Cover Image
close this bookHandbook for Emergencies - Second Edition (UNHCR, 1999, 414 p.)
View the document(introduction...)
View the documentUsing the Handbook
View the documentIntroduction
View the documentAbbreviations
View the documentUNHCR's Mission Statement
close this folder1. Aim and Principles of Response
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View the documentDefinition and Aim
View the documentResponsibilities
View the documentPrinciples of Response
close this folder2. Protection
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View the documentIntroduction
View the documentProtection in Emergencies
View the documentInitial Actions
View the documentPhysical Safety of Refugees
View the documentEmergencies as a Result of Changes in Government Policy
View the documentOther Persons of Concern to UNHCR
View the documentDurable Solutions
View the documentKey References
View the documentAnnexes
close this folder3. Emergency Management
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View the documentIntroduction
View the documentThe Key Emergency Management Functions
View the documentStages in Refugee Emergency Operations
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close this folder4. Contingency Planning
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View the documentPlanning as a Process
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close this folder5. Initial Assessment, Immediate Response
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close this folder6. Operations Planning
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close this folder7. Coordination and Site Level Organization
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close this folder8. Implementing Arrangements
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View the documentImplementing Arrangements
View the documentImplementing Procedures
View the documentMonitoring, Reporting and Evaluation
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close this folder9. External Relations
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View the documentRelations with Government and Diplomatic Corps
View the documentRelations with the Media
View the documentFunding and Donor Relations
View the documentFormal Written Communications
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close this folder10. Community Services and Education
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View the documentOrganizing Community Services
View the documentHuman Resources
View the documentFamily Tracing and Reunification
View the documentGroups at Risk and Vulnerable Groups
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close this folder11. Population Estimation and Registration
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View the documentPopulation Estimates
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close this folder12. Site Selection, Planning and Shelter
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View the documentOrganization of Response
View the documentCriteria for Site Selection
View the documentSite Planning: General Considerations
View the documentSite Planning: Specific Infrastructure
View the documentShelter
View the documentReception and Transit Camps
View the documentPublic Buildings and Communal Facilities
close this folder13. Commodity Distribution
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View the documentChoosing a Commodity Distribution System
View the documentComponents of Distribution Systems
View the documentThe Role of Refugee Women
View the documentMonitoring
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close this folder14. Health
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View the documentHealth Assessment, Planning, Monitoring and Surveillance
View the documentMain Health Programmes
View the documentOrganization of Refugee Health Care
View the documentHuman Resources and Coordination
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close this folder15. Food and Nutrition
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View the documentOrganization of Food Support
View the documentNutritional Assessments
View the documentGeneral Feeding Programme
View the documentSelective Feeding Programmes
View the documentInfant Feeding and use of Milk Products
View the documentKey References
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close this folder16. Water
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View the documentAssessment and Organization
View the documentThe Need
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close this folder17. Environmental Sanitation
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View the documentBasic Principles And Standards
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close this folder18. Supplies and Transport
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close this folder19. Voluntary Repatriation
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View the documentOn Route
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close this folder20. Administration, Staffing and Finance
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close this folder21. Communications
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close this folder22. Coping with Stress
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close this folder23. Staff Safety
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View the documentThe UN Security System
View the documentEssential Plans
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close this folder24. Working with the Military
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View the documentIntroduction
View the documentCategories of Military Forces
View the documentPossible Roles of Military Forces in Humanitarian Operations
View the documentCoordination Between Military Forces and Civilian Agencies
View the documentKey References
View the documentAppendix 1 - Catalogue of Emergency Response Resources
View the documentAppendix 2 - Toolbox
View the documentAppendix 3 - Memoranda
View the documentAppendix 4 - Glossary

Annexes

Annex 1 - Health Information System

In the early stages of an emergency it is essential to collect information on a weekly or monthly basis for the following tables:

Table Number

Table Description

1

Demographic information

2.1 A and B, 2.2

Crude Mortality Rate and Under five years old Mortality Rate
Cause-specific-mortality

3.1

Morbidity Incidence

  1. and 4.2 (set out in Annexes 4
  2. and 5 of chapter 15 on nutrition)
  1. Nutrition, Supplementary and Therapeutic Feeding Programmes
  1. 5.2
  1. Main causes of discharge/deaths in In-Patients Departments
  1. 7.1
  1. Deliveries: Birth (Total births and birth rate only)
  1. 7.4
  1. Cholera/Meningitis/Hepatitis/Micro-nutrients deficiencies

Collection of the information required for the other tables should be progressively introduced as the situation stabilizes.

In order to detect problems and to monitor the impact of any health programme, it is necessary to collect information over time so as to follow trends. The tables below are designed to allow tabulation of information on a weekly or monthly basis. Graphical presentation of the same information will make it easier to detect trends. The tables may need to be adjusted to reflect the needs of actual situations.

1. Demographic Information

Table 1 - Population

Camp/area
Names

Male
under 5 years

Female
under 5 years

Male
over 5 years

Female
over 5 years

Total
Population

Total

Sources of demographic information: registration Estimate Government Other

% of total population which is under 5 =

% of total population which is female =

Note: demographic information does not necessarily have to be reported in a table format. The denominator used for calculation of rates could differ from the official working figure and this should be clarified.

2. Mortality

2.1 Mortality rates

Mortality rates (segregated by age and sex) should be given per 10,000 per day

A. Crude Mortality Rate: CMR

Table 2.1 A

Camp/area
Names

Male

Female

Total

Number
of deaths

Death
Rate

Number of
deaths

Death
Rate

Number of
deaths

Death
Rate

Total

B. Under five years old mortality rates (U-5 MR)

Table 2.1 B

Camp/area
Names

Male

Female

Total

Number
of deaths

Death
Rate

Number of
deaths

Death
Rate

Number of
deaths

Death
Rate

Total

Female / Male ratio:

A graph line (to show trends) for CMR and U-5 MR could be attached.

2.2 Cause-specific mortality

Tables 2.2 (2.2 A for total population and 2.2 B for under-five population).

Male

Female

Total

Number
of deaths

% of the total
number
of deaths

Number
of deaths

% of the total
number
of deaths

Number
of deaths

% of the total
number
of deaths

Malaria

Pneumonia

Watery
diarrhoea

Bloody
diarrhoea

Measles

Meningitis

Cholera

Maternal
death (2.2 A only)

Peri/neo
natal

Malnutrition


Total

100%

100%

100%

From table 2.2 A and 2.2 B, pie charts could be attached to the report.

The list of diseases is provided as an indication.

Comments on mortality:

3. Morbidity

3.1 Incidence (Number of new cases per 1,000 of the population for the period)

Tables 3.1 (3.1A for total population and 3.1B for under-five population).

Male

Female

Total

Malaria

Pneumonia

Watery diarrhoea

Bloody diarrhoea

Measles

Meningitis

STDs

The list of diseases is provided as an indication.

3.2 Out-Patient Department (OPD) consultations

Table 3.2 Number of consultations per refugee per year.*

Camp Names

Male

Female

Total

Average

* from the total number of OPD consultations per camp, extrapolate to define the number of consultations per refugee per year. As an example: 10,000 consultations in one month in a camp of 30,000. 10,000 × 12 = 120,000 / 30,000 = 4 consultations/refugee/year.

Comments on morbidity:

4. Nutrition

4.1 Supplementary Feeding Programme Monthly Report

This table is contained in Annex 4 of chapter 15 on nutrition.

4.2 Therapeutic Feeding Programme Monthly Report

This table is contained in Annex 5 of the chapter 15 on nutrition.

4.3 Food basket monitoring

See chapter 15 on food and nutrition. If undertaken, please specify by whom and the results.

Comments on nutrition:

5. In-Patients Department (IPD) Activities

5.1 Activities

Table 5.1 (per week or month)

Hospital Name

Hospital Name

Hospital Name

A. No. of patients end
last week/month

B. No of patients
admitted

C. No. of patients end
week/month (A+B-D)

D. No. Discharged
of which:

D.1 authorized

%

D.2 unauthorized

%

D.3 deaths

%

D.4 transferred

%

No. of beds

Average length
of stay (No. Of days)

Occupancy rate

%

5.2 Main Causes of discharge/deaths in IPDs

Table 5.2 (per week or month).

Hospital Name:

Hospital Name:

Hospital Name:

Number
of cases

Number
of deaths

Number
of cases

Number
of deaths

Number
of cases

Number
of deaths

Malaria

Pneumonia

Watery
diarrhoea

Bloody
diarrhoea

Meningitis

Measles

Comments on IPDs:

6. Referral System

6.1 Total number of patients transferred for admission and where:

6.2 Causes of transfer

Table 6.2

Camp Name:

Camp Name:

Camp Name:

Number
of cases

% of the
total

Number
of cases

% of the
total

Number
of cases

% of the
total

Obstetrics

Surgery

Paediatrics

Internal
medicine

Blood
transfusion

Total

Comments:

7. Main Health Programmes
7.1 Reproductive Health
7.1.1 Safe motherhood

a. Deliveries: Birth

Table 7.1.1

Camp names

Number

Crude Birth Rate*

Total A:
a1 + a2 + a3

· a1: total # and % of birth in health centre or hospital:

· a2: total # and % of birth assisted by a Trained Birth Attendant (but outside health centre or hospital):

· a3: total # and % of other births (i.e. A - (a1 + a2):

· total number and % of complicated deliveries:

· total # of cases of neonatal tetanus:

· total # and % of deliveries with adequate Tetanus Toxoid (TT) coverage:

b. Ante-natal care (ANC)

· total # of expected pregnancies per year:

· total # of new ANC consultations (last 3 months) and % compared to expected:

· % of women with three ANC visits at delivery:

· are supplements given to pregnant women? specify criteria and supplements provided:

· RPR test (syphilis test): % of positive tests:

c. Other information

· maternal mortality: # and incidence per 100,000 live birth per year:

· Peri/neonatal mortality: # and incidence per 1,000 live birth per year:

· # of abortions and % per number of pregnancies:

· low birth weight (below 2.5 kg): provide # and percentage per total number of births:

· # and percentage of total number of births having a post-natal consultation:

7.1.2 Sexual and gender based violence

· # of cases of sexual and gender based violence per month (incidence per 10,000):

· is there any special programme for Female Genital Mutilation (where prevalent)? if yes, give brief description:

7.1.3 STDs including HIV / AIDS

· enforcement of universal precautions:

· % of blood tested for HIV before transfusion:

· % of HIV positive among blood tested:

· distribution of condoms, # and percentage of acceptance:

7.1.4 Family Planning (every three months)

· number of new acceptors in last three months, per method:

· total # and % of acceptors per method:

7.1.5 Adolescents

Is there any special programme for adolescents? if yes, give a brief description:

Comments on reproductive health:

7.2 Extended Programme of Immunizations (EPI)

· measles vaccination coverage:

· other antigens coverage:

· are there any vaccine preventable diseases prevalent in the camps?:

· comments:

7.3 Tuberculosis (every three months and not usually during the emergency phase)

· expected number of new cases per year (i.e. prevalence in country of origin):

· treatment protocols:

Table 7.3

January-March

April-June

July-September

October-Dec.

A. No. under treatment
at beginning

B. No. of new cases

C. No. of discharged
of which:

C.1 cured

%

C.2 defaulters

%

C.3 deaths

%

C.4 transferred

%

Total at end of period:
A+B-C

7.4 Cholera/Meningitis/Hepatitis/Micronutrients deficiencies etc.

On daily, weekly and/or monthly basis: number of cases, number of deaths and attack rate (cumulative) and Case Fatality Rate (cumulative). Graphic representation could be attached to the report.

7.5 Mental health

Provide a description of the mental health programme.

7.6 Training activities

Provide a description of training activities which have taken place during the reporting period: type of training, by whom, to whom, etc.

7.7 Laboratory activities

8. Information on other vital sectors

· availability of potable water: # litres per person per day

· availability of functioning latrines per # of persons

· % of population with adequate shelter

· quantity of soap available per person per month

· specify vector control activities

Annex 2 - Possible organisation of health services in a major emergency Number of births in a year

Unit/Location

Level

Health staff

Outline of major responsibilities

· Health Coordinating Committee
with all partners, this may be
decentralised as appropriate
· Refugee Health Unit (with
Ministry of Health if possible or
as part of UNHCR programme
team)

Capital/national level

· UNHCR Health Coordinator or
Health professionals,
Nutritionist, Pharmacist, Health
Administrator

· Planning and monitoring pro-
grammes
· Preparation and dissemination of
guidelines on standard procedures
· Overall coordination and supervision
· Procurement and supply of drugs and
equipment

3rd level

Regional/district Hospital

Regional or district level

· If necessary: say, 1 doctor,
2 nurses to help existing staff
(plus material support if
required, especially food and
drugs)
· Cost per patient or per treat-
ment could also be negotiated
with the hospital

· Complicated obstetric cases and
surgical emergencies on referral from
settlement
· Reference laboratory

2nd level

Health Centre (with limited beds
for overnight stay, as guidance:
1 bed per 2,000 to 5,000 refugees)

Each refugee settlement
of about 30,000

· As guidance: 2 doctors, 6-8
nurses, 1 midwife
· About 10 health workers
(1 health worker per 50 - 70
consultations per day)

· Supervision of settlement health
services including training health
workers and any selective feeding
programmes
· Treatment of patients not handled
at 1st level
· Security, distribution and use of drugs
· Basic laboratory
· Referral to third level

1st level

1 Health Post or clinic

Section level approximately
5,000 refugees

· As guidance, 1 nurse (from
above) and 2-3 refugee or
national health workers per
section

· Section level services, both preventative and basic curative care
· Supervision of outreach services

The community

Outreach services (organized by
section of, say 1 Community
Health Worker per 1,000 and
1 traditional birth attendant per
3,000 refugees)

· Refugee Community Health
Workers

· Identification of public and
individual health and nutritional
problems
· Referring sick patients to health post
· Home visiting
· Basic surveillance of mortality and
birth