a serious medical condition that warrants medical resettlement under urgent or normal priority.
Documenting medical needs in the RRF
An independent and qualified physician must assess the individual case and advise on conditions 1-3 above via the completion of the Medical Assessment Form (MAF), referring to the Medical Assessment Form (MAF) – Guidance Notes. The MAF should be complete, signed and dated. A MAF is valid for up to six months. When supporting emergency or urgent submissions, a MAF should be recent enough to accurately reflect the evolving situation and prognosis.
Relevant supporting documentation, assessments or reports should be included in the resettlement submission, in line with data protection and privacy principles (see 2.3 Data protection in resettlement). Additional general guidance on sharing child protection information can be found in chapter 3.5 of UNHCR’s BIP Guidelines.
Specific needs data that is necessary and proportionate for the purpose of facilitating settlement service provision should be set out in Section 6 “Specific Needs” of the RRF. This will help ensure that relevant information about services is made available to the individual upon arrival. Sharing of GBV-related specific needs data should be based on consent and in accordance with the GBV Guiding Principles.
The physician is responsible for identifying the recommended timeframe for medical intervention in the MAF (see the table below), which should then inform the processing priority level. The processing priority assigned in turn informs the choice of resettlement country and the submission priority, as different resettlement countries apply different modalities and timeframes for processing medical needs cases on an expedited basis. See 4.2 Resettlement processing and submission priority levels.
| Priority Level | Any medical condition that: | Time frame recommended for medical intervention |
| Emergency | is immediately life threatening. | < 1 month |
| Urgent | requires life-saving interventions but is not immediately life threatening, or is at risk of major progression or complication without further intervention. | 1 to < 6 months |
| Normal | is not life threatening or at risk of major progression/ complication, but requires intervention in order to ensure reduction of risk of progression/complications and to improve the person’s quality of life and overall functioning | ≥ 6 months |
Resettlement colleagues may be required to further prioritize cases submitted under this category. In deciding which cases to prioritize within the same priority level, attention should be given to other non-medical considerations, including the refugee claim and any additional protection risks faced by the individual and/or other family members. Compelling protection or humanitarian considerations should be emphasized in the RRF to strengthen the case.
Particular attention should be given to dependency when submitting an individual under the medical needs category. The individual may be dependent on family members and/or non-family caregivers on account of his or her medical needs, and caregivers should be resettled together with the individual, as appropriate.