Cover Image
close this bookHandbook for Emergencies - Second Edition (United Nations High Commissioner for Refugees (UNHCR) / Alto Comisionado de Naciones Unidas para los Refugiados (ACNUR), 1999, 414 p.)
View the document(introduction...)
View the documentUsing the handbook
View the documentIntroduction
View the documentAbbreviations
View the documentUNHCR's mission statement
Open this folder and view contents1. Aim and principles of response
Open this folder and view contents2. Protection
Open this folder and view contents3. Emergency management
Open this folder and view contents4. Contingency planning
Open this folder and view contents5. Initial assessment, immediate response
Open this folder and view contents6. Operations planning
Open this folder and view contents7. Coordination and site level organization
Open this folder and view contents8. Implementing arrangements
Open this folder and view contents9. External relations
Open this folder and view contents10. Community services and education
Open this folder and view contents11. Population estimation and registration
Open this folder and view contents12. Site selection, planning and shelter
Open this folder and view contents13. Commodity distribution
Open this folder and view contents14. Health
Open this folder and view contents15. Food and nutrition
Open this folder and view contents16. Water
Open this folder and view contents17. Environmental sanitation
Open this folder and view contents18. Supplies and transport
Open this folder and view contents19. Voluntary repatriation
Open this folder and view contents20. Administration, staffing and finance
Open this folder and view contents21. Communications
Open this folder and view contents22. Coping with stress
Open this folder and view contents23. Staff safety
Open this folder and view contents24. Working with the military
View the documentAppendix 1 - Catalogue of emergency response resources
View the documentAppendix 2 - Toolbox
View the documentAppendix 3 - Memoranda of understanding
View the documentAppendix 4 - Glossary

Appendix 2 - Toolbox

Table 1 - Key Emergency Indicators

Crude Mortality rate (CMR)

Normal rate among a settled population

0.3 to 0.5/10,000/day


Emergency program under control

<1/10,000/day


Emergency program in serious trouble

>1/10,000/day


Emergency: out of control

>2/10,000/day


Major catastrophe

>5/10,000/day

Mortality rate among children under 5 years old (U5MR)

Normal rate among a settled population

1.0/10,000/day


Emergency program under control

<2.0/10,000/day


Emergency program in serious trouble

>2.0/10,000/day


Emergency: out of control

>4.0/10,000/day

Clean water

Minimum survival allocation

7 liters/person/day


Minimum maintenance allocation

15-20 liters/person/day

Food

Minimum food energy requirement for a population totally dependant on food aid

2,100 kcaI/person/day

Nutrition

Emergency level:

>15% of the population under five years old below 80% weight for height


or

>10% of the population under five years old below 80% weight for height together with aggravating factors e.g. epidemic of measles, crude mortality rate > 1/10,000/day

Measles

Any reported cases. 10% or more unimmunized in the 6 months to 5 years age group

Respiratory infections

Any pattern of severe cases

Diarrhoea

Any pattern of severe cases

Appropriate shelter

Protection from wind, rain, freezing temperatures, and direct sunlight are minimum requirements


Minimum shelter

area 3.5 sq. m/person


Minimum total site area

30.0 sq. m/person

Sanitation

Lack of organized excreta and waste disposal. Less than 1 latrine cubicle per 100 persons

Table 2 - Public Health Emergency: Major Killers

Measles
Diarrhoeal Diseases
Acute respiratory infection (API)
Malaria Malnutrition

A significant increase of incidence of these conditions should prompt an immediate response (or the reporting of just one case of measles)

Table 3 - Common Health Problems

Disease

Major contributing factors

Preventive measures

Diarrhoeal
diseases

Overcrowding
Contamination of water and food
Lack of hygiene

· adequate living space
· public health education
· distribution of soap
· good personal and food hygiene
· safe water supply and sanitation

Measles

Overcrowding
Low vaccination coverage

· minimum living space standards as defined in chapter on site planning
· immunization of children with distribution of Vitamin A. Immunization from 6 months up to 15 years (rather than the more usual 5 years) is recommended because of the increased risks from living conditions

Acute respiratory infections

Poor housing
Lack of blankets and clothing
Smoke in living area

· minimum living space standards and
· proper shelter, adequate clothing, sufficient blankets

Malaria

New environment with a strain to which the refugees are not immune Stagnant water which
becomes a breeding area
for mosquitoes

· destroying mosquito breeding places, larvae and adult mosquitoes by spraying. However the success of vector control is dependent on particular mosquito habits and local experts must be consulted
· provision of mosquito nets
· drug prophylaxis (e.g. pregnant women and young children according to national protocols)

Meningococcal
meningitis

Overcrowding in areas where disease is endemic (often has local seasonal pattern)

· minimum living space standards
· immunization only after expert advice when surveys suggest necessity

Tuberculosis

Overcrowding
Malnutrition
High HIV prevalence

· minimum living space standards (but where it is endemic it will remain a problem)
· immunization

Typhoid

Overcrowding
Poor personal hygiene
Contaminated water supply
Inadequate sanitation

· minimum living space standards
· safe water, proper sanitation
· good personal, food and public hygiene and public health education WHO does not recommend vaccination as it offers only low, short-term individual protection and little or no protection against the spread of the disease

Worms especially hookworms

Overcrowding
Poor sanitation

· minimum living space standards
· proper sanitation
· wearing shoes
· good personal hygiene

Scabies1

Overcrowding
Poor personal hygiene

· minimum living space standards
· enough water and soap for washing

Xerophthalmia
Vitamin A
deficiency

Inadequate diet
Following acute infections, measles and diarrhoea

· adequate dietary intake of vitamin A
If not available, provide vitamin A fortified food
If this is not possible, vitamin A supplements
· immunization against measles. Systematic prophylaxis for children, every 4 - 6 months

Anaemia

Malaria, hookworm, poor absorption or insufficient intake of iron and folate

· prevention/treatment of contributory disease
· correction of diet including food fortification

Tetanus

Injuries to unimmunized
population
Poor obstetrical practice causes neo-natal tetanus

· good first aid
· immunization of pregnant women and subsequent general immunization within EPI
· training of midwives and clean ligatures scissors, razors, etc.

Hepatitis

Lack of hygiene
Contamination of food and water

· safe water supply
· effective sanitation
· safe blood transfusions

STD's/HIV

Loss of social organization
Poor transfusion practices
Lack of information

· test syphilis during pregnancy
· test all blood before transfusion
· ensure adherence to universal precautions
· health education
· availability of condoms
· treat partners

1 Scabies: skin disease caused by burrowing mites

Table 4 - Screening of New Arrivals - Reception Activities

a) HEALTH SCREENING

Nutritional screening

Children 1 to under 5 years:
Measure the mid-upper arm circumference (MUAC).
Any children with MUAC below 12.5 cm should be immediately referred to health or nutrition services for weighing and measuring and for nutritional assistance if required.

Measles immunization

Children aged 6 months to 12 (or even 15) years:
Immunize entire group and issue "Road to Health" or other immunization record card.
Note: It is often inpractical to vaccinate at the same time as screening. However screening could be used to evaluate the vaccination coverage.

Vitamin A prophylaxis

Given along with measles vaccine, but should not delay measles vaccination if vitamin A is not available.

Basic curative care

As required:
On-site first-line care for dehydration, respiratory infections, presumed malaria, trauma, and other life threatening conditions.

Referral to existing health care facilities.

b) DEMOGRAPHIC SCREENING

Population estimation

Everyone:
Estimate total population broken down by sex and age (0-4, 5-14, 15-44, and 44 years and over) Estimate numbers of vulnerable persons such as children up to 5 years old, pregnant/lactating women, handicapped, female heads of households, single women, and unaccompanied minors.

Table 5 - Approximate Staffing Levels for Refugee Health and Sanitation Services for a Population of 10-20,000

Community Health Worker

10-20

Traditional Birth Attendant

6-10

Public Health Nurse

1

Clinic Nurses Midwives

3-4

Doctors/Medical Assistants

1-3

Pharmacy Attendant

1

Laboratory Technician

1

Dressers/Assistants

10

Sanitarians

2-4

Sanitation Assistants

20

Table 6 - Site Planning Figures for Emergencies

RESOURCE

HOW MUCH YOU WILL NEED

Land

30 - 45 m2 per person

Sheltered space
(tents, or other structures)

3.5 m2 per person

Fire break space

A clear area between shelters 50 m wide should be provided for every 300 m of built-up area.
A minimum of 1-1.5 m should be provided between guy-ropes of neighboring tents on all sides

Roads and walkways

20-25% of entire site

Open space and public facilities

15-20% of entire site

Environmental sanitation

1 latrine seat per 20 people or ideally 1 per family sited not farther than 50 m from user accommodations and not nearer than 6 m.
1 × 100 liter refuse bin per 50 people
1 wheelbarrow per 500 people
1 communal refuse pit (2 m × 5 m × 2 m) per 500 people

Water

15 - 20 liters per person per day of clean water

Tap stands

1 per 200 persons sited not farther than 100 m from user accommodations

Warehouse space

For food grains in bags, stacked 6 m high allow 1.2 m2 of floor space per tonne

Food

2,100 kcal/person/day
This will require approximately 36 metric tonnes/10,000 people/ week of food assuming the following daily ration:




350-400 g/person/day of staple cereal
20-40 g/person/day of an energy rich food (oil/fat)
50 g/person/day of a protein rich food (legumes)

Table 7 - The Size of Things

Commodity volume per ton
(m3/1,000kg)

Approximate

Standard package stacking height

Typical maximum

Water

1

none

n/a

Food grains/beans

2

50 kg bag

20-40 bags

Flour and blended foods

2

25 kg bag

20-30 bags

DSM in bags

2.4

25 kg bag

20-30 bags

DSM in tins inside cartons

4

20 kg/carton
4 tins/carton

8 individual cartons or 20 if palletized

Edible oil in tins inside cartons

2

25 kg/carton
6 tins per carton

8 individual cartons or 20 if palletized

Oil in drums

1.4

200 liter drum

2 drums upright with wood between the rims or 3 drums on their sides

ORS

2.4

35 kg carton

3-4 m

Mixed drugs

3.5

45 kg carton

3-4 m

Clinic equipment and teaching aids

4.5

35-50 kg carton

3-4 m

Kitchen utensils

5

35-40 kg cartons

3-4 m

Family tents

4.5

35-60 kg/ unit

4.5 m *

Compressed blankets

4.5

70 units/bale
85 kg/bale

4.5 m *

Loose blankets

9

unit

3-4 m

* where equipment for stacking allows

Table 8 - Capacities and Characteristics of Various Aircraft

Aircraft make or type

Volume* capacity in m3

Weight* capacity in kg

Required* runway in m

Notes

Antanov AN-12

97

20,000

1,800

Antanov AN-124

900

120,000

3,000

Boeing B.707/320C

165

36,000

2,100

Boeing B.747

460

100,000

3,000

DC-3

21

3,000

1,200

DC-6

80

11,000

1,500

DC.8/63F

302

44,000

2,300

"stretch" version

DC.10/30F

412

66,000

2,500

Fokker F.27

65

5,000

1,200

Hercules L.100-30

120

15,000

1,400

Ramp for trucks, can land on earth/grass airstrips

llyushin IL-76

180

40

1,700

Pilatus Porter

3

950

120

Small door

Skyvan

22

2,100

500

Ramp: can take Land Rover

Transall

140

17,000

1,000

Ramp for trucks

Twin Otter

12.4

1,800

220

Small door

*Note that the minimum length of runway required and the maximum load capacity both depend on the altitude of the airport and the temperature. Capacity is reduced for long distances as more fuel must be carried. Carrying capacity will also vary with the actual configuration of the aircraft.

Table 9 - Capacities of Various Surface Transport Means

Carrier Type

volume
capacity in m3

weight
capacity in kg

Standard railway car

52

30,000

Standard sea/land container - 20ft/ 6.1 m

30

18,000

Standard sea/land container - 40ft/12.2 m

65

26,000

Large lorry and trailer

Varies

20-30,000

Large articulated lorry

Varies

30-40,000

Medium lorry

Varies

5-8,000

Long wheel base Landrover or pickup

Varies

1,000

Typical water tanker

8

8,000

Hand drawn cart

Varies

300

Camel

Varies

250

Donkey

Varies

100

Bicycle

Varies

100

Table 10 - Conversion Factors

To convert from

To

Multiply by

Length

Yards (1 = 3ft = 36 inches)

Metres

0.91

Metres (1 = 100 cm)

Yards

1.09

Miles (1 = 1,760 yds)

Kilometres

1.61

Kilometres (1 = 1,000 m)
The international nautical mile = 6,076 feet = 1.825 km

Miles

0.62

Area

Yards2 (1= 9 ft2)

Metres2

0.84

Metres2 (1 = 10,000 cm2)

Yards2

1.20

Acres (1 = 4,840 yd2)

Hectares

0.41

Hectares (1 = 100 acres = 10,000 m2)

Acres

2.47

Miles2 (1 = 640 Acres)

Kilometres2

2.59

Kilometres2 (1 = 100 ha)

Miles2

0.39

Volume

US gallons

UK gallons

0.83

UK gallons

US gallons

1.20

US (UK) pints

Litres

0.47 (0.57)

Litres

US (UK) pints

2.11 (1.76)

US (UK) gallons (1 = 8 pints)

Litres

3.79 (4.55)

Metres3

Yards3

1.31

Yards (1 = 27 ft3)

Metres3

0.77

Weight

Ounces (oz)

Grams

28.35

Grams

Ounces

0.035

Pounds (lb, 1 =16 oz)

Kilos

0.454

Kilos (kg, 1 = 1,000g)

Pounds

2.21

US short tons (1 = 2,000 lb)

Metric tons

0.91

US long tons (= UK tons, 1 = 20 hundredweight (CWT)
= 2240 lb)

Metric tons

1.02

Metric tons (MT, 1 = 1,000 kg)

US short tons

1.10

US long tons

UK tons

0.98

Temperature

Centigrade

Fahrenheit

1.8 and add 32

Fahrenheit

Centigrade

Subtract 32 and multiply by 0.56

Weight of water (at 16.7° C, 62° F)



1 litter = 1kg;
1 UK gal = 101 lb;

1 US gal = 8.33 lb;
1 ft3 = 62.31 lb

Table 11 - Radio Communications, Phonetic Alphabet

Letter

Phonetic Equivalent

A

Alpha

B

Bravo

C

Charlie

D

Delta

E

Echo

F

Fox-trot

G

Golf

H

Hotel

I

India

J

Juliet

K

Kilo

L

Lima

M

Mike

N

November

O

Oscar

P

Papa

Q

Quebec

R

Romeo

S

Sierra

T

Tango

U

Uniform

V

Victor

w

Whiskey

X

X-Ray

Y

Yankee

Z

Zulu

Table 12 - Typical Services and Infrastructure Requirements for Refugee Camps

1 latrine

per

1 family (6-10 persons)

1 water tap

per

1 community (80-100 persons)

1 health centre

per

1 camp (of 20,000 persons)

1 hospital

per

up to 200,000 persons

1 school

per

1 sector (5,000 persons)

4 commodity distribution sites

per

1 camp module (20,000 persons)

1 market

per

1 camp module (20,000 persons)

2 refuse drums

per

1 community (80 - 100 persons)