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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
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
View the documentAppendix 4 - Glossary

(introduction...)

United Nations High Commissioner for Refugees

Second Edition

Using the Handbook


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Chapters may be located quickly by using the key on the contents page. Particular subjects may be located by using the index. The handbook is structured as follows:

Section One summarizes UNHCR's mandate of international protection and the aim and principles of emergency response;

Section Two deals with emergency management;

Section Three covers the vital sectors and problem areas in refugee emergencies, including health, food, sanitation and water, as well as key field activities underpinning the operations such as logistics, community services and registration. The chapters in this section start with a summary so that readers, who might not need the full level of detail in each of these chapters, can understand the basic principles of the subject quickly;

Section Four gives guidance on the support to field operations, primarily administration and staffing;

The Appendices include UNHCR's Catalogue of Emergency Response Resources, which set out what resources can be immediately deployed, and how and when. The appendices also include a "Toolbox" which gathers, in one location, the standards, indicators and useful references used throughout the handbook.

In addition to the Catalogue of Emergency Response Resources, another key companion reference is the Checklist for the Emergency Administrator to which is annexed many of the essential UNHCR forms, policy documents, and guidelines referred to in this handbook, which are necessary for the administrator setting up a new office. Another key companion reference is the UNHCR Manual- this is valid at time of going to press; however, chapter 4 of the Manual dealing with programme and project management is due to be updated and replaced by the Operations Management System Field Manual.

Any part of this handbook may be copied or adapted, provided that the source is acknowledged.

Introduction

Effective emergency preparedness and response has been a major priority of UNHCR throughout the decade. In 1991, during my first field mission as High Commissioner, I witnessed the sudden and dramatic exodus of hundreds of thousands of Kurdish refugees from their homes in Iraq to Turkey and the Islamic Republic of Iran. Since then, the Office has responded to a long list of massive outflows.

These crises have caused widespread human suffering and put great demands on our Office, prompting us to develop an effective and speedy response mechanism. We have established a revolving internal roster that ensures the deployment of UNHCR staff within 72 hours. Standby arrangements with external agencies for rapid deployment of their staff have also been created. We have devised and implemented staff training, as well as specific management tools to maintain our readiness to respond quickly and effectively to emergency situations. To address humanitarian needs urgently, a centralized stockpile of goods has been assembled, which includes governmental packages of humanitarian assistance.

Having dispatched over 300 missions throughout the world since 1992, the office now has in place a solid emergency response model, an achievement for which we can all be proud. Undoubtedly, this model will face further challenges as grave human displacements continue to occur. However, this pattern is changing from the humanitarian emergencies of the early nineties. Arising more frequently now are scattered crises, often of a relatively smaller scale and with limited international visibility. Conflicts are mostly internal and more localized, although external involvement continues to play an important role. Those forced to flee their homes, as well as the humanitarian workers assisting them, are increasingly targeted by the warring factions. On the positive side, improved communications, even in some remote locations, have enhanced our ability to operate. In addition, UNHCR has worked under new cooperative arrangements with other humanitarian agencies or even governmental institutions, including military forces.

This revised and updated Handbook provides useful guidance as our Office continues to cope with the swift and increasingly dangerous nature of fresh displacement. It stresses the importance of pre-emergency planning, as well as planning throughout every stage of a crisis. It focuses on setting coordination priorities, as well as contingency and operational planning. Important information has also been included regarding staff safety and working with military personnel, as well as a section addressing the issue of how to cope with personal stress.

Reflected in this edition is the dedication and experience of field staff and specialists both within the office and from partner organizations, which spans the last 17 years since the original UNHCR Handbook was first published. I would like to gratefully acknowledge what is an exemplary group effort.

This Handbook will assist colleagues to meet the challenges ahead as we cope with the changing nature of emergencies. It should serve as a reminder that displacement crises require carefully prepared and well managed responses that optimize the unique strength and capacities of various groups and organizations. As we face these new challenges, let us look forward to fine tuning this response model that our Office has worked so hard to establish.

Abbreviations

Organizations

DPKO

Department of Peace-keeping Operations

FAO

Food and Agriculture Organization of the United Nations

IASC

United Nations Inter-Agency Standing Committee

ICRC

International Committee of the Red Cross

IFRCS

International Federation of the Red Cross and Red Crescent Societies

ILO

International Labour Organization

MCDU

Military and Civil Defence Unit of OCHA

OAU

Organization of African Unity

OCHA

Office for the Coordination of Humanitarian Affairs

UNDP

United Nations Development Programme

UNICEF

United Nations Children's Fund

UNSECOORD

United Nations Security Coordinator

WFP

World Food Programme

WHO

World Health Organization


Other Abbreviations

DO

Designated Official

ABOD

Administrative Budget and Obligation Document

DSA

Daily Subsistence Allowance

ERC

Emergency Relief Coordinator

GIS

Geographical Information Systems

IDP

Internally Displaced Persons

IOM/FOM

Inter-Office Memorandum/Field Office Memorandum

NGO

Non-governmental Organization

MT

Metric tonne

SITREP

Situation Report

UNHCR's Mission Statement


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UNHCR, the United Nations refugee organization, is mandated by the United Nations to lead and coordinate international action for the world-wide protection of refugees and the resolution of refugee problems.

UNHCR's primary purpose is to safeguard the rights and well-being of refugees. UNHCR strives to ensure that everyone can exercise the right to seek asylum and find safe refuge in another state, and to return home voluntarily. By assisting refugees to return to their own country or to settle in another country, UNHCR also seeks lasting solutions to their plight.

UNHCR's efforts are mandated by the organization's Statute, and guided by the 1951 United Nations Convention relating to the Status of Refugees and its 1967 Protocol. International refugee law provides an essential framework of principles for UNHCR's humanitarian activities.

UNHCR's Executive Committee and the UN General Assembly have also authorized the organization's involvement with other groups. These include people who are stateless or whose nationality is disputed and, in certain circumstances, internally displaced persons.

UNHCR seeks to reduce situations of forced displacement by encouraging states and other institutions to create conditions which are conducive to the protection of human rights and the peaceful resolution of disputes. In pursuit of the same objective, UNHCR actively seeks to consolidate the reintegration of returning refugees in their country of origin, thereby averting the recurrence of refugee-producing situations.

UNHCR offers protection and assistance to refugees and others in an impartial manner, on the basis of their need and irrespective of their race, religion, political opinion or gender. In all of its activities, UNHCR pays particular attention to the needs of children and seeks to promote the equal rights of women and girls.

In its efforts to protect refugees and to promote solutions to their problems, UNHCR works in partnership with governments, regional organizations, international and non-governmental organizations. UNHCR is committed to the principle of participation by consulting refugees on decisions that affect their lives.

By virtue of its activities on behalf of refugees and displaced people, UNHCR also promotes the purposes and principles of the United Nations Charter: maintaining international peace and security; developing friendly relations among nations, and encouraging respect for human rights and fundamental freedoms.

(introduction...)


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Definition and Aim

1. The majority of UNHCR's operations begin as a result of an emergency caused by a sudden influx of refugees1. The organization and procedures of UNHCR reflect this; much of UNHCR's normal work is in effect an emergency response. There are, however, situations that are clearly exceptional. This handbook addresses the needs of such situations.

Definition of

2. The distinction is one of degree: a definition of a refugee emergency for the purposes of UNHCR and this handbook might be:

any situation in which the life or well-being of refugees will be threatened unless immediate and appropriate action is taken, and which demands an extraordinary response and exceptional measures.

3. What is important is less a definition than the ability to recognize in time the development of situations in which an extraordinary response will be required of UNHCR in order to safeguard the life and well-being of refugees.

4. Much of the handbook is concerned with guidelines on the protection and material assistance likely to be needed when large numbers of refugees cross frontiers to seek asylum i.e. an emergency caused by a sudden influx of refugees.

5. Such emergencies are, of course, not the only situations which demand an extraordinary response of UNHCR. Equally swift action will be required in other types of emergency. For example, an emergency can develop in an existing operation, such as when events suddenly place in danger refugees who had previously enjoyed asylum in safety (discussed in chapter 2 on protection). It can also erupt during the final phase of an operation as in the case of a large-scale repatriation (discussed in chapter 19 on voluntary repatriation). In addition there are complex emergencies, which are humanitarian crises involving the competence of more than one UN agency (see chapter 7 on coordination for a full definition). The general guidance provided in this handbook will be useful to these types of emergencies as well.

Aim

The aim of UNHCR's emergency response is to provide protection to persons of concern to UNHCR and ensure that the necessary assistance reaches them in time.

1 For convenience, "refugee" is used in this handbook to refer to all persons of concern to UNHCR. The different categories of persons of concern, including refugees, are defined in chapter 2 on protection.

Responsibilities

Governments and UNHCR

6. Host governments are responsible for the security and safety of, assistance to, and law and order among refugees on their territory. Governments often rely on the international community to help share the burden, and UNHCR provides assistance to refugees at the request of governments.

The statutory function of providing international protection to refugees and seeking permanent solutions for their problems is however, always UNHCR's responsibility.

7. The role of UNHCR in emergency operations is primarily to protect refugees. UNHCR assists and complements the work of the government by acting as a channel for assistance from the international community, and by coordinating implementation of the assistance. Whatever the organizational manner in which UNHCR provides emergency assistance in response to a government request, UNHCR is responsible for ensuring that the protection and immediate material needs of the refugees are met in an effective and appropriate manner.

UN Organizations

8. The material needs of refugees are likely to cover sectors for which other organizations in the UN system have special competence. In particular, the World Food Program (WFP), with which UNHCR has established a close partnership, provides the major part of the emergency food needs of refugees. In recognition of each organization's comparative advantages and skills, and with the aim of giving consistency and predictability to the relationships between them, UNHCR has concluded Memoranda of Understanding (MOUs) with a number of UN organizations. These MOUs also cover issues related to emergency preparedness and response, such as joint contingency planning, joint assessments and development of standards and guidelines, as well as programme implementation. Notable among these are the MOUs with WFP, the United Nations Development Programme (UNDP) and the United Nations Children's Fund (UNICEF), which are contained in Appendix 3. UNHCR has also signed MOUs with the United Nations Population Fund (UNFPA), the United Nations Development Fund for Women (UNIFEM) and the World Health Organization (WHO).

9. Responsibility for coordinating the response of the UN system to a refugee emergency normally rests with UNHCR.

10. The UN body charged with strengthening the coordination of humanitarian assistance of the UN to complex emergencies is the Office for the Coordination of Humanitarian Affairs (OCHA)2, through coordination, policy development and advocacy. Complex emergencies are defined and discussed in more detail in chapter 7 on coordination.

Non-Governmental Organizations

11. Large numbers of non-governmental organizations (NGOs) provide assistance to refugees in emergencies. These organizations often act as UNHCR's operational partners. The division of responsibilities is determined by the implementing arrangements agreed between them, the government and UNHCR regardless of whether funding is from UNHCR or elsewhere. This is discussed in more detail in chapters 7 and 8 on coordination and implementing arrangements.

Other Organizations

12. A number of other organizations also act as operational partners in the provision of assistance to refugees in emergencies. In particular, the International Committee of the Red Cross (ICRC), the International Federation of Red Cross and Red Crescent Societies (IFRCS) with the National Red Cross and Red Crescent Societies, have long provided such assistance. The ICRC mandate requires a high degree of operational neutrality and independence, which sometimes limits their participation in coordination mechanisms and the exchange of information between them and other organizations.

13. Other operational partners could include inter-governmental organizations, for example the International Organization for Migration (IOM). The objective of IOM is to ensure the orderly migration of persons who are in need of international migration assistance. IOM works subject to the agreement of both (or all) the states concerned with the migration. IOM has worked closely with UNHCR, notably by assisting with voluntary repatriation.

2 This was formerly known as the Department of Humanitarian Affairs (DHA).

The Refugees

14. Beyond the right to international protection under the Statute of UNHCR and under the 1951 Refugee Convention and 1967 Protocol, all refugees, as indeed all persons, have certain basic human rights. These are enshrined in the Charter of the United Nations and in the Universal Declaration of Human Rights: the fundamental right to life, liberty and security of person; protection of the law; freedom of thought, conscience and religion; and the right to own property. Refugees have the right to freedom of movement. However, it is recognized that, particularly in cases of mass influx, security considerations and the rights of the local population may dictate restrictions.

15. Refugees and displaced persons also have, of course, responsibilities towards the country where they have sought refuge. These are set out in Article 2 of the 1951 Convention: "Every refugee has duties to the country in which he finds himself, which require in particular that he conform to its laws and regulations as well as to measures taken for the maintenance of public order." The civilian nature of refugee status must be respected.

Defining Responsibilities

16. All those involved, both inside and outside the UN system, should have clearly defined responsibilities within a single overall operation. This can be achieved through the establishment of an appropriate coordinating structure at various levels to ensure that duplication of effort and gaps are avoided. In certain situations, the coordinating role of UNHCR may need to be more direct and operational, both in planning and executing the emergency response, and in providing expertise in specific sectors.

Principles of Response

Introduction

17. Whatever the framework of responsibility for a particular refugee emergency, certain principles of response are likely to be valid. Many of these are common themes in the chapters that follow.

18. By definition, the needs of a refugee emergency must be given priority over other work of UNHCR. This is essential if the aim of ensuring protection and timely assistance to refugees is to be met. Leadership and flexibility are required of UNHCR in an emergency.

Get the Right People to the Right Place at the Right Time

19. The single most important factor in determining whether or not sufficient emergency assistance reaches the refugees in time will probably be the people involved in organizing and implementing the operation.

Enough UNHCR and implementing partner staff of the right calibre and experience must be deployed to the right places, and equipped with the authority, funds, material and logistical support needed.

No amount of expertise and experience can substitute for organizing ability, flexibility, a readiness to improvise, ability to get on with others, ability to work under pressure no matter how difficult the conditions, tact, sensitivity to other cultures and particularly to the plight of refugees, a readiness to listen, and, not least, a sense of humour.

Ensure the Measures are Appropriate

Identify Needs

20. An appropriate response in the provision of protection and material assistance requires an assessment of the needs of refugees that takes into account not only their material state and the resources available, but also their culture, age, gender and background and the culture and background of the nationals in whose country they are granted asylum. The provision of protection and of essential goods and services must be provided to refugees in ways which actually meet their needs.

Be Flexible and Respond to Changing Needs

21. What is appropriate will vary with time. In the early stages of a major emergency special measures that rely heavily on outside assistance may be necessary. However, as a general principle, the response should draw to the extent possible on local resources, materials and methods, and should, for example, avoid regimented refugee camps. Solutions that can be readily implemented with existing resources and simple technologies should be sought.

Identify Standards

22. It is an important responsibility of UNHCR to determine with the government and operational partners the standards of assistance that are appropriate. This requires expertise in a number of disciplines. The guidelines in Section III of this handbook suggest general considerations, to be modified in light of the circumstances of each emergency. Appendix 2 (Toolbox) also contains standards. What is to be decided for each sector is the correct level of total assistance from all sources.

23. As a general principle, the standards of assistance must reflect the special needs of the refugees based on their condition, physical situation and experiences. At the same time account must be taken of the standards planned for and actually enjoyed by the local population.

24. If the standards have been correctly determined, they cannot later be lowered without harm to the refugees. The refugees must, for example, receive a minimum basic food ration. Outside contributions required to reach the standards will, however, naturally be reduced as the refugees become more self-reliant.

Always Remember the Longer Term Objectives

25. A final general principle in considering the appropriateness of measures is that, from the start, resources must be divided between immediate needs and action aimed at longer-term improvements and the prevention of problems. For example, resources must be devoted to general public health measures as well as to the treatment of individual diseases, which will include many that could be prevented by better water and sanitation. Emergency assistance is to be allocated to the maximum extent possible to activities which will be of lasting benefit, thus keeping any relief phase as short as possible.

26. From the beginning of an emergency, and even during preparations for an emergency, planning must take into account the post emergency phase as well as the envisaged durable solutions.

Involve the Refugees and Promote Self-reliance

27. In order to ensure that the assistance provided to refugees is appropriate, the refugees must be involved from the outset in the measures taken to meet their needs. In addition, all components of the operation must be planned in such a way as to promote their self-reliance. Obvious as this principle is, the pressures of an emergency often make it easier to organize an operation from the outside for, rather than with, those whom it is to benefit.

28. If the emergency operation involves the refugees in this way from the start, its effectiveness will be greatly enhanced. Furthermore, such an approach will allow the refugees to maintain their sense of dignity and purpose, encourage self-reliance and help avoid dependency. In emergencies, refugees are often regarded as helpless and passive recipients of external assistance. In the long term this sets a pattern of dependency. Refugees must be encouraged to help themselves by using their own skills and resources from the beginning of an emergency.

It is important to encourage refugee participation at all stages of planning and implementation.

29. Refugees are often most able to help themselves, and thus be least reliant on outside assistance, if they are not grouped together in highly organized camps, but rather reside in small, less formal groups.

30. The interests and needs of specific groups of refugees, particularly vulnerable ones, are better cared for and such efforts are more sustainable if community support and involvement is harnessed right from the start. In addition, refugee involvement helps ensure that the emergency response addresses social, human and emotional needs, and goes beyond the provision of material relief.

Be Aware of Social and Economic Roles

To plan and manage an emergency response effectively, the social and economic roles of refugee women, men and children must be properly analyzed and understood to see how these roles will affect and be affected by, planned activities3.

31. It is essential to understand socio-economic factors when planning and implementing the emergency response to avoid unintentionally depriving some refugees of the benefits of assistance. This is often true for women, children, the elderly and the disabled. UNHCR pays particular attention to the needs of these groups, especially in emergencies. It is important that the basic needs of vulnerable groups (physically, mentally, or socially disadvantaged) are met. Thus in the ning and implementation of an emergency response, vulnerable groups must be identified and monitored systematically to ensure that they are not further disadvantaged. If necessary, special measures should be taken to meet their particular needs.

32. Even in an emergency, refugees are likely to have some form of representation, through a community or group organization.

It is important to find out exactly what kind of leadership structure exists.

It is also through an effective use of their representation that refugees' rights can be better promoted. However, be aware that leaders may sometimes not be representational, or may have an agenda or objectives which could have adverse consequences on other refugees.

3 In UNHCR this method for assessment and planning is known as "People Oriented Planning", and discussed in detail in A Framework for People-Oriented Planning in Refugee Situations Taking Account of Women, Men and Children, UNHCR, Geneva 1992

Do Not Treat Issues in Isolation

33. In all stages of an emergency, the problems and needs of refugees must be seen comprehensively, and sector-specific tasks be set within a multi-sectoral framework, since action in one area is likely to affect others. For example the real solution to a health problem might be found in improving the water supply. Ensure the correct balance in resource allocation between the different sectors.

A multi-sectoral approach must be a fundamental feature of an emergency response.

Ensure Environment is Considered at an Early Stage

34. Similarly, issues which are cross-cutting in nature should not be neglected. This is often the case with issues concerning vulnerable groups, children, women, and the environment. Environment concerns must be taken into account from the earliest stage. In an emergency involving large-scale population displacements, some environmental damage is unavoidable. Such damage can have an adverse effect on the health and well-being of the refugees and their host community. The emergency phase is therefore, a critical time to institute measures which limit environmental degradation. Environmental problems created at this stage become increasingly difficult and costly to redress. Every effort should be made to prevent, or at least minimize, irreversible environmental impacts caused by the emergency response activities and the presence of refugees.

Work for Durable Solutions

35. When an emergency occurs, actions taken at the very outset can have important longer-term consequences. Clear and consistent policies from the beginning will have an important long-term effect. Similarly, the immediate response of the international community to a major influx of refugees must take into account the ultimate aim of promoting a durable solution to the problem. This requires that the response both encourages the self-reliance of the refugees and reduces prolonged dependency on outside relief, and that it does nothing to prevent the promotion of a long-term solution as soon as possible.

36. As a general principle, the best solution is voluntary repatriation. Where this is not possible, assimilation within the country of asylum (local settlement) is in most circumstances preferable to assimilation within another country (resettlement), particularly for large groups and in cases where resettlement would take place in a cultural environment alien to the refugees. There may, however, be situations in which resettlement is the only way to ensure protection.

Monitor and Evaluate the Effectiveness of Response

37. Whatever the nature of the emergency, the action required of UNHCR is likely to vary with time and as circumstances change.

It is essential that the effectiveness of the response be kept constantly under review and action adjusted as necessary and in time.

This will require sound monitoring, reporting and evaluation systems, including indicators, to detect deterioration or change, and also a continuous review of the aims of UNHCR's assistance, both in terms of bringing the emergency to an early end and for the promotion of a durable solution.

38. Such monitoring must also ensure that the funds provided voluntarily to UNHCR by governments and others are being used to the best advantage. This is inherent in the principle of appropriate response. It should be borne in mind that whatever funds may be available in the early stages of an acute humanitarian emergency, the passage of time will produce financial constraints. Thus it is important that actual and potential donors see that the action proposed is indeed essential, and that its impact is effective.

Finally, an emergency response must address fully the specific needs of children, be gender sensitive and cognizant of the impact of its policies and practices on the environment.


Figure

(introduction...)


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Introduction

UNHCR's Mandate

1.

UNHCR's fundamental responsibilities are to:

i. Provide international protection to refugees; and

ii. Seek permanent solutions for their problems.

2. The need for international protection arises from the fact that refugees, unlike ordinary aliens, no longer have the protection of their home country. International protection is a temporary substitute for the protection normally provided by States to their nationals abroad until the refugee can again benefit from national protection.

In an emergency it must first be established that the persons endangered are of Concern to UNHCR and thus entitled to protection.

3. The legal basis for securing this protection, the aim of protection, and the means to provide it, must be clearly understood. This chapter addresses these questions.

Legal Instruments

4. All UNHCR staff must be familiar with the key international instruments covering the protection of refugees. Of fundamental importance are the following:

i. Statute of the Office of the United Nations High Commissioner for Refugees;

ii. 1951 Convention Relating to the Status of Refugees and its 1967 Protocol;

iii. 1969 Convention Governing the Specific Aspects of Refugee Problems in Africa of the Organization of African Unity (OAU); iv. 1984 Cartagena Declaration on Refugees, and 1994 San Jose Declaration.

5. Annex 1 lists these and other relevant international instruments and their main purpose(s).

6. Refugees enjoy basic human rights set out in instruments such as the Universal Declaration of Human Rights, and other instruments listed in Annex 1, as well as the rights they have as refugees which are described in the various refugee instruments.

Refugee Definition

7. A refugee is defined as:

any person who is outside his/her country of origin and who is unwilling or unable to return there or to avail him/herself of its protection because of:

i. a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion; or

ii. a threat to life or security as a result of armed conflict and other forms of widespread violence which seriously disturb the public order.

Whether a person is a refugee is not dependent on formal recognition, but on the fact of meeting the definition of refugee.

Protection in Emergencies

8. On the spot presence and quick action are generally crucial to the attainment of UNHCR's objectives, particularly where there is danger of refoulement or abuses such as arbitrary detention or mistreatment.

The aim of international protection in emergencies is to:

i. Ensure admission and at least temporary asylum;

ii. Prevent forcible return ("refoulement");

iii. Ensure refugees are treated according to basic human rights standards.

Admission and Non-refoulement

9. The first and most urgent priority is to ensure refugees' right to asylum is respected, and to ensure they are not forcibly returned (refouled).

Non-refoulement

10. Of cardinal importance is the principle of non-refoulement. This principle is set out in Paragraph 1 of Article 33 of the 1951 Convention which states that:

"No Contracting State shall expel or return ("refouler") a refugee in any manner whatsoever to the frontiers of territories where his life or freedom would be threatened on account of his race, religion, nationality, membership of a particular social group or political opinion".

Non-refoulement includes not rejecting or turning away a refugee at the border, as well as not returning him/her subsequent to admission to a country where he/she could face persecution.

11. The 1951 Convention provides for very limited exceptions to the principle of non-refoulement of refugees, namely, for those reasonably regarded as a danger to the security of the country where they are, or for those who, having been convicted by a final judgement of a particularly serious crime, constitute a danger to the community of that country.

12. The principle of non-refoulement has found specific expression in a number of international instruments adopted at the universal and regional levels.

13. Because of its fundamental and universally accepted character, the principle of non-refoulement has been recognized as a principle of customary international law, and hence binding on all states.

Non refoulement is a principle of international law and binding on all States irrespective of whether or not they are party to the 1951 Convention or other international refugee instrument

Admission

14. Asylum seekers must be admitted to the state in which they seek refuge, without discrimination as to race, religion, nationality, political opinion or physical incapacity. The Universal Declaration of Human Rights states that:

"Everyone has the right to seek and to enjoy in other countries asylum from persecution".

15. The General Assembly, on adopting the UNHCR Statute, called on governments to cooperate with the High Commissioner in the performance of his/her functions by, admitting refugees to their territories.

16. Refugees may not be able to meet normal immigration requirements because of their flight. The 1951 Convention obliges states not to penalize refugees for having entered their host country without the legally required formalities.

Status Determination

17. Refugees may be recognized either on the basis of "prima facie" group determination, or following individual status determination.

18. At the outset of an emergency when asylum-seekers arrive in large numbers over a short period of time, it is often impractical to resort to an individual determination of refugee status for each member of the group. In most emergencies those seeking refuge may be of concern to UNHCR, and the Statute calls for action on their behalf. When protection is clearly an urgent humanitarian need, the benefit of the doubt has to be accorded at least until a considered opinion is available.

In the case of mass influx, the aim is to secure treatment in accordance with universally recognized humanitarian principles not necessarily directly linked to the legal status of those in heed. Speed of intervention to secure protection is thus the first priority.

19. In such circumstances, UNHCR and states usually resort to refugee status determination for the entire group based on their knowledge of objective conditions in the country of origin. Every member of the group is thus considered a refugee prima facie, i.e. a refugee in the absence of evidence to the contrary.

Persons Excluded From Refugee Status

20. Certain persons do not fall under the High Commissioner's competence and are excluded from protection. These are persons with respect to whom there are serious reasons for considering that they have committed a crime against peace, war crimes (e.g. torture or execution of prisoners), crimes against humanity (e.g. genocide), serious non-political crimes (e.g. murder or rape) outside the country of refuge, or acts contrary to the purposes of refuge, or that they have been guilty of acts contrary to the purposes and principles of the United Nations.

21. Headquarters must be informed immediately of such situations and as a rule, criteria for decisions on exclusion should be taken in consultation with Headquarters. Note that asylum seekers can be given prima facie recognition as refugees on a group basis, but can only be excluded from refugee recognition on an individual basis.

UNHCR and States' Responsibilities

22. The High Commissioner's universal protection responsibilities have been placed on him/her by the General Assembly (Statute of UNHCR). The exercise of the international protection function by UNHCR is not dependent upon a request by the government concerned.

23. In countries that are parties to the relevant legal instruments, UNHCR's protection function is facilitated. The 1951 Convention obliges States which are parties to the Convention to cooperate with UNHCR in the exercise of its functions and in particular to facilitate UNHCR's duty of monitoring the application of the Convention's provisions. The 1969 OAU Convention contains a similar clause.

24. Even when an emergency occurs in a country not party to the relevant international instruments, some of the principles embodied in the Convention are considered customary international law and hence are binding on all states. Foremost amongst them is the principle of non-refoulement. In addition, the moral strength and standard setting value of the conclusions of UNHCR's Executive Committee (EXCOM) is not limited to states which are members of the Executive Committee (see chapter 9 on external relations for more details on EXCOM members).

Basic Refugee Standards

25.A set of internationally recognized basic standards of treatment applicable in refugee emergencies has been agreed1.

a) Refugees and asylum seekers should not be penalized or exposed to any unfavourable treatment solely on the ground that their presence in the country is considered unlawful; they should not be subjected to restrictions on their movements other than those which are necessary in the interest of public health and public order;

b) They should enjoy the fundamental civil rights internationally recognized, in particular those set out in the Universal Declaration of Human Rights;

c) They should receive all necessary assistance and be provided with the basic necessities of life including food, shelter and basic sanitary and health facilities; in this respect the international community should conform with the principles of international solidarity and burden-sharing;

d) They should be treated as persons whose tragic plight requires special understanding and sympathy. They shoud not be subjected to cruel, inhuman or degrading treatment;

e) There should be no discrimination on the grounds of race, religion, political opinion, nationality, country of origin or physical incapacity;

f) They are to be considered as persons before the law, enjoying free access to courts of law and other competent administrative authorities;

g) The location of asylum seekers should be determined by their safety and well-being as well as by the security needs of the receiving State. Asylum seekers should, as far as possible, be located at a reasonable distance from the frontier of their country of origin. They should not become involved in subversive activities against their country of origin or any other State;

h) Family unity should be respected;

i) All possible assistance should be given for the tracing of relatives;

j) Adequate provision should be made for the protection of minors and unaccompanied children;

k) The sending and receiving of mail should be allowed;

l) Material assistance from friends or relatives should be permitted;

m) Appropriate arrangements should be made, where possible, for the registration of births, deaths and marriages;

n) They should be granted all the necessary facilities to enable them to obtain a satisfactory durable situation;

o) They should be permitted to transfer assets which they have brought into a territory to the country where the durable solution is obtained; and

p) All steps should be taken to facilitate voluntary repatriation.

1 These were adopted by UNHCR's Executive Committee in 1981, Conclusion No 22.

Temporary Protection

26. Some countries adopt a narrow definition of the term "refugee" which does not encompass those persons who are fleeing from armed conflict (such persons are considered refugees within the definition contained in, for example, the OAU Convention). In countries with a narrow definition, the term "temporary protection" has been used to describe protection extended to categories of persons clearly in need of international protection, but in respect of whom recognition as refugees would present difficulties, either because they would not fall under the narrow definition, or because individual status determination would not be practical in view of the numbers of persons involved.

27. The basic elements of temporary protection include:

i. Admission to the country of refuge;

ii. Respect for basic human rights, with treatment in accordance with internationally recognized humanitarian standards (e.g. those basic refugee standards listed above);

iii. Protection against refoulement;

iv. Voluntary repatriation when conditions in the country of origin allow. Persons admitted to a country under a temporary protection scheme generally are not provided access to the full range of benefits accorded to individuals who are recognized as refugees.

Initial Actions

Introduction

28. The legal basis on which UNHCR intervenes to secure the protection of refugees is contained in the instruments mentioned above. Frequently the practical course of action to be adopted is, however, of more concern than the legal instruments themselves.

Often protection depends less on the fine print of a statute and more on swift appropriate action by UNHCR field staff.

29. In order for UNHCR to effectively discharge its protection mandate, the staff of the organization must have free and unhindered access to all refugees and asylum seekers irrespective of their location.

30. It should be borne in mind that action taken at the outset of an emergency may have significant long-term consequences, both for continued protection, including perhaps for other groups of refugees within the country, and for the promotion of durable solutions.

Rapid Deployment, Continuing Presence and Free Access

31. The first priority is rapid deployment of staff.

A continuing UNHCR presence with direct and unhindered access to refugees should be established in the area concerned for as long as required.

Free access and continuing presence are the vital practical support to ensuring UNHCR's mandate. Sufficient female staff must be present as this will help ensure that women refugees can express protection problems, and that these problems are recognized and dealt with appropriately.

Assessment

32. Good protection requires good information. UNHCR staff, often together with local officials, should visit all points of influx and refugee locations to gather information from refugees regarding the issues and questions set out in Annex 1 to chapter 5 on initial assessment (in particular those relating to who the refugees are, where they are from, why they have fled and identification of vulnerable groups). In addition, the refugees should be asked about the situation along the flight route and any problems encountered upon entering the country of refuge.

33. Sources of information must be developed and direct communication with contacts established in the field to ensure that UNHCR is quickly informed of any new influx or protection problem. Such open lines of communication are especially important for border regions which are remote from the capital, where UNHCR may not yet have a local presence.

34. Potential sources of information include:

Asylum seekers themselves;

Local or central government authorities;

Community and religious leaders;

National and international NGOs;

ICRC, if present;

Other UN and international organizations;

National (particularly local language) and international news media.

35. If possible the central authorities should participate in fact finding missions, as this reduces the risk of misunderstanding between UNHCR and the central authorities and between the central and local authorities.

Ensuring Respect for Non-refoulement

36. The best way to ensure respect for the principle of non-refoulement and basic human rights is to create awareness among national authorities at all levels. In a crisis situation, it may not be possible to provide formal training, but in daily contacts with camp authorities, local authorities, army personnel and border officials, the principle of non-refoulement must be made clear. Give concrete examples to the authorities of what can happen to a refugee who is returned: it can mean loss of life. Awareness may also need to be raised in the local population -the media may provide a forum - and public opinion can be an important influence.

Ensuring an Understanding of UNHCR's Mandate

37. The basis for UNHCR's concern and involvement should be explained in as practical terms as possible. Local officials may not know of UNHCR's mandate, nor of the assistance which UNHCR may already be giving elsewhere in the country.

The approach Should stress that the work of the High Commissioner is of an entirely non-political character and is strictly humanitarian and social.

Border Presence

38. Develop good contact with border authorities and monitor cross border movements: this also helps provide contact with the refugees, and gives information about what is happening in the country of origin as well as potential problems in border crossings on both sides of the border. If it is not possible for staff to be present at all border crossing points on a permanent basis, each crossing point should be checked frequently.

39. Any protection problems relating to the admission or treatment of refugees at the border should be brought immediately to the attention of the competent authorities in the host country and any other country involved, for urgent remedial action.

Location of Refugees

40. Refugees should be accommodated sufficiently far away from the borders of the country of origin to avoid security problems.

Maintaining Contact with Local Authorities

41. At both the local and central level, there must be assured access at all times to those officials whose decisions will affect the refugees' situation. Establish who they are, contact them and if possible request home telephone numbers and other means of communication so that if a protection problem arises it can be brought to the right official's attention at once. Refoulements often take place very rapidly.

42. The most senior local official directly responsible should be approached and requested to allow (at least temporary) asylum. In some cases this may be the local military commander for a region.

43. NGOs may be able to advise on the local infrastructure and decision-making process, and influential local personalities, such as community or religious leaders, may be helpful.

44. Local authorities should be kept informed of demarches UNHCR has made or intends to make in the capital - these should not only be the demarches of a political or formal nature, but also those covering practical and assistance aspects of the programme.

Protection and Assistance

45. Protection and material assistance should be planned as complementary parts of a single UNHCR operation. Assistance cannot be provided without assured asylum and without life-sustaining material assistance, protection alone will not preserve the lives and well-being of the refugees. There should be an early indication that UNHCR's intervention may result in material assistance - in other words, that the granting of asylum and meeting of immediate needs will not be a burden on local authorities' budgets. Field Officers must receive early guidance contained in section III on the extent to which commitments on material assistance may be given, in order to communicate this information with local authorities. If the influx consists of additional asylum seekers clearly belonging to a group already assisted by UNHCR, a firm assurance of material assistance within the means available is usually given. Although the link between such assistance and protection responsibilities is self-evident to UNHCR, it should be borne in mind that the connection is not necessarily so clear to local or central authorities.

Registration

46. A registration exercise should be conducted at the earliest possible stage of an emergency operation (for more details see chapter 11 on population estimation and registration).

Women and Children

47. Refugees, and in particular women and children, travelling alone or in small groups in remote border areas, are very vulnerable to extortion, abuse and sexual violence. A proactive approach is needed to ensure that protection needs are met.

UNHCR considers a child to be:

a person below the age of 18 years, unless, under the law applicable to the child, majority is attained earlier,

as defined in the Convention on the Rights of the Child.

Note that gender-related persecution can be considered a ground for recognition under the definition of refugee.

UNHCR's Guidelines on the Protection of Refugee Women, and Refugee Children: Guidelines on Protection and Care (see key references) are essential reading for those designing a protection programme. More information on the procedures noted below is contained in section III of the Handbook, in particular chapter 10 on community services.

48. Prevent protection problems for refugee women and children through good programme design in all sectors, including:

Obtaining a good knowledge of the population profile, especially the breakdown by sex and age;

Preserving the original family and community structures;

Consulting women on the design of the assistance programme, in particular on the design of the refugee camp and on the commodity distribution system;

Locating services so as not to expose refugee women to additional risk when using them;

Providing lighting in the camp especially along paths to latrines;

Ensuring an adequate number of women staff, particularly protection, community services and health staff;

Forming security patrols among the refugees themselves having the protection of women as a priority;

Providing training for police and military personnel on the rights of women and children, especially in circumstances where there is a heavy military or police presence;

Initiating tracing as soon as possible. Appropriate measures must be taken for identification, documentation, tracing, interim support and family reunion of separated children (see chapter 10 on community services for more information on unaccompanied children);

Providing structured activities and primary schools for children (this can be important as a protection tool as it can help reduce recruitment into armed forces);

Targeting assistance to remove the need for child labour;

Issuing birth certificates. Birth registration may be a prerequisite for obtaining nationality, enrolling in school and may be a vital tool for tracing. It can also be important in preventing military recruitment and other forms of exploitation.

Help Children by Helping the Family; Support Women to Preserve Family Unity.

The single best way to promote the protection, well-being and safety of children is to support their families.

Actively work to preserve family unity. Measures to promote the health and physical security of refugee women can help prevent separation of mother and child. A family, whose members have become separated or who are under serious stress, puts children at particular risk. Give priority to helping parents and other child care-givers meet the needs of their children. Also, recognize the parents' own needs. Families may need assistance in using their own coping techniques and rebuilding their support networks. Make every effort to preserve or reconstitute family help networks. Family groups wishing to live together should be helped to do so.

Monitoring and Reporting

49. Once immediate protection is secured, arrangements must be made to monitor the situation and ensure continuing respect of the rights of the refugees.

50. Immediate, clear and regular reports of developments, action taken and intended to be taken are important, whether from the Field Officer to the Head of Office or from the latter to Headquarters. Guidance must be requested as necessary and Headquarters level interventions recommended as appropriate. See Annex 3 to chapter 8 on implementing arrangements, for a standard situation report.

51. A prerequisite for intervention with a government, or for mobilization of international support, is accurate situation reporting.

Field staff at the site, anxious to provide immediate help, must remember that unless information gathered locally is shared, its usefulness is Iimited.

Formalizing Arrangements and Written Demarches

52. Any temporary or ad hoc agreements with the authorities should be formalized, as for example that covering the local UNHCR presence. Reference should be made to protection and durable solutions in any formal exchanges governing the provision of material assistance.

53. As a general rule, a written demarche should be made as soon as possible to the central authorities at the highest appropriate level. This level, and the form of the demarche, will be determined by the nature of UNHCR's presence in the country. A demarche by a newly arrived mission would normally be addressed to the Minister of Foreign Affairs (or perhaps Interior; the advice of UNDP and/or embassies should be sought). The communication might:

i. Refer to the information available to UNHCR on the influx or problem (qualifying it as necessary: the government will often know more than UNHCR);

ii. State UNHCR's view that persons involved are or may (as applicable) be of concern to the High Commissioner;

iii. Refer to the government's protection responsibilities;

iv. Request (confirm understanding, express gratitude for, etc.) assurances that persons will be granted (at least temporary) asylum (if appropriate: pending determination of status and longer-term arrangements);

v. Offer, where persons are found to be of concern to UNHCR, commitment in principle to provide material assistance (for example, "every effort" formula).

54. The text of representative level demarches should be communicated to Headquarters at once both for information and in order that they may be shared with the permanent mission and/or referred to in any subsequent Headquarters level demarches. Likewise, the texts of the latter should of course be shared at once with the field.

55. Representatives should immediately recommend action at the Headquarters level if they are in doubt that their interventions alone will secure protection.

56. New oral and written demarches must be made if there are any grounds for concern that protection is still not adequately assured (refoulement, abduction, arbitrary detention, mistreatment, abuse of women and children etc.). Complementary action at the local level should both closely monitor developments affecting protection, and concentrate to the extent possible on assisting the authorities to meet the practical problems of the influx.

Public Relations

57. In certain circumstances tensions in relations between neighbouring countries may make it necessary to stress even at the local level that the granting of asylum is a purely humanitarian act.

Emphasize that the granting of asylum is purely humanitarian and therefore not a hostile ad, and that UNHCR's presence and involvement may help reduce tension.

58. Particular attention should be paid to briefing other UN organizations and the diplomatic community, especially those interested governments whose influence may be able to facilitate protection (for example, by an early indication of support for UNHCR and/or of intent to contribute financially to the UNHCR operation).

59. Visits by national and international media and the diplomatic corps may help achieve a broader appreciation of UNHCR's protection function. The position to be taken with regard to the media will depend very much on the circumstances and whether or not publicity would help protect persons of concern to UNHCR. Close coordination within the various levels of UNHCR is necessary. Where UNHCR is already represented, previously established good contacts with the locally based (and especially local language) media may prove a valuable source of information and is useful in advancing an understanding of UNHCR's role. General guidance regarding media relations is provided in chapter 9 external relations.

Physical Safety of Refugees

Introduction

60. Even after they have been admitted to a country of refuge, refugees may still face serious threats to their safety. In emergencies, some basic human rights are particularly threatened and will need to be specially protected by law as well as by action. These threats may originate from the country of origin or of asylum or from groups among the refugees themselves.

Camp Security

61. Threats of military attacks originating from the country of origin may be reduced by locating or relocating camps or settlements a reasonable distance from the border (see chapter 14 on site planning). In addition the authorities of the country of asylum may have to increase their military presence in the border area and around refugee settlements. However, military presence inside refugee camps or settlements should be avoided.

62. In the country of refuge, threats to physical safety of refugees (refoulement, unlawful detention, sexual violence, etc.) may emanate from officials dealing with the refugees.

The authorities of the country of asylum must be made aware of the fact that they retain primary responsibility for security and must ensure the safety and well-being of refugees.

63. Corrective action is in the hands of the authorities and must be taken resolutely. UNHCR must maintain contact with the refugees and the authorities to ensure that there is adequate response.

64. Criminal attacks and banditry against refugees should be addressed by civil authorities and security forces of the host country in close cooperation with UNHCR and the refugee community.

65. In situations where armed individuals are part of the refugee population, UNHCR should encourage the screening of the whole population and the separation of refugees from armed individuals, as well as their disarmament.

66. In all cases of military and police presence, general measures as described in paragraph 48 such as awareness campaigns and training for protection of the rights of refugee women and children are important in order to prevent sexual violence against them.

67. In cases of internal conflicts among the refugee population UNHCR should initially encourage a mediation by the refugee community. If this fails, UNHCR should request the authorities of the host country to resolve the conflict.

Reducing Tension Between the Refugee and the Local Community

68. In situations which may give rise to tension and conflict between the refugee community and the local population, the following measures may be considered in addition to action to address the specific causes of the problem:

i. Arranging regular meetings between the representatives of the refugees and the leaders of the local community;

ii. Sensitizing the local population to the plight of the refugees through local media (programmes on radio and TV, articles in newspapers) and community leaders;

iii. Sensitizing refugees to local customs and traditions;

iv. Ensuring that sufficient assistance is mobilized so that the presence of refugees does not impact negatively on scarce local resources;

v. Benefiting the local community through improvements in infrastructure in the areas of water, health, roads, etc.

69. As a measure of protection, UNHCR staff should encourage and support the organization of the refugee community and ensure its involvement alongside local authorities and communities, in all aspects of the administration of the refugee settlement. Women and adolescents should be included in such organizations, particularly those dealing with issues affecting their security. Other actions should include UNHCR presence in refugee camps and special training in international refugee standards and norms for all officials dealing with refugees.

Physical Safety in Areas of Conflict

70. International humanitarian law2 provides protection to civilians including refugees in situations of armed conflict. In non-international conflicts (i.e. internal armed conflict but not police operation), all parties to the conflict are bound by the 1949 Geneva Conventions to respect all persons not taking an active part in the hostilities, and in particular:

i. To treat them humanely and without distinction as to race, religion, sex, birth, wealth or any other similar criteria;

ii. To refrain from violence to life and person;

iii. Not to take hostages;

iv. To respect personal dignity;

v. Not to pass sentences or carry out executions without due process of law;

vi. To collect and care for the wounded and sick.

71. The International Committee of the Red Cross (ICRC) is the agency charged with supervising the implementation of international humanitarian law in situations of armed conflict. In most situations of armed conflict or civil strife, the ICRC offers its services to all parties to assist victims and ensure the protection of civilian populations - including, where applicable, refugees and other displaced populations - as well as detained combatants.

72. UNHCR staff should seek the cooperation of the ICRC, wherever it is present, and benefit from its expertise in dealing with state and non-state parties alike in situations of armed conflict.

2 The four Geneva Conventions of 1949 and their two Additional Protocol of 1977 deal with protection of civilians in armed conflicts.

Operations in Areas Controlled by Non-state Entities

73. In situations of civil strife or internal armed conflict, particular difficulties may arise from the fact that UNHCR's interlocutors are not states or regular armed forces answerable to states, but insurgent groups and other non-state entities. UNHCR may have no choice but to deal with these groups as they exercise de facto control over a refugee population. It will be important to highlight the impartial, non-political and humanitarian role of UNHCR and to exercise public pressure in order to convince these groups of the importance of adhering to humanitarian and refugee law. However, when dealing with these groups, UNHCR should not imply, through any of its actions or correspondence, a formal recognition of these non-state entities by the United Nations.

Forced Recruitment

74. Another protection issue likely to arise where refugees find themselves in or near a conflict zone is that of forcible recruitment of refugees by one or more parties to the conflict. In confronting this issue, UNHCR staff must remember - and remind the authorities -that:

i. The civilian character of refugee camps and settlements must be preserved and respected in all circumstances. Therefore recruitment of any age group for military and paramilitary purposes is unacceptable;

ii. Recruitment by force may amount to cruel, inhuman or degrading treatment, which is prohibited in all circumstances;

iii. Recruitment and direct participation in hostilities of minors under 15 years of age is prohibited, and UNHCR advocates the non-involvement of all children under 18, whether they are required to participate directly in hostilities or to perform support tasks;

iv. Where refugees are forced or coerced to return to their country of origin to fight, this is tantamount to refoulement, which is prohibited in all circumstances.

Combatants

75. UNHCR is not competent to intervene on behalf of combatants. Combatants placed hors de combat (sick, wounded, shipwrecked and prisoners of war) are primarily protected by international humanitarian law, and fall under the competence of the ICRC.

76. An ex-combatant may qualify as a refugee if a well-founded fear of persecution can be established, and if there are no serious reasons for considering that the person should be excluded3.

77. Finally, note that simply because a person is carrying a weapon does not mean that he/she is a combatant - in some societies, carrying weapons e.g. knives, is traditional.

3 See Note on the Application of Exclusion clauses, IOM/83/ 96 FOM/93/96, UNHCR, 1996.

Emergencies as a Result of Changes in Government Policy

78. A special type of protection emergency can occur as the result of a sudden change, for whatever reason, in government policy towards persons of concern to UNHCR already on its territory. Those affected may include both persons known to UNHCR and recognized as refugees, and others who have hitherto neither formally requested asylum nor made themselves known to UNHCR, but who may nevertheless fall within the High Commissioner's competence.

79. The action to take in protection emergencies of this type will vary greatly in each case and only very general guidance can be given. Accurate information, a UNHCR presence where needed, and a clear and consistent policy in defence of the rights of the refugees will always be required. The guidelines that follow must be modified as necessary in light of the actual situation. Some of the considerations discussed in the previous sections may also be relevant.

80. UNHCR should immediately try to identify and if possible establish a list of persons who are, or may be at risk but were not previously known to UNHCR staff. This list must be constantly updated. Sources of information include the diplomatic community (some persons may approach or even seek asylum in embassies), the ICRC, the national Red Cross or Red Crescent society, churches and NGOs. Care should be taken to ensure the confidentiality of individual cases when establishing contacts with Embassies. Early identification, and, if possible registration of, these new cases by UNHCR can often be a very important source of protection.

81. UNHCR must maintain (or in the case of a new regime establish) close and continuing cooperation with the authorities. If the country has acceded to the relevant international instruments, these obligations remain binding, whatever new policies may be adopted. If the country is not a party to any of the refugee instruments, the Statute and universal instruments must be invoked.

82. The government is, of course, responsible for the physical security of the refugees. Every effort must be made to encourage the government to protect refugees, particularly during any periods of civil tension. The immediate aim is that refugees should be able to remain in safety in their present country of asylum. Respect of the principle of non-refoulement is of paramount importance.

83. There may be circumstances in which movement of the refugees to another country is necessary as a last resort. Such moves are quite different from large-scale resettlement as a durable solution. They may be necessary either as a result of a direct request from the government or where no other way of protecting the refugees exists. Immediate approaches to potential countries of asylum must be made at both local, embassy, and Headquarters levels. Receipt of resettlement offers may have an important influence on the government's attitude towards the refugees. Operational partners must be identified. In addition to locally-based NGOs, the assistance of the ICRC (for example, with travel documents) and the International Organization for Migration (IOM) may be sought.

84. In extreme and tense situations where refugees lives were threatened, there were cases where some form of "safe Haven" for refugees have been established. However, UNHCR's experience with "safe havens" demonstrated that refugees often could not be provided with adequate protection and continued to be exposed to high risks. It is therefore not recommended to formally establish "safe havens".

Other Persons of Concern to UNHCR

85. In addition to refugees as defined by the relevant international instruments (see paragraph 7 above), UNHCR has also been empowered to extend protection to the following categories. Refugees, as well as the categories of persons described below, are often referred to as "persons of concern to UNHCR".

Returnees

86. Returnees are refugees who return voluntarily to their country of origin and who formally cease to be refugees as soon as they cross the border. UNHCR has been entrusted by the UN General Assembly to protect and assist returnees, both during the journey and once back in the country of origin and to facilitate finding durable solutions to their problems.

Stateless Persons

87. A stateless person is a person who is not considered as a national by any country. The Universal Declaration of Human Rights states that everyone has a right to a nationality and no one should be arbitrarily deprived of his/her nationality or of the right to change his/her nationality. The main international instruments dealing with statelessness are listed in Annex 1. UNHCR has been designated as the body which can assist stateless persons in presenting their claims to appropriate authorities, and in providing technical and advisory services to states on the preparation and implementation of nationality legislation.

Internally Displaced Persons (IDPs).

88. IDPs can be broadly defined as persons who have been forced to flee their homes suddenly or unexpectedly in large numbers

Considerations Regarding UNHCR Involvement with IDP's.

89. The main requirements for UNHCR's involvement with the internally displaced4 are :

i. A specific request from the UN General Assembly, the Secretary General or other competent principle organ of the UN;

ii. The consent of the concerned state or other relevant entity;

iii. The relevance of UNHCR's expertise to assist, protect and seek solutions for internally displaced persons in the particular situation;

iv. The availability of resources for the activities in question.

4See; UNHCR's Role with Internally Displaced Persons, IOM87/97, FOM 91/97, UNHCR, 1997. as a result of armed conflict, internal strife, systematic violations of human rights or natural or man-made disasters and who are within the territory of their country.

Criteria for Involvement

Certain situations may demonstrate the usefulness of UNHCR's involvement. These are situations which present a clear link with activities UNHCR undertakes in fulfillment of its mandate, for example where internally displaced populations are, or are likely to be, mixed with returnee populations, or where the same causes have produced both internal displacement and a refugee flow, or where there is a risk of cross-border expansion of the internal displacement. Where the link with mandated activities is not present, UNHCR may consider involvement with IDPs to attenuate the causes of internal displacement and contribute to conflict resolution through humanitarian action.

Measures to Assist IDPs

Measures to assist IDPs are broadly similar to those used for refugees. However, by definition, IDPs remain within their own country, and it is the national laws of that state which provide the framework for their protection and rights, rather than specific international legal instruments. Universal human rights instruments, of course, also apply to IDPs.

The presence of UNHCR staff and the staff of other international organizations in the areas where IDPs have sought safety has proven helpful in encouraging authorities and parties to the conflict to respect national laws and universal human rights.

Durable Solutions

From the outset of an emergency, UNHCR must bear in mind the ultimate objective of refugee protection: to help refugees to overcome displacement and achieve a solution whereby national protection is re-established and they will no longer be refugees.

Voluntary Repatriation

90. Most large scale refugee emergencies are eventually resolved through the voluntary repatriation of refugees once the danger they have fled from has been removed or significantly reduced. See chapter 19 on voluntary repatriation.

Local Settlement

91. Local settlement means assimilation within the country of asylum. In the case of prolonged conflicts, refugees often at least de facto integrate into the host society. It is important in such situations that they should have official status in the country of asylum, a starting point for which should be recognition as refugees under the 1951 Convention.

Resettlement

92. Resettlement (meaning assimilation within another country) should be considered when refugees cannot repatriate or cannot settle in the country of first asylum, or are at risk in their country of refuge. The decision to resettle is taken when there is no other way to eliminate the danger to the legal or physical security of the persons concerned. Resettlement under the auspices of UNHCR is strictly limited to mandate refugees who have a continued need for international protection.

Emergency Resettlement

93. Emergency resettlement can be considered where there is:

i. An immediate threat of refoulement to the country of origin;

ii. An immediate threat of expulsion to another country from where the refugee may be refouled;

iii. A threat of arbitrary arrest, detention or imprisonment;

iv. A threat to physical safety or human rights in the country of refuge analogous to that under the refugee definition and rendering asylum untenable.

94. Categories of refugees who can be considered for emergency resettlement include: survivors of violence and torture, refugees with serious medical conditions which cannot be treated in the country of asylum, women-at-risk, children and adolescents. Priority attention should be given to those refugees with acute legal and physical protection needs such as women-at-risk, and unaccompanied children for whom a determination has been made that resettlement is in their best interests.

Emergency Resettlement Procedures

95. Emergency resettlement must be used selectively and on the basis of a thorough and objective assessment of both refugee status and urgency of removal. Emergency resettlement is undertaken when the immediacy of security and/or medical threat faced by the refugee necessitates the person's removal from the threatening conditions within a few days, or even within hours. For the sake of simplicity a notional limit of a maximum of five days is understood.

96. The following information should be sent to Headquarters immediately:

i. Full name, date of birth, place of birth, sex, nationality and ethnic origin;

ii. Detailed status determination analysis;

iii. Whether accompanied by family (if so, size);

iv. Details, as per (i), of each family member to accompany the candidate;

v. Explanation of the need(s) for resettlement;

vi. Justification for emergency categorization, and required time-frame for departure;

vii. Whether valid travel documents are held by all the refugees concerned;

viii. In case of medical emergency: diagnosis, prognosis, current condition of refugee (and family members if relevant), and whether an escort is needed;

ix. Recommendation on countries of resettlement and reasons, including third country links.

97. Detailed data in a duly completed Resettlement Registration Form (RRF) with supporting documentation must follow as soon as possible.

98. The RRF can be obtained from the Resettlement and Special Cases Section at Headquarters. This is the section of the Division of International Protection that is responsible for processing emergency submissions. In addition, the Section helps coordinate and support the resettlement of difficult protection and special needs cases. It should be contacted for advice.

99. Additional information may be found in the UNHCR Resettlement Handbook.

Key References

Collection of Conclusions on the International Protection of Refugees adopted by the Executive Committee of the UNHCR Programme, UNHCR Geneva, 1995.

Collection of International Instruments Concerning Refugees, UNHCR, Geneva, 1995.

Guidelines on the Protection of Refugee Women, UNHCR Geneva, 1991.

Guidelines on Policies and Procedures in dealing with Unaccompanied Children Seeking Asylum, WHO, Geneva, 1997.

Handbook for Determining Refugee Status, UNHCR, Geneva 1979.

International Legal Standards Applicable to the Protection of Internally Displaced Persons, UNHCR, Geneva, 1996.

Refugee Children: Guidelines on Protection and Care, UNHCR, Geneva 1994.

Refworld CD-ROM, UNHCR, Geneva, (updated regularly).

Sexual Violence Against Refugees: Guidelines on Prevention and Response, UNHCR, Geneva, 1995.

UNHCR Resettlement Handbook, UNHCR, Geneva, 1997.

UNHCR's Role with Internally Displaced Persons, IOM 87/97, FOM91/97, UNHCR, Geneva, 1997.

Annexes

Annex 1 - International Instruments Concerning Refugees and Related Instruments

International Instruments Concerning Refugees

Short Name

Full Name

Description

1951 Statute

Statute of the Office of the United Nations High Commissioner for Refugees.

The Statute of the High Commissioner's office, adopted by General Assembly Resolution 428 (V) of 14 December 1950. This sets out UNHCR's function and responsibility to provide international protection and to seek permanent solutions to the problem of refugees. It serves as UNHCR's constitution and includes a definition of persons who are of concern to the H.C. The mandate has been modified over time through subsequent General Assembly and ECOSOC resolutions.

1951 Convention
1967 Protocol

1951 Convention Relating to the Status of Refugees, and 1967 Protocol Relating to the Status of Refugees.

An international treaty which is binding upon the signatory states. It sets out the responsibilities of states which are parties to the Convention vis-a-vis refugees on their territories, and sets out the obligations of the refugees.

OAU Convention

OAU Convention governing the specific aspects of refugee problems in Africa (Organization of African Unity, Addis Ababa, 1969).

A regional complement to the 1951 Convention and 1967 Protocol. It contains an expanded refugee definition as well as provisions on safe and peaceful asylum, burden-sharing and voluntary repatriation.

i. Cartagena Declaration

ii. St. Jose Convention

i. Cartagena Declaration on Refugees, 1984.
ii. American Convention on Human Rights, "Pact of San Jose, Costa Rica", 1969.

Non binding declarations which have greatly influenced regional policies on refugees and asylum seekers, and contain an expanded refugee definition.

Excom Conclusions

Various conclusions on international protection adopted by UNHCR's Executive Committee.

Contain important guidance to States and UNHCR.

Related Instruments

The UN Charter

The Charter of the United Nations, 1945.

Places certain general obligations on member states of the United Nations of particular relevance to UNHCR's international protection function.

Universal Declaration of Human Rights

Universal Declaration of Human Rights, 1948.

Universal instrument setting out the basic human rights of all persons, including refugees.

Convention Relating to the Status of Stateless Persons

Convention Relating to the Status of Stateless Persons, 1954.

Grants a recognized status to stateless persons who are lawful and habitual residents. Similar to the 1951 Convention Relating to the Status of Refugees.

Convention on the Reduction of Statelessness

Convention on the Reduction of Statelessness, 1961.

Contains measures to ensure that persons do not become stateless.

Covenant on Civil and Political Rights

International Covenant on Civil and Political Rights 1966.

Obliges states which are parties to the Covenant to respect and ensure the rights set out in the Covenant to all individuals (within the state's territory and jurisdiction), without distinction such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

Convention Against Torture

Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 1984.

Includes the principle of non-refoulement.

Convention Relating to the Rights of the Child

Convention Relating to the Rights of the Child, 1989.

A comprehensive code of rights for all children (defined as 18 years or under).

Geneva Conventions and additional protocols

Geneva Convention Relating to the Protection of Civilian Persons in Time of War (Geneva, 1949).

Covers the treatment of civilians in time of war, including refugees.

Declaration on Territorial Asylum

United Nations Declaration on Territorial Asylum, 1967.

Includes the principle of non-refoulement.

Final Act of the United Nations Conference on the Status of Stateless Persons, 1954

United Nations Conference on the Status of Stateless Persons.

Includes the principle of non-refoulement.

(introduction...)



Figure

Introduction

1. There is no single blueprint for refugee emergency management; each refugee emergency is unique. However, experience shows that emergencies tend to evolve according to certain recognizable and documented patterns.

Good emergency management relies on knowledge of these patterns and of the effective measures to deal with them.

Emergency situations do not necessarily result in tragedy. The chance of this occurring will be greatly reduced if the emergency is well managed from the stage of preparedness onwards.

2. While emergency management shares many of the characteristics of good management in general, there are a number of distinguishing features:

i. The lives and well-being of people are at stake;

ii. Reaction time is short;

iii. Risk factors are high and consequences of mistakes or delays can be disastrous;

iv. There is great uncertainty;

v. Investment in contingency planning and other preparedness activities is crucial;

vi. Staff and managers may be under particularly high stress because of, for example, security problems and harsh living conditions;

vii. There is no single obvious right answer.

Organization of this Section

3. This section of the handbook (chapters 3 to 9) is structured to reflect the phases of emergency preparedness and response. Firstly, the preparedness activities of contingency planning and early warning are dealt with (chapter 4), followed by initial needs and resources assessment and immediate response (chapter 5). Operations planning, coordination and site level organization are dealt with in chapters 6 and 7. Next, implementing arrangements are discussed, including procedures for operations implementation and control (chapter 8). Finally, chapter 9 on external relations covers relations with the host government (including establishing a formal presence in the country of operations), relations with the donor and diplomatic community and handling media interest. Note that certain activities cut across the phases of emergency preparedness and response. This is particularly the case with external relations, coordination, and planning.

4. Figure 1 shows some of the considerations discussed in this section in diagrammatic form, in particular in relation to emergency response. The response activities of problems and needs assessments, operations planning, implementing arrangements and programme formulation are all very closely related. Some aspects treated separately may be indivisible in practice, and there is no single correct order or way in which an emergency operation should be formulated (but it must conform to established UNHCR procedures governing project submission and control).


Figure 1 - Considerations in Emergency Management

Capacity and Resources

5. Emergency management can be defined as:

the organization of capacities and resources to meet threats to the lives and well-being of refugees.

6. Preparing for and responding to refugee emergencies are tasks which require the availability of the right resources at the right time as well as the capacity to use these resources effectively.

7. Capacity is the internal organizational capability which includes planning, staffing, structure, systems, procedures, guidelines, information flow, communication, decision-making and administrative support. Resources are the financial and human resources, relief materials, support equipment, tools and facilities.

8. If capacity is weak, then the emergency response is likely to be weak, even if resources are adequate.

Strong capacity can sometimes alleviate resource shortfalls by making more effective use of limited resources.

9. Capacity is an aspect of emergency management which is sometimes not given adequate priority. Resources are often given more emphasis during both the planning and operational stages since they are a more tangible element. But it is capacity that determines the quality of an emergency response. A well-capacitated organization is more likely to be able to mount a credible and effective operation, attracting the necessary resources.

10.

Effective emergency management requires that the development and use of capacity be accorded correct priority throughout the different phases of an operation.

While much of the required capacity must be pre-existing, capacity can also be developed during an operation.

The Key Emergency Management Functions

Introduction

11. Certain management functions are essential throughout a refugee emergency. These are:

Leading;

Planning;

Organizing and coordinating;

Controlling.

12. These will be required of UNHCR as an organization and also from individuals, at all levels, within UNHCR.

If these functions are not being performed : then it is likely that there will be serious deficiencies in the management of the emergency operation.

They always remain the responsibility of the person in overall charge of the operation, though they may be delegated to other staff.

Leading

13. This can be defined as:

the process of creating and communicating a vision for the emergency operation, and providing a clear strategic direction for actions even in situations of great uncertainty and risk.

14. Successful management requires leadership; subject to the role of the government, leadership may be the most important single contribution of UNHCR to the emergency situation. Leadership requires that once decisions are reached, they are properly implemented. This discipline is essential in emergencies when there is often no time to explain the considerations involved. As far as possible, those directly concerned should contribute to decisions that affect them, but final responsibility rests with the UNHCR officer in charge.

Planning

15. This can be defined as:

setting in place the process of assessing the situation, defining immediate objectives and longer term goals and the activities to accomplish them.

16. Planning is vital both before and during an emergency, and operations planning must be based on detailed needs and resources assessments.

Organizing and Coordinating

17. This can be defined as:

establishing systems and mechanisms to achieve a given objective, and coordinating people and organizations so that they work together, in a logical way, towards the common objective.

18. It involves selecting, training and supervising staff, assigning and clarifying roles and responsibilities of all those involved, and structuring communication and information flow. In an emergency, coordinating is a crucial aspect of organizing.

Delegation of Authority and Responsibility

19. Emergency management should be organized so that responsibility and authority are delegated to the lowest appropriate level, and should be exercised as close to the operation or beneficiaries as is practical. Clear and unambiguous lines of authority and reporting should be established and communicated to all staff.

20. The management structure should be organized so that accountability for actions, including management decisions, is clear. Those who make a decision should be those with the appropriate level of knowledge to enable them to make that decision and should be responsible for ensuring its implementation and follow up (including monitoring). The involvement of unnecessary layers of management, and unnecessary numbers of people, in decisions as well as in responsibility for implementation, confuses and diffuses accountability. Ambiguity and lack of simplicity in the definition of responsibilities also slows action.

Controlling

21. This can be defined as:

monitoring and evaluating performance in comparison with plans and initiating changes where necessary.

22. Note that the key management functions are important not only during emergency response, but also in the preparedness phase, although their relative importance in each phase may vary. Organization and coordination mechanisms, for example, should be developed during contingency planning.

Stages in Refugee Emergency Operations

23. The table below depicts one model of activities as they may occur in refugee emergencies. It is important to understand that the stages and activities of a refugee emergency operation could overlap, or occur simultaneously.

24. A final phase of an emergency operation is the transition from emergency response to longer-term support (care and maintenance) and durable solutions (voluntary repatriation, local integration and resettlement). The time spent providing emergency relief should be kept to a minimum, and planning and implementation should always take account of the longer term. The importance of the balance between short term and long term is seen in a number of the vital sectors.

Stage

Typical Activities

Emergency

· Prevention;

preparedness

· Early warning;

· Contingency planning;

· Development of emergency response systems;

· Generation of support among potential host and donor governments;

· Provision of stand-by resources;

· Pre-positioning of supplies;

·Training.

Emergency response

· Problem, needs and resources assessments;

· Resource mobilization;

· Handling donor relations and media interest;

· Operations planning;

· Implementation and coordination;

· Monitoring and evaluation;

· Transition to the post emergency operation.

25. Assisting governments in seeking durable solutions for the problem of refugees is a mandated function of UNHCR. Durable solutions must always be kept in mind, starting at the contingency planning stage. It is in this period that choices are made concerning how, how much, and for how long, aid will be delivered. These choices often have repercussions on the prospects for durable solutions that last long after the emergency has ended.

Emergency Preparedness

26. The best way to ensure an effective emergency response is by being prepared. Emergency preparedness can be defined as:

planning and taking act/on to ensure that the necessary resources will be available, in time, to meet the foreseen emergency needs and that the capacity to use the resources will be in place.

27. The scope of emergency preparedness is broad and the activities at that stage can be undertaken at the global, regional and country levels.

The preparedness measures should enable an organization to respond rapidly and effectively to an emergency.

28. At the global level, UNHCR maintains centrally a range of stand-by emergency response resources. These resources have been developed on the basis of past experience in emergencies. They include staff support, human and financial resources, operational support items and services, and a centrally managed emergency stockpile. The resources are available for deployment at short notice to any area where the need arises. They ensure a minimum and predictable level of global preparedness for emergencies. Moreover, there are also training activities available which can be used for capacity building.

29. For details of these resources, see the Catalogue of Emergency Response Resources, Appendix 1.

30. Contingency planning reduces the lead time necessary to mount an effective response and is a crucial tool to enhance the capacity to respond.

At the country and regional levels, early warning and contingency planning are the key preparedness measures;

31. The contingency planning process (see chapter 4) will allow the identification, in advance, of gaps in resources. A realistic plan may encourage donors and others to provide the missing resources.

32. Contingency planning helps predict the characteristics of the impending emergency - it increases the institutional analytical capacity which can be drawn upon should an emergency occur. It also helps identify the additional preparedness activities which may be required. These may include development or restructuring of the UNHCR organization in the country, emergency staffing, stockpiling, pre-positioning supplies and training. Priority should be given to activities requiring longer lead times.

Emergency Indicators

33. An emergency may start with a sudden large influx of refugees, with several thousand persons crossing a border, causing a highly visible life threatening situation. More often however, the onset of an emergency is not so dramatic or obvious, and a situation requiring an extraordinary response and exceptional measures may develop over a period of time. It is therefore essential to be able to recognize if a situation exists (or is imminent) which requires an emergency response, and what are the likely key characteristics (see table 1).

34. The following indicators are measurable and are therefore commonly used as thresholds above (or below) which an emergency situation clearly exists, or to signal whether a situation is under control and whether there is a need for urgent remedial action. The most important of these indicators is the mortality (or death) rate (see chapter 14 on health for information on how to calculate the mortality rate. More details of the other indicators are given in the respective chapters and in Appendix 2 Toolbox).

Table 1 - Emergency Indicators

Indicator

Emergency Levels

MORTALITY RATE

> 2 per 10,000 per day

Nutritional

> 10% with less than 80%

Status of children

weight for height

Food

< 2,100 calories/person/day

Water Quantity

< 10 litres per person per day

Water Quality

> 25% of people with diarrhoea

Site Space

< 30 sq. meters per person (this figure does not include any garden space)

Shelter space

< 3,5 sq. meters per person

35. Other indicators may not be so easily quantifiable but may be just as critical, for example, the presence of a physical threat to the refugees or to the standards of human rights which they enjoy. In particular, threats of refoulement should be considered as an indicator of a need for an emergency response.

Emergency Response

36. Emergency response can be defined as:

immediate and appropriate action to save lives, ensure protection, and restore the well-being of refugees.

37. Once safe asylum is assured, the priority of emergency management will be life saving activities. Timely and rapid problem, needs and resources assessments will help confirm or identify areas where gaps still exist from the contingency planning stage, both in terms of expertise and resources required.

38. Identification of problems requiring-specialist expertise is essential. Most refugee emergencies will require, in addition to protection specialists, one or more technical experts to coordinate the crucial technical sectors, such as health, food, nutrition, sanitation, water, shelter and infrastructure.

Key References

A Framework for People-Oriented Planning in Refugee Situations Taking Account of Women, Men and Children, UNHCR, Geneva, 1992.

Contingency Planning - A Practical Guide for Field Staff, UNHCR, Geneva, 1996.

Coordination Among International Organizations in Complex Emergencies, Disaster Management Training Programme, UN, 1997.

Initial Assessment in Emergency Situations - A Practical Guide for Field Staff, UNHCR, Geneva, 1998.

Supplies and Food Aid Field Handbook, UNHCR Geneva, 1989.

UNHCR Handbook; People-Oriented Planning at Work: Using POP to Improve UNHCR Programming, UNHCR, Geneva, 1994.

UNHCR Manual, Chapter 4, UNHCR, Geneva, 1995 (and updates).

Partnership: A Programme Management Handbook for UNHCR's Partners, UNHCR, Geneva, 1996.

(introduction...)


Figure

Introduction

1. Contingency planning can be defined as:

A forward planning process, in a state of uncertainty, in which scenarios and objectives are agreed, managerial and technical actions defined, and potential response systems put in place in order to prevent, or better respond to, an emergency.

2.

It is important to consider contingency planning as a planning process from which a: contingency plan is drawn.

The planning process involves a group of people or organizations working together on an ongoing basis to identify shared objectives and define respective responsibilities and actions.

3. Contingency planning is a pre-requisite for rapid and effective emergency response. Without prior contingency planning much time will be lost in the first days of an emergency. Contingency planning builds organizational capacity and should become a foundation for operations planning and emergency response.

When to Plan

4. In most cases field workers will know simply from experience and good knowledge of the current situation when it is prudent to plan.

5. There is no rule as to when to start contingency planning - except that, when in doubt, develop a contingency plan.

It is better to plan when it is not needed than not to have planned when; it was necessary.

Early Warning

6. Early warning signs of a potential critical event should trigger a contingency planning process. Early warning is the collection, analysis and use of information in order to better understand the current situation as well as likely future events. The particular focus is on events which might lead to population displacement. Early warning can come from a wide range of sources: governments, local population, political leaders, media, academia, refugees, international and national organizations.

7. The collection and analysis of early warning information should be integrated into the routine work of UNHCR offices. Regular monitoring and reporting, in a consistent format, is an important means to ensure that trends and patterns are recorded and that any changes indicating population displacements are spotted.

8.

Where early warning information indicates the threat of a refugee emergency, contingency planning should be started automatically.

9. The most common emergency threat for UNHCR is a new influx or sudden increase in a refugee population. However, contingency planning should also take place in the midst of an existing operation. For example, contingency plans may be needed for a possible renewed influx, a natural disaster affecting a camp, an epidemic, an attack on a camp, violence in a camp, sudden spontaneous repatriation, or a security threat to staff or premises. In these situations the realities of the ongoing operation are well known, but contingency plans must be made for future developments for which one needs to be prepared.

Planning as a Process

10. Planning is an ongoing activity; the planner needs to constantly assess the situation and adjust objectives and courses of action to take account of developments.

11. A static contingency plan is soon out of date and breeds a false sense of security. By reviewing and updating planning measures regularly, the preparedness measures in place can be kept appropriate and adequate.

12. One of the most important contributions of the contingency plan to emergency response often comes from the process itself: identifying working partners, their capabilities and resources, developing a working relationship with them and coming to a common understanding of the issues, priorities and responsibilities.

The capacity of the actors to respond in an emergency will be enhanced by their previous involvement in the contingency planning process.

13. Both contingency planning and operations planning set strategic and sectoral objectives and develop an action plan to achieve these objectives. The major difference between the two is that contingency planning involves making assumptions and developing the scenarios upon which planning is based, while in operations planning, the starting point is known, and the planning will build on needs and resources assessments.

Figure 1 - Differences between Contingency Planning and Emergency Operations Planning

Aspect

Contingency plan

Operations Plan

Relation to emergency event

Before

During

Scope of plan

Global or scenario based

Both strategic and specific

Partners involved

All likely partners

Operational and implementing partners only

Focus

Developing agreed scenarios

Effective and rapid response

Relationships

Developing

Utilizing

Planning Style

Consultative

Directive and consultative

Allocation

Roles

Responsibilities

Time frame

Floating, uncertain

Fixed, immediate

Meetings

14. Many pitfalls in contingency planning can be avoided by planning collectively, marshalling the widest range of local skills, and complementing these by external inputs.

Contingency planning is best achieved through a cooperative and coordinated effort wherein all concerned work together with shared objectives over a period of time.

A single meeting that produces a plan is usually insufficient and the product often inadequate. The contingency planning process therefore revolves around regular meetings and follow up.

15. The participants in the contingency planning process should include those who might be involved in the emergency response, including the government, agencies, representatives of donor governments and local organizations and expertise. Contingency planning meetings are sometimes called "roundtable" meetings to stress the importance of participation by all involved. The views of one agency may differ from others, but this will often be to the advantage of the planning process since it provides a useful forum for all assumptions to be questioned and refined. The end product is thus more realistic. While UNHCR may facilitate the roundtable, the role and importance of each participant must be respected.

16. A contingency planning meeting should produce a draft contingency plan containing the following:

i. Scenario identification;

ii. Strategic objectives;

iii. Sector objectives and activities.

Subsequent meetings should review early warning indicators, report on actions taken since the previous meeting, and update the existing plan.

17. Inputs into these meetings include specialist expertise and advice, results from field visits, and statements of agency policy. Outputs include the contingency plan, draft budgets and standby arrangements such as stockpiles.

Contingency Planning Tasks

Scenario Identification

18. Based on early warning indicators and their own experience, the participants in the planning process should develop likely scenarios. This activity is the most intuitive, yet one of the most important, since it lays the basis for all further planning. In establishing scenarios assumptions must be made. While these will be based on best available knowledge, nothing can remove the element of unpredictability.

19. The scenario is a kind of benchmark: if the influx is smaller than envisaged, the safety margin will be welcome, if it is larger, the importance of taking urgent corrective action is highlighted.

20. For scenario development:

i. Consider all possibilities (be imaginative);

ii. Settle for a limited number of options only (1 or 2 options are the norm); otherwise the planning process will be too complicated;

iii. Use the concept of either worst case scenario or most likely scenario.

Policy and Strategic Objectives

21. Planners need to have some vision of the direction of the overall operation. To the extent possible this should be a shared vision. It is not unusual for the various partners to hold different policy approaches to a particular problem. If these cannot be reconciled, at least the differences should be known and understood by all parties. However, an effort should be made to agree on some overall principles, through establishing overall objectives for the emergency response. All activities undertaken in the plan will need to be consistent with these overall objectives.

Sector Objectives and Activities

22. This is the most detailed part of the planning process. For each sector planners should agree, in as much detail as time will permit, on:

i. Sector objectives, including standards;

ii. The main tasks;

iii. Who is responsible for implementing which task;

iv. Time frame for implementation.

Characteristics of a Good Plan

23. A good plan (whether operations or contingency) should be comprehensive yet not too detailed; it should find the right balance between covering all the important issues yet not flooding the plan with detail.

24. It should be well structured, easy to read and, importantly, easy to update. Much of the plan will be action oriented, so it should have a layout that clearly shows what needs to be done, by whom and by when.

25. It should be a living document and be constantly updated, amended and improved. It is not a document which is comprehensively revised on a schedule, but is one that is constantly in a state of change.

A short document with a clear structure will facilitate updating.

26. A contingency plan should also achieve a balance between flexibility (so it can apply to a variety of scenarios) and specificity (for key practical inputs - e.g. well positioned stockpiles). The plan must not be too directive, and yet must provide adequate guidance. It should not be expected to act as a blueprint.

27. See Annex 1 for the structure of a typical contingency plan.

Key References

Contingency Planning - A Practical Guide for Field Staff, UNHCR, Geneva, 1996.

Annexes

Annex 1 - A Model Structure for a Contingency Plan

The following is a proposed structure for a Contingency Plan. It is based on a refugee influx. Adaptation will be required for different scenarios.

Chapter 1: General Situation and Scenarios


i.
ii.
iii.
iv.
v.
vi.
vii.
viii.

Background and country information
Entry points
Total planning figure
Arrival rate
Reception and anticipated in-country movement
Settlement arrangements
Expected refugee demographic profile
Emergency response trigger


Chapter 2: Policies and Overall Operation Objectives


i.
ii.

Overall policy (strategic) objectives of the programme
Comments on policy stance of various partners


Chapter 3: Objectives and Activities by Sector


i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
xiii.
xiv.

Management and overall coordination; allocation of responsibilities
Protection, reception, registration, security
Community services
Logistics and transport
Infrastructure and site planning
Shelter
Domestic needs and household support
Water
Environmental sanitation
Health and nutrition
Food
Education
Economic activities
Support to the operation, administration, communications, staff support and safety

Each section should include a consideration of sector objectives and outputs, needs, resources, activities, and financial requirements, existing and proposed preparedness measures, implementation responsibilities and timing.

Chapter 4: Procedures for feedback, updating and future action

Describe how the Plan will be updated and revised, who will be responsible for ensuring this, and how the information will be disseminated.

Possible Annexes


i.
ii.
iii.
iv.
v.
vi.
vii.

Maps
Registration forms
List of organizations or individuals participating in the planning process
Agency Profiles (details of staff, resources, future intentions)
Gap identification charts (see chapter 6 on operations planning)
Commodity specifications
Draft budgets.

(introduction...)


Figure

Introduction

1. Emergency assistance must be based on a sound, though rapid, assessment of the refugees' most immediate problems and needs and the resources available to meet those needs.

2. The objective of the initial problem analysis and needs assessment is to provide UNHCR with a clear and concise picture of the emergency situation, in both quantitative and qualitative terms. It should provide enough information to predict the evolution of the emergency, at least in the short term. It is the basis for decisions which affect the future of the operation.

3.

More detailed assessments will follow as the emergency develops and needs evolve: assessment never stops.

The initial and subsequent assessments are intricately linked with, and will form the basis for, operations planning. The initial assessment will also build on the contingency planning process.

4. The initial assessment should:

Answer the questions "what is the main problem?" and "is there an emergency or not?";

Provide sufficient information to decide whether UNHCR should be involved in the emergency response and what the scope of that involvement should be;

Be an inter-agency initiative, but with one body providing the overall coordination. The team should include staff from UNHCR, the government and other potential partners (for example other UN agencies, NGOs). Ideally the inter-agency body used for contingency planning should provide the basis for the group carrying out a simple problem and needs assessment. Often the people carrying out the initial assessment will simultaneously be providing the initial response. Whenever possible, the assessment team should include those who will implement the emergency operation in the field;

Be carried out quickly;

Provide a full picture of the scope of the emergency, rather than focus on a limited area or sector (it is better to get the whole picture half right);

Describe the people affected by the emergency (a simple demographic profile);

Identify the coping ability of the refugees themselves;

Identify locally available resources;

Identify what are the most immediate priorities;

Use agreed and appropriate standards against which needs can be measured;

Involve the refugees, women and men, from the outset. Get to know them and understand their concerns. They are a key source of information;

Record the sources of information collected;

Cross-check information, not relying on only one tool (e.g. aerial surveys cross-checked by on the ground observations and interviews);

Involve appropriate technical input;

Use samples and surveys rather than collect too much detailed information which is difficult to analyze;

Produce recommendations for immediate action indicating the resources needed to implement them;

Be able to trigger an immediate and effective response;

Have the results shared promptly and widely.

5. The assessment should, as a minimum, answer the questions in the checklist in Annex 1. This includes essential minimum information required for planning an emergency operation.

6. The initial assessment should focus on the priority life threatening problems which are usually in the sectors of protection, water, food, sanitation, shelter and health. The assessment should measure the actual condition of the refugees against what is needed for their survival and immediate well-being (expressed as "standards"). The resources at their disposal should also be assessed.

The setting of standards appropriate for the situation is an important prerequisite for needs assessment.

7. Standards provide a benchmark against which the condition of the refugees can be measured (see Appendix 2 for some of the minimum survival standards). The standards established for emergency assistance must be consistent with the aim of ensuring the survival and basic well-being of the refugees, be fairly applied for all refugees and be respected by all involved.

8. The document Initial Assessment in Emergency Situations: a Practical Guide for Field Staff (see references) includes more detailed checklists for assessments, and contains practical information on principles, planning, techniques, methods, and forms. See also chapter 6 on operations planning for an example of a Gap Identification Chart, a useful tool for comparing needs and resources.

Organizing the Assessment

9. The initial assessment must be carried out on the spot as soon as it is clear that a refugee emergency may exist. The assessment must involve the government and other key actors.

10. Immediate access to the area where the refugees are located is, of course, a prerequisite. Getting the assessment underway as soon as possible requires quick, practical steps: establish a presence at or near the refugee site for first hand information, interview refugees, use other available sources of information, mobilize local expertise and resources.

11. While an organized approach is necessary, time must not be lost simply because the desired expertise is not immediately available. Where UNHCR is already present, initial action must not be delayed pending the arrival of staff with more expertise.

A quick response to obviously urgent needs must never be delayed because a comprehensive assessment has not yet been completed.

12. Planning the assessment involves setting the objectives, establishing the terms of reference and selecting team members. The assessment plan should indicate which information should be collected and the report should make clear if it was not possible to collect that information.

13. If UNHCR is not already present in the country, the assessment mission will normally be organized by Headquarters.

14. Any problem and needs assessment should start with a review of the existing background information (mission reports, media articles, situation reports, local maps). Ideally, a contingency plan would have been prepared and kept updated and would provide input for the assessment and the immediate response. UNHCR Headquarters can provide maps and geographical information from a computerized database. The maps and information can be tailored to the specific requirements of the assessment. The assessment should also include interviews with the refugees and others involved.

15. Tools commonly used in assessments are:

i. Questionnaires;

ii. Checklists;

iii. Visual Inspection.

16. A combination of tools is normally used in order to cross-check the conclusions. Questionnaires and checklists (see Annex 1 for a basic checklist) are particularly useful because they standardize the approach and force the assessors to plan ahead and decide which information needs to be collected. Visual inspections provide general information and can put into context data from more systematic assessments.

Immediate Response

17. Gathering information about problems, needs and resources on the one hand, and the establishment of standards on the other, will allow the immediate unmet needs to be determined.

The most urgent actions must be taken with whatever local material and organizational resources are available, even if the information at hand is incomplete.

18. In order to ensure urgent survival needs are met, the most important initial actions are likely to be: i. Ensuring the capacity to act; ii. Protection; iii. Organizational considerations.

Ensure the Capacity to Art

19. The first priority is to provide the organizational capacity required to meet the needs of the emergency.

Enough UNHCR and implementing partner staff of the right calibre and experience must be deployed.

It may be necessary to invoke emergency procedures for the allocation of funds, implementing arrangements, food supply, local purchase, and recruitment of personnel. See Appendix 1 for details of how to access UNHCR emergency response resources. With the government, the resources of other UN organizations, particularly UNICEF and WFP, and of the NGO sector must be mobilized within the framework of a plan for immediate action.

Protection

20.

Unless the refugees' right to asylum is assured there can be no assistance programme.

Action must be taken to this end, and to ensure their security and fundamental human rights. The importance of a UNHCR presence where the refugees are located has been stressed. Specific measures may be needed, for example to meet the special protection problems and needs of groups at risk (unaccompanied children, single young girls, minorities, etc.), and to protect the refugees against arbitrary actions of outsiders and against groups within their own number who may pose a threat to their safety.

Organizational Considerations

21. UNHCR must establish a presence where the refugees are, with assured communications with the main office and with Headquarters. The organization of the necessary logistical capacity to deliver the assistance will be of critical importance.

22. The priority, once problems and needs have been assessed, will be to provide vital assistance wherever the refugees are located. There will also, however, be key organizational or planning decisions to take, some of which may determine the future shape of the whole operation. These often include the points summarized below; decisions on them should be seen as a part of the immediate response.

If such decisions go by default or are wrong they will be very difficult to correct later.

Protection and Material Assistance

The Location of the Refugees

23. This will have a major influence on protection and all sectors of assistance. If the refugees have spontaneously settled in a scattered manner, they should not be brought together unless there are compelling reasons for breaking their present settlement pattern. If they are already in sites which are judged to be unsatisfactory, move them. The difficulty in moving refugees from an unsuitable site increases markedly with time. Even if those already there cannot be moved, divert new arrivals elsewhere (see chapter 12 on site planning).

Control at the Sites

24. Determine the optimum population in advance and plan for new sites accordingly. Keep careful control of actual occupation of the site as refugees arrive, so that sections prepared in advance are filled in an orderly manner.

Numbers and Registration

25. An accurate estimate of numbers is a prerequisite for effective protection and assistance. Efficient delivery of help to all in need will require at least family registration which should be organized as soon as possible. Nevertheless the initial provision of assistance may have to be based on a population estimation rather than full registration (see chapters 11 and 13 on registration and commodity distribution).

Urgent Survival Needs

26. Meet the most urgent survival needs: food, water, emergency shelter, health care and sanitation, ensuring fair distribution:

i. Involve the refugees and promote their self-reliance from the start. If this is not done the effectiveness of the emergency assistance will be severely reduced, and an early opportunity to help the refugees to start to recover from the psychological effects of their ordeal may be missed;

ii. Food. Ensure that at least the minimum need for energy is met; a full ration can follow. Set up special feeding programmes if there are clear indications of malnutrition. Establish storage facilities;

iii. Water. Protect existing water sources from pollution and establish maximum storage capacity with the simplest available means. Transport water to the site if the need cannot otherwise be met;

iv. Emergency shelter. Meet the need for roofing and other materials from local sources if possible. Request outside supplies (e.g. plastic sheeting) if necessary;

v. Health care. Provide the necessary organizational assistance, health personnel and basic drugs and equipment in close consultation with the national health authorities. Although the immediate need and demand may be for curative care, do not neglect preventive and particularly environmental health measures;

vi. Sanitation. Isolate human excreta from sources of water and accommodation.

27. Take steps to meet the social needs and reunite families if necessary. Surveys may be necessary to identify those in need, who often do not come forward. Tracing may be required. If groups of refugees have been separeted, they should be reunited. Special measures to ensure the care of any unaccompanied children will be a priority.

28. Once these and other priority measures are underway, begin the wider planning process.

Key References

Initial Assessment in Emergency Situations - a Practical Guide for Field Staff, UNHCR, Geneva, 1998.

Annexes

Annex 1 - Checklist for Initial Assessment

This checklist is based on a refugee influx, it should be modified in the light of the actual nature of the emergency.

Who are the refugees, their numbers, and pattern of arrival

Approximately how many refugees are there?

Where have the refugees come from? Why?

What is the rate of arrival? Is it likely to increase or decrease? a What is the total number likely to arrive?

What is the location of the arrival points and of the sites where people are settling (latitude and longitude)?

Are the refugees arriving as individuals or in groups? Are these family groups, clans, tribal, ethnic or village groups?

Are families, village groups and communities intact?

How are the refugees organized? Are there group or community leaders?

How are the refugees travelling - on foot, in vehicles?

What is the gender ratio of the population?

What is the age profile of the population? Can a breakdown in age be given - under five's, age 5 to 17 years, 18 years and over?

How many unaccompanied minors are there? What is their condition?

What was the social and economic situation of the refugees prior to their flight? What are their skills and languages? What is their ethnic and cultural background?

Are there individuals or groups with special social problems? Are there particular groups made more vulnerable by the situation? (e.g. the disabled, separated minors or elderly people in need of support)

What are the basic diet, shelter, and sanitation practices of the refugees?

What is the security situation within the population - is there a need for separation between different groups, are there armed groups within the population?

What is the formal legal status of the refugees?

Characteristics of the location

What are the physical characteristics of the area where the refugees are located?

What is the soil, topography and drainage?

Is there enough space for those there and those likely to arrive?

Is there all season accessibility?

Can the refugees access relief assistance from where they are located?

What is the vegetation cover?

Will the refugees need to use wood for fuel and shelter?

Approximately how many people already live in the local area?

Who owns (or has usage rights on) the land?

Is there grazing land and are there potential areas for cultivation?

What is the actual or likely impact on the local population and what is their attitude and that of the local authorities towards the refugees?

Are there security problems?

What environmental factors must be taken into account (e.g. fragility of the local environment and extent to which local community relies on it; how rapidly might it be degraded by the refugees, proximity to protected areas)?

What is the condition of the local population? If assistance is provided to the refugees, should the local population also be assisted?

Health status and basic problems

Are there significant numbers of sick or injured persons, is there excess mortality?

Are there signs of malnutrition?

Do the refugees have access to sufficient quantities of safe water?

Do the refugees have food stocks, for how long will they last?

Do the refugees have adequate shelter?

Are adequate sanitary facilities available?

Do the refugees have basic domestic items?

Is there sufficient fuel for cooking and heating?

Resources, spontaneous arrangements and assistance being delivered

What type and quantity of possessions have the refugees brought with them?

What arrangements have the refugees already made to meet their most immediate needs?

What assistance is already being provided by the local population, the government, UN organizations and other organizations, is the assistance adequate, sustainable?

Is the present assistance likely to increase, continue, decrease?

What is the government's policy on assistance to the refugees?

Are there any major constraints likely to affect an assistance operation?

Has contingency planning for this type of emergency been undertaken?

What coordination arrangements are required?

Means to Deliver Protection and Assistance

Can effective implementing arrangements be made quickly and locally, if not, what are the alternatives?

Is there already an identified refugee leadership with whom it will be possible to coordinate the delivery of protection and assistance?

What are the logistical needs and how can they be met?

Where will the necessary supplies come from?

How will they reach the refugees?

What storage is needed, where and how?

Are there essential items which can only be obtained outside the region and whose early supply will be of critical importance (e.g. food, trucks?)

What are the needs for UNHCR and implementing partner staff and staff support?

(introduction...)


Figure

Introduction

1. An emergency response requires good planning. An important aspect of planning, particularly in an emergency situation, is the development of an operations plan. The "Operations Plan" is a vital management tool which should be based on a problems, needs and resources assessment. The plan should determine programme priorities, set objectives, and specify actions that need to be taken by the actors responsible for the various sectors of an operation. Specific tasks in an emergency and the parties responsible for the implementation of these tasks need to be clearly identified and a plan formulated in as clear and concrete a way as possible.

At the start of an emergency there is a tendency to postpone planning, both because information is not available and because there are obvious urgent needs which can be met piecemeal, without a plan. This tendency should be resisted.

2. The more critical the situation, the more important it is for the operations manager to find the time to take stock, determine priorities and develop a plan for what needs to be done, when, by whom and how.

3. Ideally, the operations plan should make use of the contingency planning process, partners identified, and resources prepared, as well as the plan itself. As the same principles of planning apply, the structure of the operations plan can be based on the contingency plan (also attached here as Annex 1). There are a range of additional considerations beyond what is included in the Contingency planning format, many of which will be addressed over time. However, the main differences between contingency planning and operations planning and the characteristics of a good plan are discussed in chapter 4 on contingency planning. The tasks and approach will be different primarily because of assessments - in operations planning, the starting point is known and assessments of the situation replace the contingency planning scenarios and many of the assumptions.

4. The views of the refugees should be taken into account in drawing up the operations plan. They are the single most important resource in meeting their own needs, and will have definite ideas on how this may best be done. The plan must strengthen the refugees' own resources and self-reliance and avoid creating dependency. The plan should also reflect the aim of a durable solution.

5. The operations plan must be comprehensive, identifying all problems, needs and resources whether these are met through UNHCR or by other organizations and sources of funds. Drawing up the operations plan should be a team effort. Clear direction must, however, come from the government and/or UNHCR.

The most effective operations plans are those developed by or with the people who will implement them.

6. Although the plan should be comprehensive, this should be balanced by the need to produce the plan quickly, so that in rapidly evolving emergencies the plan will not become outdated before it is finished. In addition, lengthy plans can be difficult to update. Characteristics of a good plan are discussed in paragraphs 23 to 25 of chapter 4 on contingency planning.

7.

It should be stressed that, as with contingency planning, operations planning is a process.

A plan, as a document, is not an end in itself but simply a record of the process. It should be kept updated in light of the evolving situation: implementation of the plan should be monitored and corrective action taken, and the plan should then be adjusted and revised. The operations plan must be made available to all who need it.

8. This chapter focuses on operations plans developed with partners. However, planning within the office should not be neglected -simple plans of action at each administrative or office level within UNHCR should also be drawn up, from site to Headquarters, tying in with the overall operations plan and involving the same principles: clarifying objectives, allocating responsibilities, defining activities to achieve objectives, and defining coordination mechanisms such as staff meetings (discussed in chapter 20 on administration and staffing).

Operations Planning Tasks

9. Operations planning involves the tasks set out below:

i. Review existing plans and information in the contingency plan;

ii. Assess problems, needs and resources: identify critical unmet needs.

The problems, needs and resources assessments determine what must be done, and where the priorities are. Assessment of problems, needs and resources is part of planning: plans must be updated to take account of new assessments and progress in implementation. Identify critical unmet needs using the results of the assessments and comparing these with established standards - the determination of the standards to which assistance should be delivered is of fundamental importance. The resources which are available and those which are required must also be identified. Resources includes human resources and personnel, local and international implementing and operational partner organizations, and material resources.

At the early stages of a major emergency, it is unlikely that resources will be sufficient to meet all needs, thus prioritization will be an important part of operations planning.

iii. Set overall goals

The overall operation and strategic goals must be clarified. All other objectives and activities should be consistent with these overall objectives. In formulating objectives, the single most important question to ask is, "What is the intended result?" Objectives should be specific, measurable, achievable and realistic, and the time frame within which they should be reached should be specified.

iv. Clarify planning assumptions

It will also be necessary to clarify the main constraints, planning assumptions and principles behind the emergency operation. These should be set out explicitly, including an explanation of the role, responsibilities and policies of the government, UNHCR, other UN organizations and operational partners. In addition, standard or established procedures, such as monitoring and coordination mechanisms, MOUs etc. should also be set out. Similarly, standards in various sectors and any specific guidelines necessary should be specified (where the plan includes objectives, outputs and activities on a sector by sector basis). Although these issues should have been in the contingency plan, they will need to be revisited in the light of the problem and needs assessments, and restated as necessary to new partners, so everyone is working with the same assumptions and to the same standards.

v. Determine the courses of action to reach overall objectives (implementing arrangements).

Consider various options to reach objectives, their advantages and disadvantages; which are flexible, which are the most efficient and effective? Choosing an option for implementing arrangements which retains flexibility is important in a rapidly changing situation. Chapter 8 on implementing arrangements discusses this in more detail.

vi. Determine objectives and courses of action to reach objectives at sector level.

Decide on the objectives, activities and outputs for each sector. As with contingency planning, this is the most detailed part of the plan. The organization with operational responsibility for a particular sector or site should draw up the plan of action for that sector or site.

vii. Allocate responsibilities

Responsibilities (both within UNHCR and between different actors in the operation), need to be clearly stated.

viii. Determine coordination mechanisms

Coordination mechanisms should be established between the different actors in the operation. Coordination at different geographical levels (e.g. at the site and in the capital or regional city) needs also to be assured. In a large operation, it may be necessary to have separate coordination mechanisms for sectors.

ix. Determine monitoring mechanisms

From the start, the management of a refugee emergency must include continuous monitoring (by measuring the indicators of performance), reporting and evaluation in order to ensure that the objectives remain appropriate as circumstances change, and the activities to fulfill the objectives are being carried out effectively.

x. Record and disseminate the plan, monitor progress, take corrective action, and adjust and revise the plan.

Effective Planning Guidelines for UNHCR Teams (updated in January 1999) provide more details on managing the planning process at all levels of an operation in the most effective and efficient way possible. The assumption underlying this emphasis on the planning process is that better planning processes lead to better quality results delivered on time in a cost effective manner.

Figure 1 - an example of a Gap Identification Chart

Site1

Site2

Site3

Overall site management

Agency M

Agency M

Agency R

Protection

UNHCR

UNHCR

UNHCR

Food distribution

Agency B

Agency K

Shelter

Agency B

Agency Y

Water

Agency W

Agency W

Hearth

Agency H

Agency H

Etc.

Allocation of Responsibilities

Gap Identification Chart

10. A gap identification chart is a simple but very important and useful tool to allocate responsibilities effectively and identify the critical unmet needs of the refugees site by site and sector by sector. It illustrates who is responsible for what in an operation (by site and sector) and points out gaps where a sector or site needs attention. An example is shown below - the blanks indicate "gaps" i.e. sites or sectors for which nobody has responsibility. These would need to be given priority attention. Annex 2 shows a blank chart Figure 1 shows an example that has been filled in.

Roles and Tasks

11. The roles and tasks of all involved must be clearly stated. Delay in defining responsibility usually leads to each party defining goals independently and setting their own limits of responsibility. This in turn can lead quickly to confusion, gaps and duplication. Responsibilities should be defined for each administrative level, and for both organizations and individuals. How responsibilities are allocated to individuals is discussed in chapter 20 on administration and staffing.

12. Responsibilities are allocated to different organizations in a refugee emergency primarily through organizations' mandates, international instruments and pre-existing MOUs between organizations.

13. The responsibilities and roles are defined in more detail in response to the specific needs of the refugee situation and capacities of the different parties on the ground. These are set out in implementing agreements with implementing partners, MOUs and exchange of letters with other UN agencies, and agreements with the government. If formal agreements have not yet been drawn up and the basis of cooperation remains a Letter of Intent, the definition of responsibilities contained in the operations plan is more essential than ever (see Annex 1 of the chapter 8 implementing arrangements for a format of a Letter of Intent).

14. The responsibilities of organizations delivering assistance but which are not implementing partners of UNHCR must also be defined. This may create problems, particularly where individual NGOs wish to have responsibility for a specific sector. Final authority rests with the government, and the Representative or the operations manager should consult closely with the authorities. To the extent possible, however, any conflict of interest should be resolved within the framework of a coordinating mechanism.

Annexes

Annex 1 - A Model Structure for an Operations Plan

Based on the problem, needs and resources assessments

The following is a proposed structure for an operations plan. It is based on a refugee influx. Adaptation will naturally be required for different situations.

Chapter 1: General Situation


i.

Background and country information;

ii.

Entry points;

iii.

Agreed planning figures;

iv.

Arrival rate;

v.

Reception and in-country movement;

vi.

Settlement arrangements;

vii.

Demographic profile of the refugees;

Chapter 2: Policies and Overall Operation Objectives


i.

Overall policy (strategic) objectives of the programme;

ii.

Comments on policy stance of various partners;

Chapter 3: Objectives and Activities by Sector


i.

Management and overall coordination; allocation of responsibilities;

ii.

Protection, reception, registration, security;

iii.

Food;

iv.

Logistics and transport;

v.

Infrastructure and site planning;

vi.

Shelter;

vii.

Domestic needs and household support;

viii.

Water;

ix.

Environmental sanitation;

x.

Health and nutrition;

xi.

Community services;

xii.

Education;

xiii.

Economic activities;

xiv.

Support to the operation, administration, communications, staff support and safety;

Each section should include overall sector objectives, and site by site objectives and outputs, problems, needs, resources, financial requirements, activities, implementation responsibilities and timing.

Chapter 4: Procedures for updating the operations plan

Describe how the Plan will be updated, who will be responsible for ensuring this and how the information will be disseminated.

Possible Annexes

i.

Maps

ii.

Registration forms

iii.

List of organizations or individuals participating in the operation

iv.

Agency Profiles (details of staff and resources involved in the operation)

v.

Gap identification charts

vi.

Commodity specifications

vii.

Budgets

Annex 2 - Gap Identification Chart (blank)

Site 1

Site 2

Site 3

Overall site management

Protection

Registration

Shelter

Water

Health

Nutrition

Sanitation

Distribution

Other

(introduction...)


Figure

Coordination

Introduction

1. Coordination can be defined as the harmonious and effective working together of people and organizations towards a common goal.

2. Good coordination should result in:

i. Maximum impact for a given level of resources;

ii. Elimination of gaps and overlaps in services;

iii. Appropriate division of responsibilities;

iv. Uniform treatment and standards of protection and services for all the beneficiaries.

3. For effective coordination appropriate approaches and structures will need to be put in place at the various levels. Coordination requires good management and clearly defined objectives, responsibilities and authority.

Coordination is not free: it has costs in terms of time and other resources needed to make it work.

Coordination of the UN Response to Refugee Emergencies

4. Within the UN system the responsibility for refugees lies with UNHCR. Therefore, when there is a refugee emergency, UNHCR is the UN organization responsible for coordinating the response of the UN system to the emergency.

Mechanisms for Coordination in Refugee Emergencies

5. Effective coordination is the result of sound management. Coordination mechanisms set up without the establishment of clear objectives and assignment of responsibility and authority will be ineffective. Coordination must be based on good information exchange, particularly with the site level, otherwise it may even be counterproductive.

6. Mechanisms for coordination include:

i. International and Regional instruments and agreements which define responsibilities and roles at the global (and sometimes regional or country) level;

ii. Memoranda of Understanding and exchange of letters with other agencies, and agreements with implementing partners and host governments, defining responsibilities and roles at the situational level;

iii. A coordinating body;

iv. Sectoral committees as necessary;

v. Regular meetings;

vi. Reporting and information sharing;

vii. Joint services and facilities, for example, vehicle repair services, communications, and a joint staff security group;

viii. Codes of conduct for organizations working in humanitarian emergencies.

7. In refugee emergencies UNHCR should take the lead to ensure effective coordination if this is not already ensured, including establishing the coordinating body.

8.

Whatever the implementing arrangements, a single coordinating body should be established for the operation - for example, a task force, commission, or operations centre.

The coordinating body will provide a framework within which the implementation of the programme can be coordinated and management decisions taken. The coordinating body should have clearly defined and well promulgated responsibility and authority.

9. The elements of a coordinating body, including membership and functions are described in Annex 1. Tips for running meetings, including coordinating meetings are given in Annex 2.

10. Where a coordinating structure does not already exist, UNHCR should, in cooperation with the government, take the lead in setting up the coordinating body and mechanism. This is a crucial component of UNHCR's leadership role. The coordinating body may be set up and chaired by the government with strong support from UNHCR, or be co-chaired by the government and UNHCR, or be chaired by UNHCR alone.

11. The membership of the coordinating body should include government ministries and departments, as well as other UN agencies, NGOs and other concerned organizations. It is important to coordinate the activity of all NGOs - whether they have entered into an implementing agreement with UNHCR or not. In a large scale emergency with a number of actors, the coordinating body could become unwieldy. However, it should still be possible to ensure some degree of representation or participation on the coordinating body by all actors either directly, or on sectoral committees, or through close working partners who are represented on the coordinating body.

12. The coordinating body should hold regular, formal meetings during which overall progress is reviewed and plans adjusted. These meetings should be complemented by informal contacts with members of the coordinating body.

13. When required, the coordinating body should create sectoral committees, for example for health and nutrition. Such committees will be responsible for coordinating implementation in that sector and reporting back to the coordinating body. They could also play an important part in the development of specific standards for the delivery of assistance. When the operation is sufficiently large, a sectoral committee could be coordinated by a UNHCR sector coordinator.

14. A coordinating body can also be of considerable value when new agencies arrive, both in integrating their assistance in the overall programme and with practical administrative arrangements and briefing.

15. Coordination must be based on good information exchange, particularly with the site level. The framework for the organization and coordinating mechanisms at the site level is likely to broadly reflect that established centrally. To get information passed vertically between central level and site level can be as hard as getting information passed between organizations. Each organization should be responsible for ensuring that there is good communication between its staff at site level and centrally, and that important information is then passed on to the coordination body.

Coordination of the UN Response to Complex Emergencies

16. A complex emergency can be defined as:

a humanitarian crisis in a country, region or society where there is a total or considerable breakdown of authority resulting from internal or external conflict, and which requires an international response that goes beyond the mandate or capacity of any single agency and/or the ongoing UN country programme.

17. Likely characteristics of complex emergencies include:

i. A large number of civilian victims, populations who are besieged or displaced, human suffering on a major scale;

ii. Substantial international assistance is needed and the response goes beyond the mandate or capacity of any one agency;

iii. Delivery of humanitarian assistance is impeded or prevented by parties to the conflict;

iv. High security risks for relief workers providing humanitarian assistance;

v. Relief workers targeted by parties to the conflict.

18. The Office for the Coordination of Humanitarian Affairs (OCHA), is the UN body charged with strengthening the coordination of humanitarian assistance of the UN to complex emergencies. OCHA has three main functions in this field: coordination of humanitarian response, policy development and advocacy on humanitarian issues.

19. OCHA discharges its coordination function primarily throughout the Inter-Agency Standing Committee (IASC) which is chaired by the Emergency Relief Coordinator (ERC), with the participation of humanitarian partners1. The IASC ensures interagency decision-making in response to complex emergencies, including needs assessments, consolidated appeals, field coordination arrangements and the development of humanitarian policies.

20. Where there is a complex emergency an individual or agency is appointed to be responsible for the coordination of the UN system response at field level - this individual or agency is designated the "Humanitarian Coordinator".

21. The decision on who to appoint as Humanitarian Coordinator is made by the Inter-Agency Standing Committee (IASC).

22. The agency appointed as Humanitarian Coordinator will depend on the nature of the emergency, and comparative existing agency capacity in the region.

23. There are four possible options which are normally used for the coordination of UN assistance in a complex emergency. These are:

i. Resident Coordinator

The Resident Coordinator is the leader of the United Nations country team and is normally the head of UNDP in a particular country. In a complex emergency, the Resident Coordinator may also be designated as the Humanitarian Coordinator.

ii. Lead Agency

One of the UN agencies may be selected to coordinate and this is often the agency which provides the majority of the assistance;

iii. Humanitarian Coordinator

If the emergency is of considerable size a Humanitarian Coordinator may be appointed distinct from the office of the Resident Coordinator and lead agency. The Humanitarian Coordinator normally phases out once the emergency reaches recovery phase and any residual tasks are returned to the Resident Coordinator;

iv. Regional Humanitarian Coordinator

If the emergency affects more than one country a Humanitarian Coordinator having regional responsibilities may be appointed.

1 The full members of the IASC are OCHA (convenor), FAO, IOM, UNDP, UNHCR, WFP, UNICEF, WHO, and there are a number of standing invitees, including the Red Cross movement and NGOs. i. Resident Coordinator

Role of UNHCR and Other UN Agencies in a Complex Emergency

24. In complex emergencies involving refugees, UNHCR will be responsible for protection and assistance activities on behalf of the refugees. UNHCR may also be appointed lead agency, and therefore be responsible for the coordination of the UN response.

25. Whether or not UNHCR is lead agency, the UNHCR Representative remains directly responsible to the High Commissioner on all issues related to the UNHCR country programme as well as policy matters and issues related to UNHCR's mandate.

The protection of refugees must remain the sole prerogative of the High Commissioner.

Organization at the Site Level

Introduction

26. The framework for the organization and coordinating mechanisms at the site level are likely to reflect broadly those established centrally. However, there is one fundamental difference between the site and central levels: at the site level the refugees themselves should play a major role.

The organization of the refugee community must support and enhance their own abilities to provide for themselves.

27. A clear understanding of the aims and objectives of the emergency operation and proper coordination are even more important at the site level than centrally, for it is here that failures and misunderstandings will directly affect the refugees.

Of particular importance will be the adoption of common standards when a number of organizations are providing similar assistance.

Regular meetings of those concerned are essential. There should be an overall coordinating mechanism chaired by the government authority, UNHCR Field Officer, and/or an operational partner, and this mechanism may be complemented by sectoral committees.

28. Certain activities are interdependent or have a common component and will need particularly close coordination at site level. For example, environmental sanitation measures must be closely coordinated with health services, and the home visiting component of health care with feeding programmes and community services.

29. A rapid changeover of outside personnel can create major problems for site level coordination, though some specialists may obviously be required for short periods. The importance of continuity is proportional to the closeness of contact with the refugees. Operational partners at the site should have a standard orientation and briefing procedure to ensure continuity of action and policy despite changes in personnel.

Community Organization

30. The importance of preserving and promoting a sense of community is stressed in chapters 10 and 12 on community services and site planning. The approach to thinking about and understanding site and community organization should be from the smallest unit - the family - upwards, rather than imposed from the largest unit downwards, which would be unlikely to reflect natural or existing community structures and concerns.

31. The basic planning unit for site organization and management is likely therefore to be the family, subject to traditional social patterns, and distinctive features of the population (e.g. numbers of separated minors, adolescent and women headed households). Larger units for organizational and representational purposes will again follow the community structure. For example, the next level up is likely to be community units of about 80 to 100 people, grouped according to living arrangements, followed by groups of communities of about 1,000 people. Different settlement services are decentralized to these different levels - e.g. water and latrines at household level, and education and health facilities at community and larger levels. The physical layout of the site will have a major influence on social organization.

Generally, the smaller the Settlement the better - the overriding aim should be to avoid high density, large camps.

Community Involvement

32. The refugees must be involved in planning measures to meet their needs and in implementing those measures. The way the community is organized can help ensure that the refugees' specific skills are made use of and that the personnel for services at the site will come from the refugees.

33. There are three levels to the involvement of refugees. The first is in the overall planning and organization, for example the determination of what is the best and culturally most appropriate solution to a problem, given the constraints of the situation. This level requires that the refugees have a social organization within their community that is properly representative. As the previous social structures may have been severely disrupted, this may take time to redevelop but will be important to the success of the emergency operation and for the future of the refugees. Meanwhile, urgent action to meet evident needs must of course be taken.

34. The second level of involvement is in the practical use of the refugees' skills and resources wherever possible for the implementation of the operation. The refugees themselves should run their own community to the extent possible. Where suitably qualified or experienced refugees exist, such as nurses, teachers and traditional health workers, they must obviously be used. Where they do not, outside assistance should ensure that refugees are trained to take over from those who are temporarily filling the gap. Other services include feeding programmes, sanitation, (maintenance and cleaning of latrines, drainage, garbage disposal, vector control, etc.) construction (shelters and communal buildings) education, tracing and general administration. Note that women and adolescents often have the necessary skills but lack the confidence or language skills to come forward - an outreach programme to identify them might be necessary.

35. At the same time, other traditional skills - for example in construction or well-digging -should be harnessed. While specific measures to develop self-reliance will vary with each situation, their aim should always be to avoid or reduce the refugees' dependence on outside assistance. The more successful measures are generally those based on methods and practices familiar to the refugees.

36. The third level is the education of the community on life in their new situation, which may be markedly different from their previous experience. Public health education in such matters as the importance of hygiene in crowded conditions, mother and child care and the use of unfamiliar latrines is an example. As another example, if unfamiliar foods or preparation methods have to be used, immediate practical instruction is essential. Education and guidance of this sort are best given by the refugees themselves (including women and youth), with outside assistance.

Refugee Representation

37. Refugee settlements are not, typically, simple replicas of former community life, and large numbers of refugees may be living temporarily outside their traditional community leadership structures. However, in nearly every emergency, some refugee leaders, spokespersons, or respected elders will be present. It will be necessary to define with the community the method of choosing leaders to ensure fair representation and proper participation in both the planning and implementation of the emergency programme. The more the settlement differs from former community life, the more important this action is likely to be to the success of the programme.

However, be aware that some new power structures might emerge, for example through force, and may exercise de facto control over the population, but may not be representative.

38. The system of refugee representation should:

i. Be truly representative of the different interests and sectors of the community, and of both men and women;

ii. Include various levels of representatives and leaders to ensure adequate representation and access for individual refugees;

iii. Avoid unconscious bias, for example on the basis of language. Bear in mind that there is no reason why a refugee should be representative of the community simply because he or she has a common language with those providing outside assistance;

iv. Be based on traditional leadership systems as much as possible but provided these allow proper representation (for example, if the traditional leadership system excludes women, there should nevertheless be women representatives);

v. Be consistent with the physical divisions in the layout of the site.

Key References

A Framework for People-Oriented Planning in Refugee Situations taking account of Women, Men and Children, UNHCR, Geneva, 1992.

Partnership: A Programme Management Handbook for UNHCR's Partners, UNHCR, Geneva 1996.

UNHCR Handbook; People-Oriented Planning at Work: Using POP to Improve UNHCR Programming, UNHCR, Geneva, 1994.

Annexes

Annex 1 - Elements of a Coordinating Body

Each of the factors listed below would need to be evaluated against the particular context and policy of the host government. At the beginning of the operation UNHCR should secure a suitable meeting room for coordination meetings.

Membership

The nature of the coordinating body and its usefulness will be determined partly by its membership.

1. Criteria for participation:

i. Provision of direct services;

ii. Regular attendance at coordination meetings;

iii. Compliance with service guidelines and standards;

iv. Regular financial contributions to coordination mechanism.

2. Other organizations may wish to attend coordination meetings without full participation in the coordination mechanism:

i. Organizations which may choose not to fully participate, e.g. ICRC;

ii. Funding organizations and donor representatives;

iii. Public interest groups;

iv. Military forces.

Functions of the coordination body

1. Meetings.

These may be needed at the central and the site level, and include:

i. Overall coordination meetings, which may be needed daily at the start of an emergency;

ii. Sectoral committee meetings (e.g. health, registration, water);

iii. Conferences.

2. Identification of needed services and soliciting voluntary agencies to assume responsibilities for the provision of these services.

3. Allocation of donated commodities and financial contributions.

4. Guidelines and standards for the provision of services.

5. Orientation of newly arrived agencies.

6. Orientation of incoming staff.

7. Research and documentation.

8. Support for settlement coordination committees.

9. Coordination with agencies outside the country.

10. Information sharing.

11. Fund raising.

Annex 2 - Tips on running a meeting

1. Set clear objectives for the meeting

· Why is the meeting needed and what is the expected outcome? (Communication? Problem-solving? Planning? Decision-making?)

· Who should attend the meeting?

· Should the meeting be formal or informal?

2. Prepare an agenda

· Make a written agenda with clear objectives and approximate timing for each item;

· Ensure that the agenda states why the meeting is needed;

· Make sure the agenda is realistic (not too many items) and sequence the items appropriately;

· Put the difficult, important issues near the beginning (perhaps dealing first with something quick and simple);

· Plan breaks if the meeting is more than 1 hour in length;

· Avoid mixing information sharing and decision-making in the same meeting - hold separate meetings for these functions.

3. Documentation

· Circulate a detailed agenda, list of participants and any background documentation (such as minutes of previous meetings) in advance (but not too far ahead) of the meeting, 2 to 3 days before is best;

· Indicate the time, place and duration of the meeting;

· Prepare audio-visual materials in advance.

4. Seating arrangements

· Choose a circular or rectangular table;

· Avoid a long, narrow table if possible as this makes communication more difficult;

· In an informal setting, a semicircle of chairs facing a flip chart is the best;

· Everyone should be able to see each other;

· Participants should not be too crowded or too far apart.

5. During the meeting

· Start on time;

· Have the participants introduce themselves if they do not know each other;

· Clarify the objective(s) of the meeting and review the agenda and time limits;

· Outline how the meeting will be conducted (methodology);

· Identify the rapporteur or secretary for the meeting;

· Ask the participants if they agree to the agenda and be flexible on minor changes if there is consensus;

· If applicable, review action items of previous meeting(s);

· Make sure you have everyone's attention before opening the meeting.

During the meeting the chairman or facilitator should

· Avoid getting personally involved in the discussions;

· Keep an overall view of the objective(s);

· Do not lose the thread of the argument;

· Stick to the agenda (but be flexible within agenda items);

· Ask for information and opinions;

· Summarize and reformulate key points (have the rapporteur or secretary use the flip chart to record the points as they occur);

· Clarify and elaborate where needed;

· Concentrate on key issues and stop digressions;

· Test for consensus;

· Ensure everyone gets a chance to speak;

· Assign responsibilities and deadlines for agreed tasks (action, responsibility, and date by agenda item);

· Set date, time and place for next meeting;

· Close the meeting on time, on a decided and positive note.

7. After The Meeting

· Keep a record of the meeting. It should include the following basic items:

i. A list of the participants noting those who were invited but did not attend ("apologies" list);

ii. The conclusions, decisions, recommendations and the follow up action required, by agenda item, with the name of the person responsible for action and time frame;

iii. The time, date and place of the next meeting.

Note: working in small groups

Dividing the participants into small groups can be useful in large meetings (more than 12 participants), when discussions are lengthy. Depending on the subject, it can allow in-depth discussion on specific questions and possibly help to solve problems.

(introduction...)


Figure

Introduction

1. Appropriate arrangements to implement an emergency operation will be fundamental to its success. UNHCR has a unique statutory responsibility for the provision of international protection. However, there is no such unique statutory responsibility for the provision and distribution of material assistance to refugees, which might be carried out by other organizations - governmental, UN agencies, NGOs, as well as directly by UNHCR. There are a number of factors which will influence the implementing arrangements for assistance operations. This chapter outlines implementing arrangements and procedures in emergencies including monitoring, reporting and evaluation. UNHCR guidelines for standard procedures must be referred to for more detail.

Implementing Arrangements

2. Depending on the scale and needs of the emergency, a number of different implementing arrangements may be needed in the various sectors. One organization might have operational responsibility for health care, and another for logistics. Even within a sector, operational responsibility may have to be split up. Different operational partners might have responsibility for health care in different refugee sites or communities. In UNHCR terminology, an operating partner is an organization or agency that works in partnership with UNHCR to protect and assist refugees, and an implementing partner is an operational partner that signs an implementing agreement with UNHCR.

3.

Whenever possible UNHCR seeks to implement assistance indirectly through an implementing partner rather than directly.

The origin of this policy is found in the Statute of UNHCR. Article 1 requires the High Commissioner to seek "permanent solutions for the problem of refugees by assisting Governments and, subject to the approval of the Governments concerned, private organizations...". In accordance with Article 10, the High Commissioner "shall administer any funds, public or private, which he/she receives for assistance to refugees, and shall distribute them among the private and, as appropriate, public agencies which he/she deems best qualified to administer such assistance".

Degree of Operational Responsibility of UNHCR

4. Although UNHCR normally seeks to implement indirectly through an implementing partner, there are circumstances in which it may be necessary and/or clearly in the interests of refugees for UNHCR to assume greater operational responsibility. UNHCR's degree of direct operational responsibility will vary for each emergency situation, and also with time as the operation evolves.

5. Factors influencing the degree of operational responsibility undertaken by UNHCR, other organizations and the government include the following:

i. The government's capacity to manage the refugee emergency, because of the scale, nature, location of the emergency, and ability of existing government structures to respond;

ii. The existence and capacity of other organizations in the country, and in the sectors where assistance is most needed;

iii. The stage of the emergency. At the start of an emergency, the government itself frequently has full operational responsibility. For example, a new influx is often first assisted by the local district and provincial authorities. On the other hand, in other circumstances, it is often at the start of an emergency where UNHCR has the greatest operational responsibility because there may be no suitable operational partner immediately available within the country.

6. Where UNHCR does assume a high degree of operational responsibility, swift action is needed to ensure that the necessary personnel and expertise are available, by obtaining the rapid deployment of sufficient UNHCR staff (see chapter 20 on administration and emergency staffing). At the same time, steps should be taken to identify and mobilize other organizations to assume responsibilities in the various sectors as soon as possible.

The Operational Role of the Government

7. Whatever the implementing arrangements, overall responsibility remains with the host government, assisted by UNHCR. The government's concurrence must, in accordance with Article 1 of the Statute, be sought on the proposed implementing arrangements.

8. The government may not have the capacity to be the primary operational organization, but may play a major role in the implementation of various activities of UNHCR and donors. In this case, it is preferable to ensure that the policy arm of the government (e.g. the Ministry of the Interior) is separate from the "operational" entities, since, as recipients of UNHCR funds, the relationship with the latter is substantially different.

It is preferable that the implementation of programmes be carried out by existing line ministries - e.g. the Ministry of Health for hearth programmes. As a rule, new government departments should not be specifically created to respond to the refugee emergency.

Every effort should be made to resist the creation of such specialized departments.

The Operational Role of UN Agencies

9. UNHCR always retains responsibility for the protection needs of refugees, but the refugees' material needs are likely to fall within sectors for which other organizations in the UN system have special competence through their mandate, experience and capacity, e.g. WFP and UNICEF. The roles and responsibilities of UN agencies are defined through their mandates and MOUs, and situation-specific responsibilities are set out in exchanges of letters and agreements - this should avoid duplication, minimize gaps, and clarify roles on the basis of recognition of comparative advantages.

Non-Governmental Organizations

10. Where the government is not the implementing partner in a particular sector, there may be advantages to selecting a national organization or an NGO with the required capacity as a partner. National or locally-based organizations may already be delivering emergency assistance, would already have staff on the ground, and would already be familiar with the country.

11. Many international NGOs have great experience of refugee emergencies and some can deploy teams and resources at short notice, both for specific sectors and for general management. In addition to their own staff, they will also know of a wide circle of individuals with the appropriate skills and experience. International NGOs already working in the country may be strengthened by their headquarters. For instance, under the overall responsibility of the national Red Cross or Red

Crescent Society, the IFRCRCS may be able to help strengthen quickly the capacity of the national society to implement the emergency operation.

12. Criteria for the selection of implementing partners may be found in Chapter 4 of the UNHCR Manual.

Implementing Procedures

Implementing procedures are subject to change. The forms, terms, documentation, procedures and references (e.g. chapter 4 of the UNHCR Manual) referred to in this section from paragraphs 13 to 31 may change from time to time. However, the basic principles should remain the same.

13. Authority to implement the activities envisaged in the operations plan must be given formally through implementing instruments. These define the conditions which govern project implementation and authorize the obligation and expenditure of funds.

14. Authority to implement is firstly delegated internally within UNHCR. This is usually given through a Letter of Instruction (LOI) which authorizes the UNHCR Representative to implement projects directly or to enter into implementing agreements with implementing partners. Based on the internal delegation of authority, implementing agreements can be signed with UNHCR's implementing partners.

Any party disbursing UNHCR funds must have a formal signed agreement with UNHCR.

The Emergency Letter of Instruction (ELOI)

15. An Emergency Letter of Instruction (ELOI) is simpler in form and procedure than a "normal" LOI and is used to delegate implementing authority rapidly to the field. It is usually sent via e-mail, fax or telex. The ELOI gives the Representative in a country where an emergency is rapidly evolving the immediate authority to incur expenditures, and to enter into agreements for project implementation with implementing partners. It is not intended to cover the entire emergency operation, but to permit a rapid response to immediate needs, pending the formulation of an assistance project based on a detailed needs and resources assessment. Thus, in order to ensure continued assistance once these funds are exhausted or the ELOI project is terminated the manager of the operation should, as soon as possible, send Headquarters a detailed project proposal for the issuance of an LOI, in accordance with the procedures set out in Chapter 4 of the UNHCR Manual.

16. The minimum information which the Field Office must send to Headquarters in order that an ELOI be prepared is a budget proposal in US dollars at sector level. No project description or workplan is required.

17. Headquarters can then issue an ELOI with the following basic information:

i. Total requirements;

ii. Initial obligation level;

iii. Purpose of the expenditure (at sector level);

iv. Any time limit applicable to the expenditure;

v. Project symbol;

vi. Summary budget at sector level.

18. Actual expenditure under an ELOI must be recorded at a more detailed level (sector activity or, preferably, sub-item). It must be charged to the appropriate project under which implementation is taking place. A voucher must be completed to record every disbursement made, showing the name of the payee, the amount, the project symbol, the purpose and date of disbursement. The voucher should be signed by the payee or supported by receipted bills and sent to Headquarters with the monthly accounts.

19. In certain circumstances, the ELOI may not be necessary, as it will be possible to reallocate funds under an existing LOI.

Implementing Agreements

20. Implementation of all or part of a project may be sub-contracted to one or more implementing partners. A party disbursing UNHCR funds must have a formal signed agreement with UNHCR. The agreement must be based on the internal delegation of authority, and must comply with the terms of the authority (LOI, ELOI, etc.) and the Financial Rules. The standard clauses which must figure in any implementing agreement are described in Chapter 4 of the UNHCR Manual.

21. If the government or an international organization advances relief supplies from their own resources, UNHCR may agree in writing to reimburse them in cash or kind, provided the maximum US dollar commitment is specified and does not exceed unobligated funds available under the ELOI or other existing authority. Any such commitments should immediately be reported to Headquarters.

22. An agreement with the government covering the provision of assistance is quite separate from the administrative agreement that governs the status of the High Commissioner's representation in the country. Where this administrative agreement (often referred to as the "UNHCR Cooperation Agreement") needs to be concluded, special instructions will be given by Headquarters. See also annexes to the Checklist for the Emergency Administrator for examples of such agreements.

Letter of Intent

23. If the implementing partner must start providing assistance before there is time to conclude an agreement, a signed "Mutual Letter of Intent to Conclude an Agreement" can authorize the obligation of funds. This is a temporary arrangement until there has been time to develop the detail of the agreement. The letter must include certain basic clauses. Annex 1 contains a sample format for such a letter and the basic clauses.

Agreements

24. The form of the agreement will depend on the circumstances and on the identity of the implementing partner. The agreements exist in two different formats. Bipartite agreements are for projects implemented by a governmental or a non-governmental organization. Tripartite agreements are for projects implemented by an non-governmental organization and where the host government is a third signatory to the agreement. The individual signing on behalf of UNHCR should be the addressee of the ELOI or LOI. The agreement sets out the responsibilities of each party, for example the government's contributions to the programme (land, services etc.) and its undertakings on facilitating the import and transport of relief supplies (traffic and landing rights, tax and customs exemptions, etc.).

Administrative Expenditure by Implementing Partners

25. UNHCR looks to implementing partners to contribute their own resources to the refugee programme, and to develop the capacity to meet their own support costs, in particular their headquarters support costs. UNHCR recognizes, however, that certain types of support costs could be a legitimate charge on UNHCR voluntary funds. Support costs (as opposed to operational costs) are defined in Chapter 4 of the UNHCR Manual, as are the guidelines applicable to the coverage of such costs.

Direct UNHCR Expenditure

26. In many cases, there may be a need for direct UNHCR project expenditure in addition to programme delivery, and administrative support. This might include international procurement by UNHCR, clearing, storage and internal transport expenses for contributions in-kind, and initial direct operational expenditure by UNHCR Field Officers at the refugee site.

Procurement

27. The Representative may enter into a contract (or series of related contracts1 for the procurement of goods and services up to a certain limit (US$100,000 in 1998), without special Headquarters approval, but subject always to the appropriate authority (e.g. the ELOI) and procedures.

28. Where the Representative needs to enter into a contract (or series of related contracts) in excess of this amount, approval must be obtained either from Headquarters, or from the Local Committee on Contracts. A Local Committee on Contracts can be established when circumstances demand, for example at the beginning of an emergency where required goods and services are available locally. It can only be established with the approval of Headquarters (according to the procedures in Annex 2).

29. In all cases, the Representative must ensure that there is always due assessment of the available alternatives, including competitive bidding, before procuring any goods or services.

30. Procurement procedures are described in Chapter 4 of the UNHCR Manual, and set out in Annex 2. See also chapter 18 on supplies and transport.

Contributions In Kind

31. Contributions in kind may be made towards needs foreseen under the emergency programme. Whether these are made bilaterally or through UNHCR, their value (generally assessed on the same basis as foreseen in the budget costing) will normally be credited against the appropriate budget item, and the cash requirements through UNHCR for that item reduced accordingly. This mechanism may need to be carefully explained to the government and implementing partners. For all contributions in kind made through UNHCR, a separate project or an "in kind LOI" will be established by Headquarters for the value of the contribution. The addressee of the relevant LOI is required to provide reports from the field to Headquarters on the arrival and distribution of the contribution. Paragraph 53 of chapter 9 on external relations discusses contributions in kind received by the Field.

1 Related purchases are contracts entered into with one supplier within the previous 90 days which amount to $100,000 or more, not including contracts that have been approved by the Committee on Contracts.

Monitoring, Reporting and Evaluation

32. Control of UNHCR funds by the UNHCR field office and operational partners, and monitoring and evaluation, should be in accordance with established UNHCR procedures and the relevant clauses of the ELOI or LOI. Proper project control, including the close monitoring of obligation and expenditure levels, is particularly important in an emergency because of the risk of over-expenditure and the need to reallocate under-used resources without delay.

33. Careful and close monitoring of the activities and outputs is essential. Whatever the implementing arrangements, a UNHCR presence at, or at least frequent visits by the same person to, the site of the refugees will be required.

34. Monitoring is the ongoing review of an operation or project during its implementation to ensure that inputs, activities, and outputs are proceeding according to plans (including budget and work schedules). Monitoring tracks progress towards objectives, and that progress should be analyzed and evaluated by management, who can make improvements and take corrective measures to better achieve those objectives. Monitoring can be summed up in the question: "Are we doing the thing right?".

35. Projects should also be evaluated to analyze the goals of the project themselves: their relevance and achievability - this can be summed up in the question "Are we doing and have we done the right thing?".

Sufficient information must be available to decision-makers so that the operation can be adjusted to meet changing needs or to correct shortcomings.

36. Monitoring and evaluation should not be considered as time consuming detractions from protecting and assisting refugees, but as important tools in an emergency to ensure that activities being carried out retain their relevance in rapidly changing situations, and continue to address the most urgent problems. The circumstances of refugee women and children should be specially monitored; their circumstances could and should be used as benchmarks for monitoring the effectiveness of the overall operation.

37. Reports should be in standard formats or cover standard issues, in order to ensure important information is covered but avoiding unnecessary detail. Always bear in mind the purpose of the report, and who will be reading it, keeping it concise and to the point. Energy should not be wasted on exchanging information that is not acted upon - a report that is not read and acted upon is a waste of paper and time.

38. See Annex 3 for a suggested format for a standard emergency situation report.

Situation reports should be sent as a matter of routine.

Specific reports will be required for various sectors like protection, health and community services.

39. Regular reports should be made by the implementing partner to UNHCR at field level. The reporting obligations of implementing partners must be set out in the implementing agreements. The Field must also send regular reports to Headquarters - implementing partners' reports that are forwarded to Headquarters must always be accompanied by an analysis and comments from the Representative.

Special Considerations

40. In a refugee emergency, staff may be faced with a number of questions on which the following guidance may be helpful.

Payment for the Purchase or Rent of Land Occupied by Refugees.

41. As a matter of policy, UNHCR does not buy or rent land, which the government of the country of asylum is expected to provide.

Headquarter's approval is required for exceptions to this policy. Construction on the land may however be financed by UNHCR.

Payment to Refugees

42. The issue of paying refugees in cash or kind for certain assistance activities (e.g. some community services, establishing basic infrastructure and shelters) will inevitably arise. How this issue is resolved can have a crucial effect on a settlement's character.

Payment can destroy the sense of responsibility refugees feel for their welfare.

However, the absence of payment may mean that tasks essential to the settlement's well-being are either not done or have to be done by paid outside labour.

43. In the first days of a settlement's existence payment to refugees would not normally be appropriate. In this start-up phase refugees should assume their responsibility towards themselves and their fellows to participate in the establishment of their settlement. Even payment-in-kind is probably inappropriate at this stage. In addition to the unfortunate impression of creating a right to payment, it may also involve commitments which cannot continue to be met, or have to be met at the expense of the entire settlement's general ration. Problems with the supply system are almost inevitable at the beginning of a settlement's life and no group should in such circumstances get extra commodities to the direct detriment of others.

44. In the longer-term, certain types of community work frequently start to emerge as areas where standards will drop if some form of payment is not given. This is often the case with key public health services whose importance is not always correctly understood by the refugees. Before starting any payment scheme, calculate its full potential cost and ensure that the required extra funds or food are available. The continuing financial implications for a large refugee population may be considerable.

It should be borne in mind that, after payment is introduced for One type of job or for one group of workers, others will see this as a precedent.

It will be necessary to have some very clear but restrictive criteria for paid community work, The wage system introduced should not inhibit progress towards a self-reliant settlement. Those agencies responsible for different sectoral services should meet the wage costs of refugees working in that sector.

45. As the refugees are already supported, remuneration levels should be well below national rates. It is important that this remuneration be fairly applied to all refugees doing broadly the same work. A major cause of discord at many refugee sites has been the payment by different organizations of markedly different rates to refugees for the same work.

A standard scale is essential.

Whether or not there are differentials recognizing different levels of skill will be a matter to decide in consultation with the refugees.

Provision of Services to the Local Population.

46. The local population should not see the refugees as a burden, because of their effect on existing local services and environment, nor should the refugees be a cause of resentment, because of benefits which may seem to accrue only to them. So activities to benefit the refugees such as maintaining or improving the local infrastructure (roads, hospitals and schools) or to look after the local environment, could help avoid or diminish resentment on the part of the local population.

47. Bilateral aid programmes and other organizations, both within and outside the UN system, should be encouraged to help affected nationals. Assistance available to refugees should take account of the conditions of nationals in the area and a flexible approach should be adopted - the principle is that provision of services to refugees should not be higher than that available to the local population.

Corruption

48. UNHCR should ensure that all concerned with the provision of assistance know clearly what UNHCR policy is regarding corruption. UNHCR is obliged by donors and by its mandate to ensure that all funds distributed by it are properly used for the benefit of refugees and all transactions must be in accordance with the Financial Rules. UNHCR should clearly specify which practices are acceptable and proper and which are not. It should also be clear that breaches of the policy will not be tolerated, and this message will be reinforced if rigorous monitoring and control are apparent to all parties.

Political and Religious Activity

49. Everyone has a right to political and religious expression: however, refugees are also obliged to conform to the laws and regulations of the host country as well as to the measures taken for the maintenance of public order. UNHCR itself is obliged to be non-political2. Responsibility for security and public order at the refugee site always rests with the government. To help maintain order, site planning should take into account any need there may be to physically separate any previously hostile groups among the refugees.

50. Other organizations active in the delivery of assistance may have a religious aspect in their normal work. Some are traditional partners of UNHCR, and the separation of religious and other activities is long established and well understood, but for others it may be useful to recall the basic principles. Religious activities by those outside the refugee community, where permitted by the authorities, must be clearly dissociated from the delivery of assistance and services to refugees.

No proselytizing should take place in association with the provision of services such as education, health and community services.

2 Para. 2 of the Statute of the United Nations High Commissioner for Refugees states: "the work of the High Commissioner shall be of an entirely non-political character: it shall be humanitarian and social..."

Key References

Partnership: A Programme Management Handbook for UNHCR's Partners, UNHCR, Geneva, 1996.

Supplies and Food Aid Field Handbook, UNHCR, Geneva, 1989.

UNHCR Manual, Chapter 4, UNHCR, Geneva, 1995 (and updates).

Annexes

Annex 1 - Sample Letter of Mutual Intent to Conclude an Agreement

NATIONS UNIES - HAUT COMMISSARIAT POUR LES REFUGIES

UNITED NATIONS - HIGH COMMISSIONER FOR REFUGEES

Date

Notre/Our code:

Dear

I should like to refer to our exchanges [add details as appropriate] concerning the implementation by [name of implementing partner] on behalf of the United Nations High Commissioner for Refugees (UNHCR) of a programme of emergency assistance to [origin and number of beneficiaries].

It is my understanding that it is our mutual intention to conclude and sign as soon as possible an agreement covering our cooperation in the above mentioned programme. This agreement will incorporate, inter alia, the attached clauses and will require [name of implementing partner] to report in financial and narrative form on the use of all contributions received from the High Commissioner. The conclusion of an agreement embodying these requirements is mandatory under the Financial Rules of UNHCR whenever funds are made available by UNHCR.

I should be grateful if you would confirm in writing below that this understanding is correct, and your agreement that the use of the sum of [amount in local currency or in US dollars], that the High Commissioner intends to make available to [name of implementing partner] on receipt of this confirmation, will be considered as subject to the terms of the Agreement, once concluded and signed.

[signature and title of addressee of ELOI]

I confirm that the understanding set out above is that of [name of implementing partner], which agrees that the use of the sum of [amount in local currency or in US dollars] will be considered as subject to the terms of the Agreement, once concluded and signed.

[signature and title of addressee of letter above, and date]

MANDATORY CLAUSES

Clauses governing Rate of Exchange (1.08 or 2.03), Maintenance of Financial and Project Records (3.08), Inspection and Audit (3.11 and 3.12), Audit Certificate (3.13) and Non-Liability of the High Commissioner (4.05 and 4.06) are STATUTORY REQUIREMENTS and cannot be excluded (paragraph numbers given are those from UNHCR Manual, Chapter 4, Appendix 8). These clauses are set out below:

Rate of Exchange

1.08 (if the government is a signatory to the Agreement): grant the most favourable official rate of exchange for all conversions into local currency of funds provided by the High Commissioner for the implementation of the project governed by the UNHCR Agreement;

2.03 (if an NGO is the implementing partner): apply the most favourable official rate of exchange for all transactions relating to the implementation of the project governed by the UNHCR Agreement;

Maintenance of Financial and Project Records

3.08 maintain separate project records and accounts containing current information and documentation which, inter alia, shall comprise:

a) copies of the UNHCR Agreement(s) and all revisions thereto;

b) payment vouchers, clearly showing the (Sub-) Project symbol, the name of the payee, the amount, the purpose and date of disbursement, evidencing all payments made and with all pertinent supporting documentation attached;

c) vouchers evidencing the receipt of all remittances, cash or any other form of credit to the project account;

d) periodic analyses of actual expenditure against the project's budget;

e) records of all financial commitments entered into during the project;

f) reports by auditors on the accounts and activities of the project;

Inspection and Audit

3.11 facilitate inspection and audit of the project governed by the UNHCR Agreement by the United Nations Internal Audit Service or any other person duly authorized by the High Commissioner on behalf of the United Nations. Should they at any time wish to do so, the United Nations Board of Auditors may also carry out an audit of the project. Audits of the project will include, inter alia, the examination of the project accounting records in order to determine that the charging of administrative and operational support costs to the project complies with those specified in the annexes to the UNHCR Agreement. For auditing purposes, project accounting records shall be retained for the six years following the project's termination;

3.12 facilitate visits by the High Commissioner or of any other person duly authorized by him/her to the project site(s) to evaluate the progress and achievements of the project during its period of implementation or thereafter;

Audit Certificate for Governmental Implementing Partners

3.13 submit to the High Commissioner, within three months of the final date for liquidation of commitments, an audit certificate issued by the appropriate government audit authority, together with such comments as the auditor may deem appropriate in respect of project operations generally and, in particular, the financial situation as reported by the Government;

Audit Certificate for International NGO Implementing Partners

3.14 submit to the High Commissioner, within six months of the end of the Agency's fiscal year, a copy of its consolidated audited financial statements, wherein UNHCR funding is clearly identified, issued by an independent audit authority and as presented to and endorsed by the Agency's governing body. The audit report and opinion should include such comments as the auditor may deem appropriate in respect of UNHCR funded project operations generally and, in particular, the opinion should clearly indicate that UNHCR funds were duly included in the audit;

Audit Certificate for National NGO Implementing Partners

3.15 for all UNHCR Agreements for a value of US$100,000 and above, submit to the High Commissioner, within six months of the final date for liquidation of commitments, an audit certificate issued by an independent audit authority. The audit report and opinion should include such comments as the auditor may deem appropriate in respect of project operations generally and, in particular, the financial situation as reported by the Agency to UNHCR in its final Sub-Project Monitoring Report. For all UNHCR Agreements for a value of less than US$ 100,000, UNHCR reserves the right to request an audit in accordance with Clause 3.11 above.;

Non-liability

4.05 not be liable to indemnify any third party in respect of any claim, debt, damage or demand arising out of the implementation of the project governed by the UNHCR Agreement and which may be made against the other parties to the Agreement;

4.06 not accept liability for compensation for the death, disability or the effects of other hazards which may be suffered by employees of the other parties to the UNHCR Agreement as a result of their employment on work which is the subject matter of the Agreement.

Annex 2 - Procurement by a UNHCR Field Office

1. Introduction

1.1. The procedures applicable to the procurement of goods and/or services by UNHCR Headquarters or UNHCR offices in the field (other than contractual arrangements for the employment of staff) vary according to the US dollar value (at the prevailing United Nations rate of exchange) of the goods or services, and are described below.

1.2 For all purchases of substantial quantities of relief or other supplies by UNHCR offices in the field. Representatives should nominate a purchasing/logistics focal point with a clear line of responsibility. Local purchases will be initiated by, or at least cleared with, the purchasing/logistics focal point. In all circumstances, including the evaluation of contracts for the supply of goods and services or consultancies, the procedures described below will apply. The term "Purchase Order" is to be read as also applying to other forms of authorization used in relation to contracts for services or corporate or institutional consultancies.

1.3 In all cases of procurement of goods and/or services, the procedures and controls applied should be in accordance with Appendix 8 of Chapter 4 of the UNHCR Manual and must provide an open, competitive, qualitative and accountable process to obtain such goods or services which meet project requirements at the lowest available cost. It is the responsibility of the addressee of the Letter of Instruction to ensure that the relevant procedures are adhered to.

1.4 All contracts entered into for the procurement of goods and/or services should ensure exemption from, or reimbursement of, all customs duties, levies and direct taxes on services and goods, supplies or any other articles imported or domestically purchased.

1.5 It is the responsibility of the Representative to ensure that each UNHCR office in the field maintains a register of all commercial contracts entered into and that a sequential number is assigned to every such contract.

1.7 For a value of less than US$ 2,500

A Purchase Order may be issued without recourse to formal tender, provided that funds are available under the Letter of Instruction and that at least three informal offers or prices have been considered and the best offer has been selected.

1.8 For a value of over US$ 2,500 and up to US$ 5,000

A Purchase Order may be issued provided that funds are available under the Letter of Instruction and that at least three informal quotations have been compared and the best offer has been selected. A written record of the quotations and the reasons for the selection must be kept.

1.9 For a value of over US$ 5,000 and up to US$ 50,000

A Purchase Order may be issued provided that funds are available under the Letter of Instruction and that selection has been made on the basis of at least three competitive offers obtained in response to a formal Quotation Request sent to selected suppliers inviting them to submit sealed quotations within a specified time frame. Chart 3.F and Annex VIII of the Supplies and Food Aid Field Handbook provide guidelines and an example of a Quotation Request. The Quotation Request must stipulate that all offers must be received at the UNHCR office in signed and sealed envelopes and marked with the Quotation Request number. All quotations received must remain sealed and must be kept under lock and key until the expiration of the bid deadline. All bids must be opened before a witness by the Administrative Officer or the Officer in charge of administration in the office, and must be initialled by both the person opening the bids and the witness. The witness shall be selected by the Representative and drawn from the professional or national officer categories. All formal quotations will be compared on a Tabulation of Bids form as per Annex IX of the Supplies and Food Aid Field Handbook. The recommended supplier and the reasons for selecting that supplier will be stated thereon.

1.10 For a value of over US$ 50,000 and up to US$ 100,000

Representatives will establish a Purchasing Committee to consider bids and to make the appropriate recommendations. The approval of Headquarters is not required. Rules and procedures concerning Purchasing Committees and their composition are set out below. In a country with more than one Field/Sub Office, the Representative may wish to establish Purchasing Committees at different duty stations. Depending on local costs and current exchange rates, Representatives may also lower the financial limit of procurement to be considered by the Purchasing Committee. The Committee will consider quotations subject to the same conditions as set out in paragraph 1.9 above. If appropriate, the Representative and/or the Committee may wish to request specialist advice from the Programme and Technical Support Section or the Supply and Transport Section at Headquarters.

For a value of US$ 100,000 or more:

1.11 A submission must be made to the Committee on Contracts at Headquarters except in cases where Headquarters has authorized the establishment of a Local Committee on Contracts as described in 3 below. For submissions to the Headquarters Committee on Contracts, a minimum of four formal quotations must be requested and considered by the Purchasing Committee which will make a proposal as to the most suitable supplier to the Committee on Contracts through the relevant Desk at Headquarters. In cases where Headquarters has authorized the establishment of a Local Committee on Contracts, the latter may evaluate and decide on all bids without recourse to the Purchasing Committee. Nevertheless, in all cases, the relevant specialists in the Programme and Technical Support Section and the Supply and Transport Section must be consulted before or during the tendering and evaluation stages so as to ensure compliance with technical requirements and that prices are compatible with international market rates for the goods or services under consideration. Submissions to the Committee on Contracts should include information as shown in Chart 3.G of the Supplies and Food Aid Field Handbook. After approval by the Committee on Contracts (or a Local Committee on Contracts), a Purchase Order may be issued.

2. Purchasing Committee

2.1 Procurement of goods or services by a UNHCR office in the field for a value of over US$ 50,000 and up to US$ 100,000 must be approved by a Purchasing Committee. This Committee will also prepare proposals to the Headquarters Committee on Contracts for procurement for a value of over US$ 100,000 in cases where Headquarters has not authorized the establishment of a Local Committee on Contracts. The Purchasing Committee will be established and chaired by the Representative and will consolidate the requirements, oversee the tendering process, select suitable local suppliers and record its recommendations in writing.

2.2 The Committee will be composed of Members and alternate members designated by the Representative and drawn from the professional or national officer categories. Staff members responsible for procurement should be excluded from membership. In cases where several implementing partners require similar supplies the Representative may consider including in the Purchasing Committee staff from implementing agencies. A quorum will consist of three Members.

2.3 The staff member in charge of procurement should present a written proposal to the Purchasing Committee which will include information on the goods or services to be procured as per Chart 3.G of the Supplies and Food Aid Field Handbook. The minutes of the meeting will be taken and issued (at least in draft) within two working days after the meeting. Alternatively, particularly in an emergency, Members of the Committee may approve purchase by signature of the proposal with appropriate comments. In general, the Committee should adopt procedures similar to those of the UNHCR Committee on Contracts as set out in Annex 8.5 of Chapter 4 of the UNHCR Manual, except for the provisions concerning emergency procedures.

3. Local Committee on Contracts

3.1 In a UNHCR office in the field, the Representative may request Headquarters to approve the establishment of a Local Committee on Contracts, particularly in the early stages of an emergency operation and when required goods or services are known to be available locally or regionally. The authority to establish a Local Committee on Contracts must be obtained from Headquarters, which will normally stipulate the purpose, the geographic, time and financial limits, the necessity to apply the relevant rules and procedures and, if applicable, the necessity to consult the Supply and Transport Section or the Programme and Technical Support Section on the prices and sources of supply of commodities and/or services available in the region. The Committee will be chaired by the Representative or by a formally designated alternate, and will be composed of at least three professional staff members. If there is no quorum, the matter will be referred to the Committee on Contracts at Headquarters. The Local Committee on Contracts will consider quotations subject to the same conditions as set out in paragraph 1.9 above.

3.2 All requests for the establishment (or the extension of the period of validity) of a Local Committee on Contracts should be sent via the Desk to the Chairman of the Committee on Contracts who will check the criteria and the justifications provided, and, if appropriate, request the Secretary of the Committee on Contracts to prepare an authorizing communication. The authorizing communication should be cleared by the relevant Regional Bureau and the Chief of the Supply and Transport Section, and be authorized by the Chairman of the Committee on Contracts. Requests for the establishment of a Local Committee on Contracts must include a full justification as well as information on the requested time and financial limits, and must also confirm that the goods or services being sought are available locally or regionally and that the requisite minimum number of professional staff would be available to act as Members of the Local Committee on Contracts. Requests must include the names of three members and three alternate members.

3.3 The Representative shall appoint a secretary to the Local Committee on Contracts to receive submissions to the Committee, to schedule meetings and secure the relevant documentation, to conduct required correspondence, to maintain the Committee's files and to prepare and distribute minutes of the Committee's proceedings.

3.4 Copies of the minutes and proceedings of each meeting of the Local Committee on Contracts, together with a Tabulation of Bids form and copies of the contracts entered into or purchase orders placed (and any amendments to these) must be forwarded to the Secretary of the Committee on Contracts at Headquarters who will present these to the Chairman and Members of the Committee on Contracts for their comments. The minutes must contain a summary of the discussion, the reasons for decisions taken, details regarding the contractor or supplier selected and the potential costs involved.

Annex 3 - Example of a Standard Emergency Situation Report (SITREP)

1. In emergencies, it is essential that regular situation reports reach the outside world (other UN agencies, implementing partners). The frequency of such reports will be determined by the characteristics of the situation; more frequent reports will be necessary in the initial stage of an emergency. Situation reports should give an overall view of the situation with sufficient factual content and explanation of changes since the last report to answer rather than raise substantive questions. By indicating progress achieved, problems encountered and steps being taken or planned to overcome these problems, the reports should give a cumulative picture of how the needs of the refugees are being met. It should report on actions including actual and planned activities; however, it should not dwell on intentions.

The SITREP should:

Be short;

Focus on priority areas;

Give quantitative data in a standard format (e.g. give the death rate as deaths/10,000/day NOT the number of people who have died);

Highlight trends (e.g. increasing/decreasing water supply, increase/decrease in arrival rate);

Clearly say who is expected to take any actions which are specified.

2. A suggested format is given below. Information contained in the SITREP should be analyzed and consolidated before being passed on to the next management level. The practice of simply copying "raw" and un-analyzed information from one level to another should be avoided. If the same format is used by all levels from site to central office to Headquarters, it will make it easier to consolidate reports from various areas. Major headings should as a rule be the same in each report, indicating "no change" if appropriate. The report can either be structured by sector of assistance with sites covered under each sector, or alternatively, by site, with sectors of assistance covered under each site heading. In either case, the information under each sector of assistance and for each location should cover as applicable:

i. Current situation;

ii. Particular problem areas, remedial action planned with time frame;

iii. Any variation from overall implementing arrangements;

iv. Any action required from the addressee of the SITREP.

3. The reports should be sequentially numbered, copied to other UNHCR offices as appropriate (including the UNHCR liaison office in New York). The report may be used as the basis for wider situation reports issued from Headquarters.

SITREP (number)

COUNTRY

COVERING PERIOD (date) TO (date)

Drafted, cleared, authorized by () on (date).

A. GENERAL SITUATION

B. MAJOR DEVELOPMENTS

Summary of general assessment of situation, assessment of refugee location, and field deployment of UNHCR staff. Summary of major trends including protection.

C. REFUGEE STATISTICS AND REGISTRATION

By location in country of origin or by distinct groups if not self-evident. Explanation of changes since last report. Indication of sources, e.g. government, UNHCR, etc. Any additional information (as relevant) on gender breakdown, vulnerable cases, variances between UNHCR and official figures, group or individual determination, etc. A format for reporting on population in emergency situation reports is given in Annex 1 of chapter 11 on population estimation and registration.

D. PROTECTION AND DURABLE SOLUTIONS Summary of any developments.

E. OPERATIONS

E.1. Coordination

Government departments, UN system, NGOs - both at central and field levels.

E.2. Overall Implementing Arrangements

Role of authorities. Operational role of UNHCR. Role of UNHCR's government counterparts, other UN agencies, international organizations and NGO partners. Other sources of significant assistance.

E.3. Assistance

Summary of main developments since the last report, broken down by sector and/or site, as applicable. Additional information provided could include major problems encountered in programme delivery and modifications required to implementing arrangements.

F. EXTERNAL RELATIONS

Significant events in relations with donor government representatives, with diplomatic missions in general and with the media.

G. ADMINISTRATION AND STAFFING

Establishment of UNHCR presence, office premises, vehicles and equipment, staffing arrangements, local recruitment, etc.

Annex 4 - Format for Reporting on Population in Emergency Situation Reports

Period: From _______________ to_________________

Type/
status of
population

Current
location

Origin/
from

Pop. at
start of
period

New
arrivals

Decreases

Pop. at end of period






Vol. return

Resettle-
ment

Other

Total

% of
total
0-4
years*

%of
total
who are
female*

*Estimate

Main source of information is Government; UNHCR; NGO

Main basis of the information is Registration; Estimate

(introduction...)


Figure

Relations with Government and Diplomatic Corps

1. All matters of protocol relating to establishing a new UNHCR presence in an emergency are likely to be handled by the Foreign Ministry in the same way as for other United Nations organizations. However, substantive matters concerning refugees may be handled by another authority, for example the President or Prime Minister's office or the Ministry of Interior. Guidance on the form of written communications with the government is given below.

2. It is important that the diplomatic corps accredited to the country is kept informed of UNHCR's activities from the start of an emergency. An informed and concerned diplomatic corps will be helpful in gaining support for the emergency operation both from the host country institutions and from donor governments for funding.

Briefing Meetings

3. Briefing meetings should start in the early days of an emergency and continue on a regular basis. There may already be a contact group of the ambassadors most interested in refugee matters who could be briefed in the early days of an emergency. Where there is no such group, or to make the arrangements for meetings more formal, it may be appropriate to invite the ambassadors of member states of the Executive Committee of the High Commissioner's Programme (EXCOM) to the briefings (for a list of EXCOM members, see Annex 1).

The aim is to keep Executive Committee : and other immediately concerned Governments well informed while not devoting scarce time to a major protocol exercise.

4. A number of people may be helpful in giving advice on the organization and participants of the meetings, including: the ambassador from the country of the current Executive Committee Chairman may be helpful in advising on the organization of briefings, or the Dean of the Diplomatic Corps, or the ambassador of the country currently holding the presidency of the European Union (as a major donor group), or the Organization of African Unity or other regional groups.

5. A representative of the government would normally be present at these briefings. United Nations organizations and NGOs directly involved in the emergency operation should also be invited to attend.

6. Unless chaired by the representative of the Government, the meeting should normally be chaired by UNHCR. Other agencies should be encouraged to give account of their activities. Initially these meetings may need to be held fortnightly or even weekly, but once a month is a reasonable interval once the situation starts to come under control.

7. It may be useful to prepare for briefing meetings by prior discussions with other participating agencies to ensure that there is agreement on the issues and on information such as population figures.

8. If a question cannot be answered immediately, arrangements to follow up on an individual basis with the questioner should be made.

9. These briefing meetings will be important for fund-raising purposes. Representatives of donor governments will form part of the diplomatic corps and will therefore be involved in the meetings. Additional smaller briefing meetings may be appropriate, to deal with particular concerns of a donor, or to respond to a donor mission, or in respect of major protection issues which might require smaller, more discreet, briefings.

10. A useful complementary measure, which might eventually substitute for the diplomatic and other briefings, is a weekly or monthly written report prepared by UNHCR. The standard internal emergency situation report, or sitrep, could be used as the basis for this report (the format for this is suggested in Annex 3 of chapter 8 on implementing arrangements). If the sitrep is to be used in this way the parts which must not be made public should be clearly marked. Other United Nations bodies directly involved should contribute an account of their work. Such situation reports should be given wide distribution in the operations area and to focal points at Headquarters.

11. Implementation of these briefing arrangements will require valuable time and effort. Clearly the priority is to deliver the emergency assistance needed by refugees. However, if those interested do not have a regular source of information on the progress of the operation, UNHCR staff may end up spending even more time on individual briefings.

Relations with the Media

Introduction

12. The media has traditionally been an ally of UNHCR and other humanitarian agencies working in difficult conditions. The media, especially locally based correspondents, can also be a useful source of information. There may be considerable media interest in an emergency and perceptions of how the international community in general, and UNHCR in particular, is responding will be set in the early days. This has important implications for support for UNHCR. It takes time to correct an unfavourable first impression, and media interest may have shifted elsewhere before this happens.

The best way to have positive media coverage and support is to run the most effective emergency operation possible in the circumstances. Expertise in relations with the media can never substitute for good performance.

13. Television, radio and newspapers operate on tight deadlines and need factual stories on the emergency, with some background information. Magazines and some radio and television programs cover stories in depth and have more time available for research and subsequent re-checking. Television news channels (such as CNN, BBC World and Sky News), and wire services (for example AFP, AP, Reuters), produce bulletin-type news stories, have very short deadlines, and are likely to be the major source for world-wide coverage of the emergency.

14. Given the logistical difficulties of some emergencies, journalists are likely to approach humanitarian agencies with requests for help in moving around. Whenever possible, and taking into account the operational priorities and the sensitivity of some situations, journalists, both national and international, should be assisted in getting to the story.

General Guidelines for Relations with the Media

15. The first decision to make concerns who should handle relations with the media. The media prefer information directly from those responsible, which can be very time-consuming. It is therefore recommended that a Public Information Officer be a member of the UNHCR field team from the start.

16. The Public Information Officer must have full and immediate access to information concerning developments in the operation and UNHCR policies and reactions. He/she needs to be updated by the most senior UNHCR Officer in the operation as often as necessary, at least once per day in a major emergency. The Public Information Officer should then be responsible for all aspects of relations with the media. Where there is no UNHCR Public Information Officer, good contacts with the press officers of other organizations will be helpful for general advice, and for organizing joint news conferences.

17. In emergencies the media will probably go to the location of the refugees, often unannounced, and expect a briefing from UNHCR field officers on the spot. The briefing given should be limited to facts and practical intentions. See below for tips for interviews.

18. When intense press interest in a particular event can be predicted, there is much to be said for preparing a short and simple statement, distributing it to the enquirers, and avoiding further comment. Close internal coordination with field staff is essential, particularly if the interest relates to an event occurring in a location where UNHCR has field staff. Sending the statement to Headquarters is essential as questions are likely to be raised in Geneva.

19. Newspaper editors will generally print a factual correction, and will often give space in opinion or correspondence columns for UNHCR to comment on errors of interpretation of UNHCR's role and policy. It is more difficult to correct a factual error made on television or radio. However, when trying to made corrections, these should be corrections of fact not interpretation.

UNHCR should be careful to avoid public polemical debate.

Locally-based Media

20. The national media will be very important in determining local attitudes to the refugees, and may also give an early indication of sensitive issues and even government policy. The government may be as concerned by national coverage as by foreign coverage. Local foreign-language newspapers may be less important, except indirectly as a result of their effect on the diplomatic community or foreign press corps.

21. Field offices should monitor the local media, including the radio and television, which may play a much greater role in influencing public opinion than newspapers. Good relations should be developed with local correspondents covering the emergency. However, exercise considerable discretion until there is practical experience of the outcome of interviews. Language barriers are often a source of misunderstanding, particularly on the telephone and a locally recruited Public Information Assistant can be very helpful in this regard.

22. It will probably be useful to make early contact with the news editors of the main national (and any local foreign language) radio, and television stations and newspapers to explain UNHCR's role. Stress that every priority is being given to the needs of the emergency and give a contact reference, should further information be required.

Information Sharing with the Government

23. The government may be sensitive to coverage of the refugees, and early contact should be established with the official press office or information service. General statements or press releases should be shared with the government information services and the department handling refugees and UNHCR. Statements relating to joint government-UNHCR actions may have to be cleared with the government first.

Field/Headquarters Information Sharing

24. A regular and swift exchange of information is essential. Many questions on the operation will be asked directly in Geneva and New York. There is a UN press briefing in Geneva every Tuesday and Friday morning, where UNHCR participates, and a weekday press briefing at noon in New York by the spokesperson of the Secretary-General. In addition, UNHCR calls special news conferences whenever necessary.

25. The Public Information Section at Headquarters must have access to up-to-date information. The Field should therefore:

Keep media interest in mind when reporting to Headquarters (for example in sit reps);

Provide information (in sitreps or separately) on matters likely to be of specific press interest;

Send reviews of local media coverage to Headquarters.

26. In addition, if the Field has given an interview with a major foreign newspaper or network, or if a foreign correspondent has been aggressive or appeared unsatisfied with answers, the Public Information Section at Headquarters should be forewarned.

27. Similarly, the Field must be kept regularly informed by the Public Information Section at Headquarters of international media coverage. Important international media reports (including those based on briefings given in the field) may not be available in the field.

Press who contact Headquarters before going to the field should be clearly briefed that only limited attention and logistical support can be devoted to them by the field offices during the emergency phase.

Tips for Interviews

28. Reporters generally respect the ground rules for an interview, provided these are clearly established in advance. The interviewer and interviewee should agree on type of attribution and how the interviewee will be quoted: for example: by name, "a UNHCR spokesman", "UN sources", "humanitarian worker", "sources in the international community", etc. An interview may need to mix full attribution for the facts, and no attribution for information on political considerations and constraints. Alternatively an interview can be fully attributed and may often be tape recorded. An interview can also be for background information, and in this case what is said by the interviewee is not attributed directly.

29. Radio and television interviews can provide good coverage for UNHCR's aims. They are, by definition, for full attribution. If this is not advisable because of particular sensitivities, avoid such interviews. Bear in mind that interviews on radio and television can be edited.

30. In all interviews and comments to the media, when in doubt err on the side of discretion. Considerable experience and self-discipline is needed to limit remarks to what was previously planned. Having agreed to give an interview or answer questions, showing hostility or irritation will nearly always be counter-productive, no matter how unreasonable or loaded the questions are.

31. UNHCR's work is difficult and mistakes will inevitably be made, but do not try to hide problems and difficulties.

Though it is important to be discreet, honesty and clarity are the best policy.

Most journalists understand these problems and respect efforts in what they know are very difficult conditions. In fact, it is almost always best to talk about problems before the media find out about them on their own - and they usually do. Finally, if mistakes are made, admit them and try to learn from them.

32. When a complete answer to a question is given and a silence ensues, leave it silent. There is no law stating that one has to say more than one wants or intends to say. It is better to pause to construct a response than to ramble. Do not suggest follow-up questions, unless it is in order to disseminate important information.

33. Do not ask for a story to be killed or suppressed. Attempts at censorship will backfire and are likely to generate two immediate consequences; stepped up investigation of the matter to be suppressed; and an unfavourable story on the attempts to suppress it.

34. When in a press conference and especially with the electronic media, state the most important point at the beginning. In subsequent answers and statements, refer again to the most important point. When dealing with radio and television, keep answers short; television and radio put severe restrictions on how much information can be used and long drawn-out explanations and answers tend not to be used and the main point not covered.

35. Give direct answers to direct questions. If the facts are not known, say so, and offer to get back to the reporter with the information.

36. Sensitive political or policy questions should be referred to the main UNHCR field office. Responses to general questions about the situation should be made with UNHCR's mandate and goals in mind.

37. Take the initiative/control. Avoid answering speculative "what if" questions.

Be prepared to take the lead and direct the interview into positive areas of information about the operation.

38. Key things to remember for all interviews are:

BE YOURSELF. While journalists are always on the lookout for a good story, they are not out to make your life miserable. So relax and be friendly. Look at the interviewer. Avoid nervous gestures and mannerisms. Keep your answers short and simple;

BE POSITIVE. Do not criticize colleagues or other UN organizations and NGOs. We are all in the same boat;

BE CONVERSATIONAL. When you talk to journalists, keep it simple and clear. Do not use the type of language found in many UNHCR internal documents. In everyday conversation, ordinary people don't use terms like "modalities", "durable solutions," "inter alia" "specific international protection mandate," "NGO," and "implementing partner." Use examples that will make the information comprehensible to your audience;

BE CONCISE. A 10-minute interview may end up being seconds on the air, or three lines in the newspaper. It is essential to crystallize your thoughts in a few quotable sentences;

BE IDENTIFIABLE WITH UNHCR. If you are being interviewed for television, or if a photograph will accompany the report, try to get a UNHCR logo in the background -possibly a flag or on a vehicle, wear a UNHCR T-shirt or cap.

Guidelines For Appearance On Television

39. Key things to remember for television interviews are:

DO's

Do make and maintain eye contact with the questioner, not the camera. Do not let your eyes wander;

DO wear suitable subdued-coloured clothes. Normal working clothes for field conditions are fine - ties and suits are not appropriate;

DO check your appearance before going in front of the camera, hair, buttons, zips?

DO make short statements, each holding up on its own;

DO remember to make your most important points as early as possible;

DO, before you begin, discuss with the interviewer what line the discussion will take;

DO remember that the interviewer and audience know less about your subject than you do;

DO remember that any programme is likely to be edited before use.

DONT's

DON'T smoke;

DON'T wear sunglasses or jewellery;

DON'T forget that the smallest mannerisms show up more obviously on television;

DON'T fidget or fiddle with pens, pencils, lighters, etc.;

DON'T say "I think" too often, it sounds as though you are uncertain of your subject. Talk about "we" or "UNHCR" instead.

Visibility of the Operation

40. In addition to working with the media to ensure coverage of UNHCR operations, emergency managers must pay attention to the visibility of the operation.

41. Proper identification of staff, vehicles, buildings and relief materials contributes to improved dialogue with beneficiaries, local authorities and partners.

In conflict zones, visible markings can be an important security measure for staff and property.

42. Staff should be visible and identifiable as UNHCR personnel. Visibility items for staff, vehicles and buildings are available from Headquarters (see Catalogue of Emergency Response Resources, Appendix 1). A visible UNHCR will help to show the beneficiaries and the outside world that UNHCR is present, active and delivering services to the refugees.

Funding and Donor Relations

Emergency Fund

43. The availability of funds is a prerequisite for any UNHCR emergency action. The initial funding in an emergency for project and operations delivery and administrative support expenditure is likely to be allocated from UNHCR's Emergency Fund. Under the terms of UNHCR's Financial Rules, the Emergency Fund is established to provide "financial assistance to refugees and displaced persons in emergency situations for which there is no provision in the programmes approved by the Executive Committee", and to meet additional administrative expenditures resulting from those emergencies. The High Commissioner may allocate from the Emergency Fund up to US$25 million annually, provided that the amount made available for any one single emergency does not exceed US$8 million in any one year and that the Fund shall be maintained at not less than US$8 million. Further details are provided in Chapter 4 of the UNHCR Manual and in Appendix 1, Catalogue of Emergency Response Resources.

Central Emergency Revolving Fund

44. The Central Emergency Revolving Fund of the UN Office for the Coordination of Humanitarian Affairs was established to provide funds within the UN system to respond rapidly to emergencies. The fund has a target level of US$50 million and is financed from voluntary contributions. It is used for cash advances to UN operational organizations and entities. In principle these advances are to be reimbursed as a first charge against income subsequently received, usually as a result of consolidated appeals. Further details are provided in the Catalogue of Emergency Response Resources (Appendix 1).

Using Existing Funds

45. If an emergency develops in an existing operation, immediate funds may be available from those already foreseen for that operation or, if appropriate, from the Programme Reserve. Depending on the scale of further needs, and also on the time of year when the emergency occurs, further funding could either be proposed to the Executive Committee as a new current year project or as a new project for the coming year, or could be the subject of a special appeal.

Communicating Needs to Donors

46. Operational needs, progress and constraints must be clearly communicated to donors. A donor relations strategy should be established in the first days of an emergency and maintained for its duration.

47. Donor relations should be maintained through:

i. Briefing meetings and regular contact at field level between UNHCR staff and donor representatives. Regular briefing meetings (see paragraphs 3 to 11 above) with donors should aim to keep them up to date on actions being taken, protection issues, and any constraints;

ii. Regular contact and follow-up at Headquarters level;

iii. Involving donor representatives in missions to see refugee sites and other points at which assistance is delivered;

iv. Indirect communication of operational needs through UNHCR visibility in the media.

48. It is important to highlight UNHCR's protection and coordinating role when communicating with donors. Coordination must be a reality on the ground with UNHCR taking, and being seen to take, an appropriate leadership role.

49.

Only request funding for operations and budgets which have been formally approved.

There are no exceptions to this. This is necessary to ensure funding is targeted where it is most needed, to provide consistency in operational priorities and objectives, and in communicating these priorities to donors. Several sections in UNHCR brief donors and it is important for credibility that the briefings be similar. In case of doubts regarding what should be presented to donors for funding, contact the Donor Relations and Resource Mobilization Service at Headquarters for advice.

50. Steer donors towards funding those activities or areas of the operation that are most in need of funding. When appropriate, promote regional funding. Do not forget that the emergency may have a regional dimension. Include this and other elements of the UNHCR operation in the briefing and be prepared to discuss funding for all aspects of the operation with donors.

51. Contributions tightly earmarked to one aspect of the operation impede flexibility. Sometimes substantial contributions are strictly earmarked and there is little scope for amending budgets once they are approved.

Donors should be encouraged to make unearmarked contributions whenever possible.

However, if donors do want to earmark a contribution to a specific part of the operation, advise them to check with the Donor Relations and Resource Mobilization Service at Headquarters to ensure that this portion of the operation has not been funded already, or offered for funding, to another donor.

52. Particularly in emergencies, donors may offer to supply commodities or services rather than make a cash contribution. To a large extent it will be up the Field to decide on the suitability of such contributions. The offer should be immediately reported to the Donor Relations and Resource Mobilization Service at Headquarters, and the donor requested to follow up with Headquarters. In kind contributions need to be coordinated by Headquarters to avoid duplication of similar contributions by different donors, and to avoid confusion over the amount of cash versus total contribution1.

Preparation of an Emergency Appeal

53. The primary document for communicating with donors is the emergency appeal. It is the appeal which needs to be brought to the donors' attention at briefings, and it is the activities in the appeal against which progress should be reported.

54. The emergency appeal is developed by both the Field and Headquarters.

Information contained in the appeal about operational needs to be generated at the point of delivery - i.e. the field - so appeals written primarily in the field are the most effective in raising funds.

Headquarters is responsible for issuing the appeal: it should have all the information necessary from the Field as soon as possible to enable it to approve budgets and to issue the appeal at the earliest opportunity.

55. The government should be consulted in the development of the appeal. The appeal should also take into account the results of the initial assessment, and the budget should cover all foreseen expenditures.

56. If the situation changes dramatically during the emergency, and the current appeal becomes inappropriate, then the Field should review operational objectives and agree the new direction with Headquarters before the revised operation is presented to donors.

57. The appeal and the way the operation is funded can be a potential source of confusion when the government is UNHCR's operational partner. The total target can be misunderstood as being entirely intended for expenditure in the country, whereas the budget will, of course, cover all UNHCR's direct expenditure, such as for any international procurement and field and Headquarters operational delivery and administrative support, including protection. Clarity on this point from the start, for example in any local press release or comment, can avoid embarrassment later.

1 Further information on contributions in kind can be found in Procedures for Handling Contributions In Kind, IOM/65/96 - FOM/74/96, UNHCR, November 1996. Budgetary procedures for dealing with contributions in kind are discussed in chapter 8 on implementing arrangements.

Communication Between the Field and Headquarters

58. Headquarters and the Field need to work together closely on funding and donor relations issues. The focal point for this at Headquarters is the Donor Relations and Resource Mobilization Service. The Private Sector Fund Raising Unit at Headquarters may also issue appeals to the general public or aimed at individual or corporate donors.
59. Donor Relations and Resource Mobilization Service at Headquarters should:

Advise how to deal with a particular donor;

Provide latest information on funding for the operation;

Follow up with donor capitals on potential contributions discussed in the field;

Produce and distribute appeals (with the active participation of the Field);

Prepare specific submissions to donor funding agencies (with the active participation of the Field);

Submit detailed reports to the donors.

60. The Field should:

Produce the basic operation information and information for the appeals;

Inform Headquarters when a donor has indicated an interest in contributing funds, whether to the appeal, to a particular operation, to earmarked activities, or as a contributions in kind, and should also ask the donor to follow up through the normal channels at Headquarters;

Provide information to the donors about the current situation and UNHCR's plans. When deciding on a contribution, donors need relevant information. Some information will be in the emergency appeal and given at briefings, but some donors require more detailed information. Timely and detailed responses will ensure the most rapid funding;

Provide reports and information to Headquarters to assist it in submitting reports to donors. To ensure continuity of funding it is essential that the required information be provided from the Field without delay.

Reporting to Donors and Special Requirements

61. A variety of reports are required by donors in order to account for their contributions and to release additional funds. Bear in mind that donor reporting cycles do not necessarily correspond to UNHCR's reporting and operation cycles.

62. Some major donors to UNHCR's emergency operation require particularly detailed reporting at both financial and narrative level in a unique format with strict deadlines. These special reports are prepared by the Donor Relations and Resource Mobilization Service at Headquarters on the basis of information from the Field. Some donors also monitor implementation directly through their local representatives.

63. A number of donors attach great importance to the visibility of their financial support, through the marking of assistance material and other means.

Formal Written Communications

64. When establishing a new UNHCR presence in a country, there is likely to be a need for a number of formal written communications to government or local authorities. The purpose of this section is to give brief guidance on the preparation of formal letters and "notes verbales" (formal notes written in the third person - see sample in Annex 2).

65. Formal letters are used for communications to ministers, ambassadors and senior officials (for example, the Director-General of a government department) on important matters.

66. Note the following points for written correspondence with ambassadors, ministers and other dignitaries:

i. The proper opening salutation is: "Sir" or "Madam", with "His/Her Excellency" used, if appropriate, only in the address. However, it may be local practice to begin and end with "Your Excellency". When in doubt check with UNDP or use "Sir". His/Her Excellency precedes all other titles and ranks (e.g. Her Excellency Dr. X Y; His Excellency General A B, Minister of the Interior);

ii. The expression "I have the honour ..." is usually used only in the opening sentence;

iii. "You" can normally be used in the text. However, in a long text it may be courteous from time to time to interject the more formal address (e.g. "I should be grateful if you, Sir, [or Your Excellency] would confirm that this is also the understanding of your Government");

iv. Formal letters end with "Accept, Sir/Madam/Your Excellency, the assurances of my highest consideration".

67. A note verbale is a formal note written in the third person. Notes verbales may be addressed to a Minister for Foreign Affairs or a Ministry of Foreign Affairs, an ambassador or an embassy. Notes verbales are always used in replying to an incoming note verbale. It is written from person to person (e.g. Representative to Minister) or office to office (e.g. Branch Office to Ministry). The following points should be noted:

i. Typical uses of notes verbales include the exchange of information between UNHCR and governments, embassies or permanent missions. The note verbale is not normally used to communicate with other United Nations agencies and is never used to address NGOs or the public. The note begins either, "The Special Envoy/Representative of the United Nations High Commissioner for Refugees in (country) presents his/her compliments to ... and has the honour to ..." or "the Branch Office of the United Nations High Commissioner for Refugees in (country) presents its compliments to ... and has the honour to ...";

ii. Titles must be given in full, at least in the opening and closing paragraphs. Be sure to use the full correct designation of the country (Kingdom of ..., Republic of ..., Democratic Republic of..., etc.)2;

iii. The complimentary closing of a note verbale is always the same: "The (Representative/Special Envoy) of the United Nations High Commissioner for Refugees in (country) avails him/herself of this opportunity to express (renew) to ... the assurances of his/her highest consideration", or, as appropriate, "The Branch Office ..." etc.;

iv. The note should bear no signature. The Office stamp should be placed over the typewritten date and the officer responsible for its dispatch should sign his/her initials within the stamp. The Representative or Special Envoy and an alternate may be required to register their initials or even signatures with the protocol department of the foreign ministry;

v. The place and date should appear on the bottom right-hand side of the last page. The address does not appear on a note verbale;

vi. The text of the note verbale should be single spaced with double spacing between paragraphs.

68. Both formal letters and notes verbales may bear file references, as brief as possible, on the top left of the first page.

69. Notes verbales are always answered by notes verbales, and formal letters by formal letters. Apart from the restrictions on the use of notes verbales given above, there are no completely clear-cut rules about which to employ when UNHCR is initiating the communication. In general terms, the note verbale conveys brief information and is the normal form for routine exchanges with the protocol department, for example, when seeking customs clearance for relief supplies or advising of the arrival of international staff. References to important meetings with senior officials and major issues, particularly those already discussed, are better treated in a formal letter. A formal letter may also reach the action officer more quickly than a note.

70. If it is necessary to set out UNHCR's position on a specific subject (policy, action taken, intentions, etc.), this may be done in the form of an aide-mire written in the third person. An aide-mire has no addressee and is simply headed Aide-Mire, with the title below. A similar purpose is served by a "Note by the Office of the United Nations High Commissioner for Refugees", a minor difference being that this description goes below the title. An aide-mire would normally be used to convey information to a government ministry or department, an embassy or the diplomatic corps. For a less formal or wider distribution, the "Note by ..." form may be appropriate.

71. All four types of communication should be presented on UNHCR letterhead stationery.

2 The following document is a useful guide: Terminology, Country Names, United Nations Bulletin No. 347 (STICSI SER.F/347/Rev. 1).

Annexes

Annex 1

MEMBER STATES OF THE EXECUTIVE COMMITTEE
OF THE HIGH COMMISSIONER'S PROGRAMME
As of November 1998


Algeria

Madagascar

Argentina

Morocco

Australia

Namibia

Austria

Netherlands

Bangladesh

Nicaragua

Belgium

Nigeria

Brazil

Norway

Canada

Pakistan

China

Philippines

Colombia

Poland

Democratic Republic

Russian Federation


of the Congo

Somalia

Denmark

South Africa

Ethiopia Finland

Spain Sudan

France

Sweden

Germany

Switzerland

Greece

Thailand

Holy See

Tunisia

Hungary

Turkey

India

Uganda

Iran (Islamic Republic of)

United Kingdom

Ireland

United Republic

Israel


of Tanzania

Italy

United States of America

Japan

Venezuela

Lebanon

Yugoslavia

Lesotho

Annex 2 - Example of a Note Verbale

NATIONS UNIES - HAUT COMMISSARIAT POUR LES REFUGIES

UNITED NATIONS - HIGH COMMISSIONER FOR REFUGEES

Note Verbale

The United Nations High Commissioner for Refugees (UNHCR) Branch Office for [Ruritania] presents its compliments to the Ministry of Foreign Affairs of ___________________ and has the honour to request authorization to import [two Toyota land-cruisers]. It requests furthermore that the usual advice be sent to the appropriate authorities for exemption of payment of import duty, excise duty, registration and licensing fees for [these vehicles]. Details of (the vehicles) are as follows:

1. Bill of lading number:

TAN-P-C 16-11/25-03

2. Engine numbers of vehicles:

B-L-C 741-1334

B-L-C 24-04-01

The Office of the United Nations High Commissioner for Refugees avails itself of this opportunity to renew to the Ministry of Foreign Affairs [of Ruritania] the assurances of its highest consideration.

(stamp)

[name of place of UNHCR office in Ruritania], [date]

(introduction...)


Figure

Overview

Situation

The trauma of becoming a refugee can be very great. Normal structures which have regulated community well-being and also cared for groups at risk such as older persons, women, children and the disabled, have broken down and need rebuilding. Social and psychological problems are created or exacerbated and appropriate measures for resolving these problems are essential.

Objectives

To provide for the welfare of the whole refugee group and to ensure that the most vulnerable refugees have equal access to basic goods and services.

To assist the re-establishment and development of refugee community structures which can be used in the management of the assistance programme and which can also minimize longer-term problems of dependency.

To ensure that the assistance provided is appropriate for the refugees.

Principles of Response

· Refugee community participation (including both men and women) should be promoted in all sectors, by building on the community's own resources as much as possible and encouraging individual, family and group self-reliance;

· Special services for the vulnerable should, as far as possible, be provided by the refugee community itself;

· Services should be decentralised but within a structured plan, and must reach those in need;

· Community services should be developed in co-ordination with and in support of the priority life support sectors and should be an essential component of the overall assistance operation.

Action

· Assess community problems, needs and resources. Help refugees to identify and establish the services which will meet their needs in all sectors;

· Ensure prompt identification of and support to the most vulnerable;

· Develop appropriate community management structures including mechanisms to ensure participation of women in decision-making and ensure that all groups within the population are appropriately represented. Identify community workers who can help the vulnerable, spread relevant information and support other sectors;

· Take immediate action to prevent family break-up and reunite families as soon as possible.

· Identify and provide care for all isolated vulnerable individuals, especially unaccompanied minors. Spontaneous groupings, if already bonded, should be kept together;

· Establish communication links with the refugees to ensure good two-way communication between the refugees and those assisting them;

· Build the capacity of the community by identifying training needs and by helping to organize practical and hands-on training in community work.

Introduction

1. The shock of having to leave home and the circumstances of life as a refugee, particularly in the early stages of an emergency, create major emotional and social problems and exacerbate existing problems in the community. The trauma of flight and its aftermath may leave the refugees confused, frightened, lonely and insecure, facing an unknown future in a strange, sometimes hostile, environment. Separation from or loss of other family members as well as lack of community support are common in refugee emergencies, and causes emotional stress and problems for individuals and their community.

2. The most important action that can be taken to help reduce the shock and stress for the community is to provide security, stability and protection. In part this can be done materially, and in part by ensuring protection and involving the refuges from the start in the organization of all aspects of their new lives, and in particular the search for durable solutions. Community services are a vital bridge between the refugee and the goods and services of the new settlement. Without help in adjusting to this new environment, the sense of loss and isolation can deepen even in circumstances of relative material well-being.

3. It is important to involve the refugees in the provision of assistance and allow the community to share the responsibility of caring for itself and its vulnerable members. This minimizes dependency and encourages self-reliance.

The approach used during the emergency period will determine the whole pattern of behavioural response of refugees towards external assistance.

4. In every emergency, there will be refugee groups at risk with psychological or social problems that require particular attention. The most vulnerable are those with no family support who are dependent on external assistance for their daily survival. This dependence may be because of their age; their physical condition; their psychological condition; or socio-economic problems. The social disruption of emergencies causes these problems to be both aggravated and overlooked - but in stable non-emergency situations, the community itself meets many of the needs of groups at risk. Thus services to meet these needs are best given in a community-based programme.

Organizing Community Services

· Plan and implement the community services programme with the refugees;

· Use a phased approach to implement a community services programme;

· Assess the needs by screening the whole community; the most vulnerable rarely come forward themselves;

· Co-ordinate closely with other sectors.

Introduction

5. The main objectives of community services should be to identify and assist those persons whose basic needs are not being adequately met and to ensure the general welfare of all refugees. A community services programme should mobilize appropriate community resources, with outside help as necessary, to screen the refugee population for those facing urgent problems and see these immediate needs are met. Community services can then proceed to strengthen self-reliance and develop community activities.

6. A three-phased approach has been developed to implement the community services programme:


Phase 1

assessment, action plan, guidelines;


Phase 2

foundation of community services programme;


Phase 3

building up community service:

To measure performance in each of these phases (which are not mutually exclusive), a community service checklist can be used (see Annex 1).

7. Experience suggests that even in an emergency many needs can best be met by resources that exist within the community. Every community has its own beliefs, social values, customs, traditions and preferences for how problems should be resolved.

A community services programme should seek to enhance and improve existing and positive coping mechanisms.

Community problems are best solved using an integrated, inter-disciplinary approach, working with other sectors. Community services staff should therefore work as part of the UNHCR team, contributing to assessment, planning, programming and monitoring activities of other sectors.

8. Community services programmes generally require a decentralised structure, allowing refugee community workers to work with the same refugees, getting to know and be known by them. An active community services team is likely to be a major referral unit, helping to direct refugees to available resources and identifying areas of need where other services (health, nutrition, etc.) may be targeted.

Assessment and Action Plan

9. A careful initial assessment will determine the most pressing social problems, and the plan of action. This assessment should cover the whole community, with particular attention to identifying refugees with special needs who may not come forward themselves. The assessment and resulting plan should take into account demographic and cultural information regarding the refugee population, as well as the policies and resources in the country of asylum. Another priority in drawing up the community services programme is to identify gaps in the general assistance programme.

10. The outcome of the assessment will determine the community services action plan, including priorities of actions to be taken, the role of the various partners, and the need for special programmes, such as family reunification or assistance to victims of violence (see key references for guidelines on these topics).

11. Before establishing the community services team (see the section on Human Resources below), it will be necessary to identify appropriate local, national and international partners, including NGOs, governments, local and refugee community leaders. Involving local communities and government will help raise refugees' sensitivity to the needs and culture of the local population, and will also facilitate local acceptance of refugees, thus preventing tension.

Foundation of Community Services Programme

12. It is important to identify and promote refugee self-management groups either within mainstream structures or if more culturally appropriate, in separate groups. These should include women and youth. Community support for the vulnerable must be encouraged. Refugee volunteers can help identify vulnerable refugees and ensure their access to general services.

13. To ensure that all refugees, especially the most vulnerable, have access to services:

i. Direct all refugees to appropriate health or nutrition services;

ii. Organize immediate tracing of lost children and registration of these and other vulnerable individuals and provide assistance to all those alone and unable to care for themselves;

iii. Address the problems of survivors of abuse or violence.

14. In order to minimize long term dependency, and ensure the services are appropriate for the whole refugee group, community services will promote refugee participation in all sectors, and build the refugee community's problem solving capacity. Community services should also raise awareness and mobilize refugees on sanitation and environment issues and respect for local community resources.

Building up Community Services

15. Once the community services programme has been established, community services are built up by: building the capacity of implementing partners; co-ordinating community outreach and community training activities; establishing information networks; running a training programme for community workers; setting up education programmes and running the tracing and special programmes. General community activities, for example, cultural events and recreation, will be important for the creation of a greater sense of normality and security, and the reduction of stress, as well as fostering the refugees' sense of community.

Human Resources

· The refugees themselves should play the central role;

· Continuity of personnel is very important;

· Professional impartial conduct and confidentiality must be maintained;

· Teamwork with other sectors is essential.

Introduction

16. Refugees trained as community workers should be the backbone of the community services programme. Outsiders will be severely limited by language barriers and lack of familiarity with social values and customs. Refugee community workers will be responsible for assisting groups and individuals through outreach work, and referring individuals to appropriate services where necessary. In some cultures, traditional healers are especially skilled at resolving psychological problems.

17. Training refugee community workers is a priority. Training should draw on refugees' own knowledge of their community, and make use of outside expertise (from within the host country if possible). Training should cover social work and community development, with inputs from other disciplines such as public health, nutrition, sanitation, protection, water, shelter.

18. Refugee community workers should be drawn from the various groups within the refugees, and a particular effort may be needed to ensure that a sufficient number are women. There should be a proper balance between workers from different social and ethnic groups.

19. The number of such workers required will depend greatly on the community's own response mechanisms, and the geographical distance between site locations, population size and complexities of the situation. However, one worker per 1,000 refugees is usually appropriate. In addition, there should be community workers in the health centres, as there is a tendency for people with special needs to be directed to these even when the problem may not be medical.

20. Staff from outside the refugee community will be required to co-ordinate community services, manage training programmes and deal with problems beyond the resources of the refugees. This outside assistance is likely to involve both international and national personnel. The role of international personnel may be limited principally to overall co-ordination, guidance, support, training and liaison with the authorities and other organizations concerned.

Familiarity with social values and customs is essential.

21. National personnel will play an important role because of their cultural knowledge and understanding of the refugees. Additional specialist staff may be needed to focus on specific issues. A memorandum of understanding exists between UNHCR and Radda Barnen (Sweden) under which specialized community services staff can be quickly de ployed to emergencies (see Appendix 1, Catalogue of Emergency Response Resources, for details).

Continuity of personnel is necessary for effective community services because of the fundamental part played in these services by human contact and trust.

22. Interpreters are a vital link of communication between UNHCR and the refugee community as they bridge the gap created by cultural, national, linguistic and racial differences. Interpreters are usually selected from the refugee or local community and should include an adequate proportion of women. Refugee interpreters have the benefit of knowing and being committed to helping their community; however they are likely to be placed in a difficult position as intermediary between refugees and UNHCR and expected to be answerable to both. Therefore, if possible, refugee interpreters should not be used in sensitive situations such as status determination interviews.

Working as a Team

23. Community services should support, and have strong links with, other sectors. For example:

Protection: Community services and protection have complementary roles in dealing with refugee problems on a day-to-day basis and working with refugee groups at risk. There will be areas of overlapping concern, for example, in training, promotional and advocacy activities at the community level; programmes for unaccompanied minors such as tracing, family reunification and foster care; and in developing preventive mechanisms and community-based solutions to deal with harassment of minority groups and sexual violence;

Health services: Many problems have both a medical and social component. Refugees might not make use of health services because they are too weak or infirm, too traumatized or just unfamiliar with the health service. Women may be particularly constrained if there are insufficient female health staff. On the other hand, problems of all kinds may be referred to health centres - so community outreach workers should be located in the health centre. Community networks can be used to promote basic health messages in cleanliness, sanitation, breast feeding etc.;

Site planning and construction: Community services can assist in the identification of social and cultural determinants of shelter planning, promote the involvement of all the community, including women, help establish refugee committees to oversee construction, and ensure that the community will take responsibility for providing shelter for its more vulnerable members in locations where they can be protected and assisted;

Environment: Community services should convey environmental messages such as the need to preserve trees and vegetation during emergencies (see chapter 12 on site planning). Community services should also promote simple, but crucial, energy saving techniques such as covering pots with lids during cooking, drying, chopping and splitting firewood before burning, and soaking beans and grains to reduce cooking time. Community services staff should work closely with environment specialists in areas such as forestry and domestic energy, to ensure these activities take into account the concerns and priorities of the local and refugee community. Without community participation, environmental programmes might not achieve their objectives;

Logistics: Community services should also work with logistics officers to ensure that vulnerable groups and groups at risk have equitable access to all commodities.

Family Tracing and Reunification

· Tracing and reunion of separated family members must be organized as quickly as possible;

· Refugees must be able to send and receive mail.

24. Procedures for the reunion of refugee family members separated during flight or within the country of asylum should be agreed with the authorities and implemented as soon as practicable. Tracing programmes should be set up and co-ordinated in the country of asylum, country of origin and regionally. At camp or local level, simple and effective tracing mechanisms include posting lists of names with photographs on the community notice boards in different locations, using the radio, or even making announcements by megaphone. The tracing arrangements must be widely promulgated; a central contact point in each site is likely to be needed. Tracing is a delicate task, and has to be organized by people who have the necessary experience and skills. A suitably experienced agency may be needed to implement these activities. Tracing requires the involvement of the refugees themselves, who will play a key role. The local population and authorities can also play an important role. Confidentiality of information and protection of individuals is also essential.

25. Consider the causes of separation when establishing tracing systems. Separation may have been caused by large scale population movements but may also have been due to other factors such as children opting to leave their families, or placement of persons outside their family for survival purposes. Outsiders, often relief workers, may have removed a child from an apparently dangerous situation, without informing the family and without proper documentation.

26. The following actions should be taken:

Organize tracing and reunion of separated family members as quickly as possible, giving first priority to unaccompanied minors and other extremely vulnerable individuals;

Combine a variety of systems: on the spot tracing, use of community mechanisms and formalized tracing at a regional level;

Coordinate activities with agencies having expertise, e.g. the ICRC. Note that ICRC procedures, using the national Red Cross or Red Crescent societies, can be lengthy but may be the most appropriate for difficult cases;

Ensure regional standardization of registration systems;

Set-up a communication network in the community including a mailing system. A properly organized exchange of news (Red Cross messages) may considerably diminish the workload of a tracing service and accelerate the reunion of family members. Refugees have the right to send and receive mail.

Groups at Risk and Vulnerable Groups

· Develop and strengthen community-based support for vulnerable groups wherever possible;

· Ensure that children are cared for in ways that meet both their physical and emotional needs; individual care of unaccompanied children is all-important;

· Ensure that all groups among the refugees can participate in decision making affecting their well-being.

Introduction

27. In dealing with vulnerable groups, community based support is preferred, and only as a last resort should small, special facilities be established. These should be short-term to shelter vulnerable individuals while identifying community support mechanisms.

28. Experience shows that in refugee emergencies certain groups are likely to be more at risk than others. Standard criteria for vulnerability, and for eligibility for the provision of special assistance should be developed in conjunction with refugees. Some groups may be excluded from decisions directly affecting their wellbeing, and the particular needs of these groups may be unintentionally ignored or excluded in programme development. This exclusion may result in making the group vulnerable. This is often the case with minority groups. Women, who often make up the majority of the population, can be excluded in much the same manner.

29. In emergencies vulnerable refugees may need special transport where the refugee has physical problems which would prevent long distance movement. This would include older persons, the disabled, women in late pregnancy, severely malnourished or those in severe psychological distress. If special transport is needed, the refugee should be accompanied by a responsible attendant (usually a relative) and a clear reunion point identified to prevent further vulnerability through separation.

30. When individual casework is necessary, up-to-date records and confidential individual dossiers should be kept, and a simple periodic reporting system instituted, focusing on the needs identified and services provided rather than giving just statistical data. It is important that case records are transferred with refugees when they are moved. A coordinated response avoids unnecessary repetition of basic interviewing which is not only a waste of time but can also be psychologically damaging.

Children (including Adolescents)

31. For the purposes of this Handbook, "children" should be understood to mean "persons below the age of 18 years" (as defined in the Convention on the Rights of the Child, 1989), and therefore includes young children and adolescents.

32. Children make up a large proportion of most refugee populations. Early interventions during emergencies will help to normalize and stabilize their situation. Specialized agency expertise may be needed for parts of a child-focused programme.

33. Birth registration may be a prerequisite for obtaining nationality, enrolling in school and may be a vital tool for tracing. It can also be important in preventing military recruitment and other forms of exploitation. Ensure that the births of all refugee children are registered. Ideally births should be registered through the same procedure applicable to nationals. Where this is not possible the authorities should be encouraged to establish a separate birth registration system for refugee births. If this is not possible either, organize a temporary attestation system to ensure, at a minimum, that the date, place of birth and the names and nationalities of both parents are recorded. The UNHCR Field Office or the Red Cross/Red Crescent could, for example, issue such an attestation.

34. Different age groups will have different problems, young children have very different needs from teenagers.

35. UNHCR has an MOU with UNICEF which outlines their respective responsibilities for children and unaccompanied minors- UNICEF takes the lead in countries of origin and UNHCR in countries of asylum (see MOU attached as Appendix two).

36. Take the following action:

Identify and develop community-based mechanisms to monitor refugee childrens' assistance and protection needs;

Identify whether the child population as a whole might have any specific characteristics or needs as a consequence of the trauma of their flight and life before finding asylum: in particular, where children have been victims of and/or participants in armed conflict, or might have particular psychological, physical or social problems as a consequence;

Identify what current risks there may be to the child population: for example a risk of on-going military recruitment, or of sexual exploitation or abuse;

Promote the social role of adolescents in the community and their responsibility towards others in need, for example they can serve as community workers. Adolescents will need support, especially if they have assumed adult roles as heads-of-households. They will also need access to and education about reproductive health services, and vocational training;

Coordinate with the health and nutrition sectors in organizing education campaigns and outreach activities in community health, nutrition and sanitation, such as promoting breast feeding, immunization and feeding programmes;

Organize play groups, recreation activities and emergency education for pre-schoolers and for school age children including girls and vulnerable children;

Identify resources within and outside the community which could be used to address the needs of children and young people (and their families). These community resources should encourage self-reliance, and work towards preventing domestic violence, sexual abuse, drug and alcohol abuse and involvement in military activities;

Integrate the needs of children in all programming activities.

Unaccompanied Minors

37. UNHCR defines an unaccompanied minor as one who is below 18 years of age who has been separated from both parents and for whose care no person can be found who by law or custom has primary responsibility. Note that other organizations may have other definitions of unaccompanied minors. In addition, note that unaccompanied minors are sometimes also called separated minors.

38. Labelling children as orphans tends to encourage adoptions, (and in some cases, there may be enormous external pressure for orphanages and/or third country adoption) rather than focusing on family tracing, foster placements and increasing community support.

The description "unaccompanied minors", or "separated minors", should always be used in place of "orphans".

39. Although the government of the country of asylum should take legal responsibility for these minors, with UNHCR offering advice and assistance, in practice if government resources are thinly stretched, UNHCR may take a more pro-active role.

Prevention of Separation

40. Family unity must be preserved as much as possible - take no action that may prevent family reunion. The failure to protect family unity not only results in avoidable physical and emotional suffering, but subsequent efforts to reunite families are costly and difficult, and delays in family reunification will impede durable solutions. Although children are often separated from their families while their families are in flight, steps can be taken to minimize further separations, and to maximize the chances of timely and successful reunion.

Steps to prevent separation include supporting households at risk, and ensuring care provided to unaccompanied minors does not become an incentive for parents to abandon their children to institutionalized care.

41. There is sometimes pressure to rescue minors from dangerous situations but some child-only evacuations have caused years of separation and in some cases the breaks have been permanent. The physical dangers may be over estimated, while the children's psychological need to be with their parents may be under appreciated.

There should be no evacuations separating children from their parents or others recognized as primary caretakers (custody) unless essential to protect life.

42. If an evacuation is essential, the following safeguards should be observed. Minors should be accompanied by an adult relative, and if this is not possible, by a qualified care-giver known to the children, such as their teachers. The minors' identities must be fully documented before departure. Whenever possible, documentation should travel with the minors, and caregivers should be waiting at the destination. The evacuation must be coordinated with the designated lead agency. If the minors are moved across an international border, written agreements with the government should be secured in advance in order to ensure family visits and reunions are possible.

43. Continuity of existing care arrangements will help avoid further disruption and may facilitate reunion. Siblings should be kept together, as should unrelated children who have been living together and give each other emotional support.

Assessment, Identification, Registration and Tracing

44. Make a rapid assessment of the situation of unaccompanied minors among the refugee population. The first source of information for identifying unaccompanied minors will be the refugees themselves and the community leaders. A general registration or census of refugees may provide a suitable occasion for initial identification without raising expectations before seeking more detailed information.

45. A general registration or census will also identify those children not alone, but not with their immediate family, and who thus require tracing. Give priority to identifying children under five years, girls who may be subject to sexual abuse and boys who may be recruited into military service.

46. Once identified, unaccompanied minors should be individually registered as soon as possible (see Annex 2, unaccompanied minor registration form).

Registration should not raise expectations for special status and advantage.

The Emergency Kit for Unaccompanied Children provides guidance and tools for identification, registration, and tracing. This can be ordered from Headquarters and contains a priority actions handbook, emergency registration books, cameras, equipment and basic supplies.

47. Ensure that children are issued with separate registration documents and ration cards and that these documents (including a recent photograph), always travel with the child. These measures will avoid confusion if a fostering arrangement breaks down.

48. Unaccompanied minors should be individually assessed and medically screened. A sympathetic and imaginative approach to interviewing children is very important and best conducted by carefully trained refugees, if possible by someone the child already knows and trusts. If an interview has to take place through an interpreter, the interpreter must be well briefed, with his or her role limited to direct translation, and must not be allowed to break personal contact between interviewer and child. Children may react very differently, depending, for example, on the degree of their trauma, fear and shyness. The presence of the child's friend(s) at the interview can not only reassure the child but may also yield important information. Any accompanying adults or persons who brought the child forward should also be interviewed.

49. As soon as unaccompanied minors are identified, start to trace their parents or families. Family tracing is not considered exhausted before a two year investigation has been completed. All claims for reunification must be verified, as mistakes and false claims sometimes occur.

Care and Protection of Unaccompanied Minors

50. Children separated from their immediate next-of-kin during a refugee emergency are often cared for by the refugee community, frequently within an extended family.

It is only where children cannot be cared for by the community that special measures will be required for their care.

Whenever possible, children should be placed with families, as institutional placements cannot provide adequately for children's developmental needs and social and cultural integration into society. Ideally, they should be cared for by relatives or others from the same ethnic or cultural groups.

51. One of the most important principles in the care of any child is that relationships must be stable, because of the importance of the emotional bond developed with the care-giver. An unaccompanied minor must be placed in a family where bonding can continue until the parent(s) or recognized first caretaker(s) are found. The child will then need time to reestablish a bond with his or her parent(s) or original caretaker(s). A period of overlap with the two families may therefore be necessary, in order to permit the re-establishment of the relationship with the parents while avoiding an abrupt severance of the ties with the foster family. Where years have elapsed, the child's interests may be better served by remaining with the foster family. UNHCR's usual practice is to allow unaccompanied minors over 15 to take decisions concerning durable solutions for themselves.

52. Criteria for foster family care should be worked out together with the community. Foster care arrangements should be formalized as quickly as possible by signed contracts or agreements, with an understanding that children should be returned to their immediate family if located. Particularly needy host families may be provided with an incentive to support the child on a case by case basis, but not as a systematic measure for all foster families. Food rations and other normal assistance should of course, continue to be provided for the child through the foster family. However, the child should continue to have registration and ration documents separate from those of the foster family. Foster care arrangements should be monitored closely through outreach activities in the community. Careful account should be taken of cultural attitudes towards fostering. For instance, in some situations, a family may find it hard to conceive of taking in a child except as a servant.

53. Where child care centres are necessary, they should be small, decentralized within the community, and integrated into community activities.

Remember that when the facilities and services provided for unaccompanied children are significantly better than those otherwise available, parents may actually place children in special care.

54. The advantage of small residential centres is that if reunification with the parents is expected to take place quickly, such centres provide an efficient way of caring for the children while at the same time not losing sight of them during the upheaval and confusion at the start of an emergency.

Unaccompanied minors should be integrated into the life, activities and services available to other children. Avoid either marginalizing them or paying them special attention.

55. Ensure continuity and stability in care (foster families and other) by employing refugee and national community services staff who are less likely to move on than international staff.

56. Provide supervision, support and training to child care workers, including child interviewing techniques, child development, community mobilization and child trauma. Train refugees and aid workers to identify and register unaccompanied minors from the outset of an emergency.

Women

57. While it is not correct to see women as a vulnerable group, women do have specific needs which, if not met, can put them at risk, such as vulnerability to exploitation and sexual abuse, sexual discrimination and restricted access to basic services. In addition, many decisions in camp management which affect women are made without them being consulted. Not including refugee women in decision making about camp management may put them at risk and add to their workload. In addition, the effectiveness of the assistance programme may be reduced because the problems and needs of all the beneficiaries have not been properly identified.

58. However, when seeking women's participation in decision-making, it is also wise to remember that measures which challenge the status quo may be threatening to traditional leaders. Special efforts may be needed to overcome resistance to change.

Culture and tradition cannot be used as reasons to exclude refugee women from participation in decision-making.

To Ensure Women's Participation:

Include refugee women in leadership functions and give them responsible roles in the community including participation in decision-making bodies;

Ensure that women have equal access to services and facilities, particularly health and reproductive health care services, and inform persons concerned about these resources;

Encourage activities such as adult literacy classes which will help empower women and bring them together for mutual support;

Provide community support to women by organizing recreational and educational activities for children;

Develop preventive protection mechanisms with the community to ensure protection of women against all forms of abuse;

Work with the elders and other influential groups to gain their support for the participation of women in camp management.

Single Parent Households

59. In refugee emergencies, the majority of single parent households are female-headed. However, community services must be sensitive to the needs of both male and female single parents. Men may have to be supported in the functions of rearing children and organizing household responsibilities. Women who have to manage the family needs on their own are at risk as they are vulnerable to exploitation and harassment, especially if they are young. They may be exposed to pressures attached to provision of food and material resources. Women must therefore be included in food management and other committees. Some women may have to resort to prostitution in order to provide for their families, particularly if they do not have any skills to earn a livelihood.

Survivors of Violence

60. Men, women and children can be victims of violence in conflict situations (including torture, rape or solitary confinement) and suffer consequent trauma. Rape is a crime of violence, and is sometimes used as a systematic method of intimidation. Survivors of rape can be any age from the very young to the very old and belong to any social group. It should be remembered that survivors of sexual violence including rape can be men as well as women. It is important to recognize that the consequences of sexual violence on children and adolescents will differ from that on adults.

61. Where there is a high risk of violence, steps can be taken to reduce exposure and vulnerability. Crimes of sexual violence may be more likely to occur where women and/or children are exposed and vulnerable, such as when they collect firewood or water from distant points. The level of risk of violence including sexual violence from within or outside the community, should be reflected in taking increased precautions in camp security, and in creating mechanisms to allow people to travel outside the camp in safety e.g. fuel-wood gathering in groups.

Take the Following Action

Establish services for survivors of violence which are integrated into other community and health care services;

Ensure confidentiality is maintained;

Organize counselling support services using trusted, supportive refugee staff, including female staff;

Organize support groups with people who are trusted;

Provide a safe place for survivors to stay, with friends if possible;

Ensure appropriate legal and medical services are established and accessible, including access to female staff;

Mobilize community support by discussing the general problem with them to ensure more compassionate treatment. Religious heads and community leaders in particular can influence attitudes to survivors of violence;

Ensure that site layout, fencing and lighting promote physical safety. Good site planning, including location of services, will help create conditions where violence will be less likely (see chapter 12 on site planning).

Sensitize the community to the problem and the seriousness of domestic violence. An emergency situation often triggers an increase in levels of domestic violence, particularly in the early stages. However, in the later stages of an emergency incidents of domestic violence may remain high and on occasion escalate, if the situation generates high levels of stress.

62. Urgent medical treatment must be provided to any person who has been raped to help deal with the physical trauma. A protocol for management of such persons, based on host country laws, should be adopted.

63. Post trauma reactions to sexual violence include feelings of shame and guilt, anger, humiliation, nightmares, withdrawal, depression and suicidal tendencies. Family, friends and community support groups must be alerted to these possible reactions so that they can understand and assist the survivors of violence.

64. Social attitudes to rape are usually very judgmental. A woman who becomes pregnant by rape may need help in being accepted by her family and the community or in placing a child for adoption. In some cases a man or a woman who has been raped may have to leave their present location in order to lead a normal life. This is especially the case of a woman with a child, who may then be left without family support. Additionally, she may feel hostile towards the child, a common post trauma reaction.

65. Any documentation of a case should be undertaken with the utmost confidentiality. It is the survivors choice whether or not to take legal action; there may be very strong considerations not to do so. If legal action is taken, the survivor will need support and protection in every step of what is a painful process, and should be made aware of exactly what degree of protection and care will be available.

66. Community services, protection and health staff must work together for survivors of rape and sexual violence. Protection staff can provide information on legal action and monitor the legal process if charges are pressed. Health personnel should make necessary treatment facilities and documentation available. Community services should work directly with the survivor concerned, and with the family of the survivor, as well as establish support groups and more generally sensitize refugees to the problems of rape. A refugee team, which could complement the UNHCR community services team, may be established to provide outreach to women reluctant to come forward.

Disabled and Handicapped

67. Disabled and handicapped persons might have problems in accessing goods and services available to refugees and steps must be taken to ensure this access, including that of disabled children to whatever schooling is available. In some refugee situations, but more often in returnee situations, additional dangers of land-mines mean that an information campaign must be started immediately to prevent further disability. Initial care for the disabled should be through families and the community, nevertheless, rehabilitation services (e.g. wheelchairs, crutches) should also be introduced as soon as possible. Community based rehabilitation to care for disabled people is an approach that should be promoted from the outset of an emergency.

Older Persons

68. The presence of older people in the community can strengthen the bonds and the sense of belonging. However, physical deterioration may limit their mobility and hence their access to basic services. Those most at risk are living alone or caring for young children.

Older persons can constitute a significant proportion of the refugee population though they are often overlooked.

69. Consideration should be given to include older persons in the supplementary feeding programmes. Even if older people can obtain food rations, limited mobility may preclude collection of water or fuel essential for food preparation.

70. For the more frail elderly, family and community care should be encouraged. Refugee community workers should identify neighbours, relatives or others who can help these people with food, water or fuel collection.

71. It should be kept in mind that after any repatriation, the elderly may make up a high proportion of refugees remaining behind in the country of asylum. Hence local government structures and local NGO capacity should be strengthened to care for them.

Isolated Social Groups

72. Every society has its social, religious, political or ethnic groups whose access to services is restricted even under normal conditions. They become particularly vulnerable during emergencies as assistance is likely to be channelled through the leaders of the majority groups. Immediate assessment should be made of any of these groups to determine if they can be integrated into the refugee community, or whether special provision must be made.

In the early stages of an emergency, cultural and traditional customs that may be harmful to particular groups of refugees such as genital mutilation, early marriages and other abusive practices should be addressed and appropriate action taken.

Education

· Education programmes can help address not only the psychological and social needs of the children, but also the well being of the whole community, by helping to organize the population and by providing structure for the children and their families;

· Education programmes can provide important support to lifesaving activities;

· Every child has the right to education. Even in an emergency, start providing appropriate education as soon as possible;

· The priority is to make primary schooling available to all. Special efforts will probably be necessary to ensure the proper participation of girls in the programme;

· Refugee schools should be organized and run by the refugees themselves, to the extent possible, with proper outside support.

Introduction

73. Establishing an education system is important for the well-being of the whole refugee community, as well as for the social and psychological well-being of children and young people. Setting up basic schools will give a structure and sense of normality to a dislocated and traumatized community. Refugees are dislocated not only from their homes and families but also from their community - the old community is disrupted while new community structures are only gradually evolving. Schools can be the initial community focal points, and a sense of well-being may be created if the new community is partly structured around institutions which are as familiar as schools, rather than around, for example, distribution points, registration and health centres which may be more representative of the problems of their current situation.

74. In addition, schools can be initiated and managed by the community itself much more easily than other refugee institutions, again enhancing self-esteem and self-reliance. Refugee teachers and parents often establish informal schools even in an emergency - as soon as basic needs in food water and health are met, because they recognize the importance of a school system for the reasons set out above.

Informal schools started by the refugees themselves should be supported, and can be used as a basis to begin the programme.

75. In addition to community building, other important functions of the education system in an emergency are:

i. To disseminate survival and life skills messages. Simple messages can be spread through the school system, on issues such as health, sanitation, nutrition, and looking after the local resources (fuelwood for cooking) so they do not become too rapidly depleted;

ii. To provide parents with extra time to work on family survival needs;

iii. To serve as an important protection tool in certain circumstances, e.g. through providing an alternative to military recruitment;

iv. To provide continuity of education which can help reintegration in the country of origin.

Every child has the right to education, as set out in the Convention on the Rights of the Child.

76. Detailed information on planning education programmes and on standards for refugee schools is set out in the latest edition of NHCR's Education Guidelines. These guidelines are essential reading for those establishing an education programme.

Setting up an Education Programme

77. Basic education must be provided and, although priorities in the emergency phase may mean that the full implementation of an education programme is difficult, a start must be made. An education programme should only be delayed if the emergency is clearly going to be short-lived.

The emergency education programme should provide free access to organized activities and basic education for all refugee children and young people.

78. Identify teachers from the refugee population who can organize recreational and educational activities, and identify agencies to support the development of basic education programmes.

Simple Activities

79. In the beginning, the aim is to establish a simple programme of structured recreational and simple educational activities for children and young people. This is possible even with limited educational supplies - simply gathering the children together for a set period each day and keeping them occupied is a valuable first step. Identify teachers from the refugee population who are willing to do this. The activities should support the lifesaving measures underway in other sectors by including simple messages on health, sanitation etc. appropriate for the children's level, and by providing parents with extra time to work on family survival needs. Recreational and activity materials of the type listed in Annex 3 could be used to support such a programme.

80. The initial activities should then be developed into a primary school system, based on the curriculum of the country of origin. The timing of the transition from the simple activities to the more formal primary education will depend on the evolution of the emergency. Where the school system in the country of asylum is similar to that of the country or area of origin and refugee numbers are limited, resources may be provided to local schools to enable them to accommodate refugee students, provided this is cost-effective.

Basic Education

81. A single, unified primary school system should be developed as soon as possible. Educational materials of the type described in Annex 4 can be used to establish a basic education programme. The materials on this list would meet the initial needs of 1,000 refugees, and include sufficient writing materials for two classrooms of students in the earliest stages of primary school plus one classroom for students who have completed 2 or 3 years or more of primary schooling. If each classroom is used initially for separate morning and afternoon shifts, then a total of 240 students can be catered for. Typically there would be two or more writing materials kits (of the type specified in Annex 4) per school, according to the number of classrooms on each site.

The curriculum should initially be based on that of the country or area of origin, to facilitate reintegration upon repatriation.

82. Where possible, contact should be made with the Education Ministry of the country of origin, initially to obtain school textbooks and teachers' guides and later regarding certification of education and training received by refugees and teachers. In order to open schools as early as possible, temporary shelters may be erected using plastic sheeting. The community should be mobilized to help build and maintain school buildings. Other items required for simple classroom structures, latrines etc. should be constructed, using local materials where possible.

Smaller, decentralized schools are generally preferable to large schools. Primary schools should be established within walking distance for young children.

83. Recreational and sports programmes for children and adolescents should be included as part of the education programme, and necessary space should be allocated at the time of site planning. The likelihood that additional classrooms may be needed at a later stage should likewise be borne in mind at the time of site selection and demarcation.

It is probable that young refugees will have had their formal education disrupted. There Should therefore be no limitation of entry to schooling according to the age of the children or adolescents.

84. Initial budgets should provide for the printing or photocopying of classroom materials for pupils and teachers, based on core elements of the country of origin curriculum as well as for the initial purchase of school and recreational supplies. Budgetary provision may also be necessary for the translation and reproduction of materials supporting health, environment, peace education and other messages.

Action

Identify humanitarian agencies to be responsible for educational assistance in each location and to establish and train community education committees and parent/ teacher groups;

Identify school sites, and erect temporary shelter, ensure construction of latrines;

Provide writing and recreational materials to support community initiatives (see Annexes 3 and 4);

Convene a refugee education committee. Include refugees, local education authorities, relevant UN agencies, implementing partners and refugee educators, at appropriate (district and/or national) levels;

Consult UNHCR Headquarters and the local UNICEF office regarding availability of educational materials and school-books;

Arrange the timing of educational and recreational activities around other household and family activities to get maximum participation and cooperation of refugees;

Establish schooling in all refugee locations with refugee education advisers and teachers. Make plans for moving to a normal system of education as soon as possible;

Aim at a realistic level of service which can be sustained over the longer term;

Organize in-service training of teachers. Training should cover: school organization; basic teaching methods; review of basic subject matter; and dissemination of messages regarding health, sanitation, environmental conservation and peace;

Monitor participation of girls in educational programmes and promote girls' enrollment and attendance in school. Identify what are the root causes of non-attendance by girls. Promote recruitment and training of female teachers (at least 50 per cent);

Reintegrate out-of-school children and youth in school or non-formal education. Causes of school drop-outs and non-participation in community activities should be monitored.

85. An education specialist may be needed to advise on programme development. Liaise with UNHCR Headquarters, regarding materials and expertise available internally and through standby arrangements (see Catalogue of Emergency Response Resources, Appendix 1).

86. The provision of education may give the refugees a privilege not enjoyed by the local population of some locations. If the government is in agreement and there is a common language of instruction, it is usually appropriate to open the schools to the local population. Some assistance may be provided to national schools located very near to refugee schools.

Key References

Assisting Disabled Refugees, UNHCR, Geneva, 1996 revision.

Environmental Guidelines, UNHCR set of environmental guidelines for different sectors (May 1998 revision): Domestic Energy Needs in Refugee Situations; Livestock in Refugee Situations; Forestry in Refugee Situations. UNHCR, Geneva, 1996.

Evacuation of Children from Conflict Areas, UNHCR, UNICEF, Geneva 1992.

Guidelines for Educational Assistance to Refugees, UNHCR, Geneva, 1995.

Guidelines on the Protection of Refugee Women, UNHCR, Geneva, 1991.

Memorandum of Understanding between UNHCR and UNICEF, 1995.

Refugee Children: Guidelines on Protection and Care, UNHCR, Geneva, 1994.

Refugee Emergencies: A Community-Based Approach; UNHCR, Geneva,1996 (revision).

Sexual Violence Against Refugees: Guidelines on Prevention and Response, UNHCR, Geneva, 1995.

Working with Unaccompanied Minors: A Community-Based Approach; UNHCR Geneva 1996.

Urban refugees, A Community-Based Approach. UNHCR, Geneva, 1996.


Figure

Annexes

Annex 1 - Community Services Checklist

The following chart covers the three phases of community services in an emergency. In each phase activities are identified and quantitative and qualitative indicators listed which can be used to assess the effectiveness of the community services programme.

CS = Community services

CSO = Community Services Officer

PHASE 1. ASSESSMENT, ACTION PLAN, GUIDELINES

Major Activities

Community Service Checklist

1.1. Assists with overall programme management

Are CS resources available through LOI?
Does the CSO participate in the UNHCR management team and support other sectors - water, sanitation, shelter, health, food and nutrition, programme, protection and environment?

1.2. Helps meet basic refugee survival needs

Have CS considerations been included in the needs and resource assessment?
Have refugee leaders been identified and involved in assessment?
Do vulnerable groups have access to initial assistance?
Have relevant local government and other local resources (NGOs, host families) been identified?
Have CS standards and guidelines been set?
Is there an action plan based on the above?

PHASE 2. FOUNDATION OF COMMUNITY SERVICES PROGRAMME

Major Activities

Community Service Checklist

2.1. Facilitates refugee participation and self-management

Have refugee committees and information networks been established with women's participation as well as men and are vulnerable groups represented?
Is community awareness building and information dissemination undertaken?
Is there a CS coordination mechanism with refugees, implementing partners and government?

PHASE 3. BUILDING UP COMMUNITY SERVICES

Major Activities

Community Service Checklist

3.1. Assistance to groups at risk, promoting their self-sufficiency

Unaccompanied minors
Are they protected from exploitation by provision of information centres etc.?
Are reception points established for reunifying parents and children?
How many UAMs are identified? a Is the community mobilized to provide foster care?
Is information disseminated on the reunification programme?
Traumatized children and adults
Do children attend clinics, child care services, schools or organized play?
Is there a system of identification and referral of acute cases to local facilities and are volunteers identified?
Are there special programmes established and are children participating in these therapeutic activities?
Single parent households
Are neighbours or volunteers mobilized for support?
Have interest groups formed?
Survivors of violence
Are means of safety and security identified and implemented?
Are activities established to provide a supportive environment and re-establish normal life?
Disabled
Are preventative measures established?
Are children immunized?
Have health education messages been identified and disseminated? Are the disabled referred for identification and treatment? · Are their families supported?
Are the disabled receiving education?
Unaccompanied older persons
Do they receive assistance in daily survival?
Are they involved in community activities?
Has a skills inventory of elderly been established?
Ethnic minorities and mixed couples
Is their safety and security ensured through site planning?
Have community activities been developed to foster peace and reconciliation?
Adolescents
Are they involved in community activities?
Single Females
Are they protected?
Have neighbours and volunteers been identified to offer support?
Have community activities been organized?
Have females been accomodated in a physically secure place in the refugee community?
Other specific groups
Is there a system of emergency support for urban refugees, co-ordinated with programme and protection?

3.2 Establishment and maintenance of reproductive health services

Has consultation been held with refugees groups?
Have needs and priorities been identified within categories -safe motherhood, family planning, HIV/AIDS, STDs, sexual and gender based violence, special needs of adolescents?
Have clinics and services been established?
Have refugee health workers been mobilized and trained?
Are women attending the services?

3.3. Promotion of refugee self-reliance and durable solutions

Self-help activities
Have projects been established for community development? Training
Are refugee training programmes developed, have refugees been trained?
Has capacity building (on-the-job or orientation training) been organized for government, NGO, CS workers?
Education
Are schools established (especially primary) and students enrolled? Is non-formal education established?
Is the education of girls taken into consideration?
Capacity building of refugee infra-structure
Are structures established (including community centres, clinics, housing)?
Have some programmes been handed over to refugee groups?
Are women included as part of the refugee leadership structure?

Annex 2

Sample
Unaccompanied Minor Registration Form




Child's Name

PLACE PHOTOGRAPH

Sex

Age

Registration No.

HERE



ICRC Number

1. Write names of brothers & sisters who are with the child.
2. Find out the name and location of persons who found or brought child to current location, interview that person and record that information.
3. Interview any other adults & children who may have information on child's family and record that information.
4. Write down any visit the child receives: date, name and address of visitor and relationship to the child.
5. Record child's movements: date and places: e.g. hospital, nutrition centre, etc. and final move for family reunion or other reasons.










REGISTRATION FORM

Child

Father

Mother

Date

Reg. No.

Last and First Name

Age

Sex

Last and First Name

Last and first Name

Note: Find out immediately who found the child and name, address of that person.

Are there other persons who know how to find child's family? Continue to talk to the child to obtain and write down more information about locating family.

Last Address of Child & Family

Present Caretaker or Organization Complete Name and Address

With Siblings Yes/no

If Child leaves, note reasons: Family Reunion, moved to another place, where, reasons? - Died, etc.

Annex 3 - List of materials for Recreational and Other Activities

(Resource box for children and young people)

Quantities indicated below are required for 1,000 total refugee population. For the younger children:

Qty

Item

2

footballs

2

medium-sized inflatable balls

8

skipping-ropes, long

40

skipping-ropes, short

80

slates (A4)

80

slate pencils

80

slate cleaning cloths


For young people

2

volleyballs

2

volleyball nets

2

footballs

100

exercise books (100 pages, lined)

100

pens, ball-point


For storage of the above materials

1

lockable metal or plastic container

1

padlock


For use by the team leading the activities

2

double sided chalkboards

2

registration books

2

notebooks A4 (250 pages, lined)

4

tambourines

4

large handbells

8

whistles

2

air pumps

2

puncture repair kits

6

boxes of white chalk (144 sticks)

2

soft tape-measures

2

lockable sports bags

2

small padlocks

Note

The materials on this list is sufficient for a refugee population of 1,000 people. (Thus, a refugee population of 50,000 persons would require 50 times the quantities indicated on the lists).

Supplementary items based on local needs and culture should be added (such as items needed for local games). If these items are not available locally the UNHCR Supplies and Transport Section in Geneva should be asked to assist with their purchase. Specific items normally used by the refugee children should be added.

Annex 4 - Writing Materials List

Quantities indicated below are required for 1,000 total refugee population.

For the younger children:

Qty

Item

160

slates

160

slate pencils

160

slate cleaning cloths

160

pencils

160

exercise books (100 pages)


For older children

240

exercise books (100 pages, lined)

240

exercise books (100 pages, squares)

240

ball point pens


For storage of the above materials

3

lockable metal or plastic containers

3

padlocks


For use by the teachers

3

double sided chalkboards

6

boxes of white chalk (144 sticks)

1

chalkboard ruler

1

chalkboard compass

1

chalkboard set square

18

ball point pens, (6 blue, 6 red and 6 black)

3

large pencil sharpeners

3

register books

3

rulers, 30 cm

3

chalkboard dusters

9

erasers

3

boxes of HBO pencils (12)

3

poster sets (alphabet, numbers in the language and script of the refugees)

3

duffle bags to carry teacher items

(introduction...)


Figure

Overview

Situation

Refugee emergencies are characterized by a mobile population, often with rapidly fluctuating numbers. It is often difficult to collect exact information on the total number and composition of the population.

Objectives

To find out the total number of the population of concern, and the breakdown of the population by age and sex, and by groups of special significance. The exact identity of those special groups will depend on the particular circumstances of the emergency.

Principles of Response

· Knowing who the refugees are and their number is essential for an efficient and cost effective operation;

· Formal mass registration should normally be the aim. Where this is not immediately possible, this can be reached in stages, starting with the first stage of population estimation;

· The final goal is a full registration of the refugee population;

· Information collected will be important for voluntary repatriation and re-integration into country of origin;

· Involvement and understanding by the refugees themselves is essential to the success of registration.

Action

· Use population estimation techniques as a first step;

· Plan towards a full registration, keeping the population informed;

· Identify resources needed for full registration;

· Review the need for full registration and implement each phase towards full registration as soon as each is feasible.

Introduction

· Knowing how many refugees there are and who they are is fundamental for planning and managing an efficient operation. There are several ways of determining numbers with sufficient accuracy;

· Although an accurate enumeration is essential, a formal mass registration should not necessarily be an automatic response at the start of an emergency;

· Successful registration needs good planning, careful implementation and consistent monitoring.

1. To plan and manage an efficient operation, one of the first things to know is how many refugees there are and who they are. An accurate enumeration is therefore an essential component of any assessment.

2. Chapter II, 8(f) of the UNHCR Statute states that the High Commissioner shall provide for the protection of refugees by "obtaining from Governments information concerning the number and condition of refugees in their territories". It must be made clear to the authorities that an assistance operation cannot be carried out without this information.

3.

Although an accurate enumeration is essential, a formal mass registration should not necessarily be an automatic response at the start of an emergency.

There are a number of methods for accurate population estimation (including age/sex breakdown) which do not require formal registration. In some circumstances these simpler methods may be preferable as an initial response.

4. The main advantage of registration is that it provides a unique opportunity to acquire basic information for subsequent programming. It also helps avoid disputes about refugee numbers. Registration will also be an essential component of any individual or family tracing programme and may be an important factor in protecting refugees.

5. The most practical time to register refugees is when they arrive at a reception/ transit centre or site for settlement. Registration is often carried out in conjunction with health screening. Transferring refugees to a new site also provides a good opportunity for mass registration.

6. A discrepancy may arise with time, between official figures and the best estimates of those working closest to the refugees. Unless this discrepancy is swiftly resolved major problems will follow. Small discrepancies are likely, given the difficulties in enumeration and registration. Large ones can be avoided by timely action to verify numbers through the various methods set out in this chapter.

7. For detailed information on registration and population estimation techniques, refer to Registration - A Practical Guide for Field Staff.

Population Estimates

· For most methods of population estimation, it is important to understand the community structure of the beneficiary population;

· Estimates should be updated regularly.

Introduction

8. The following methods can be used to estimate the population:

i. Counting;

ii. Administrative records;

iii. Lists compiled by refugee leaders;

iv. Extrapolation and Global Positioning System (GPS);

v. Aerial photography.

9. Understanding the community structure of the beneficiary population is important for most methods of population estimation - for example, living arrangements and the average number in a family group.

10. Annex 1 provides a format for reporting population estimates as part of an overall situation report. Estimates should be updated regularly.

Counting

11. If there are easily identified entry or transit points during a refugee influx (e.g. bridges or transportation sites), then a daily count of the number of people passing through these points can give a reasonable estimate of the refugee population. Sufficient staff should be immediately positioned at bridges and other critical points to provide 24 hour coverage. These staff members should be provided with counters to aid counting, and with simple recording and reporting forms.

Administrative Records

12. Local authorities at the refugee site may collect population data on the refugees. If possible, national census and other population data should be obtained from the country of origin as a means of cross-checking the host area data.

Lists Compiled by Refugee Leaders

13. Lists of names can be compiled by refugee leaders and verified through a process agreed with the refugee community.

To ensure the system is as accurate and fair as possible, it is particularly important to understand the community structure.

The normal community structure and hierarchy in a society are often disrupted during exodus and different people often take on the role of leadership in the country of asylum. It is essential to understand the role, motives and effectiveness of the new leadership. Community services and field staff can help in this. Records compiled by refugee leaders may even eliminate the need for registration, provided they are checked and verified at random and updated regularly.

14. The lists can also be useful in identifying vulnerable refugees who need special assistance. Community services staff should visit vulnerable individuals and families to help confirm the accuracy of lists provided by the leaders.

Shelter Count and Extrapolation

15. Population estimates can also be obtained by calculating the total area of the camp, then counting shelters in a fraction of the camp, from which the population of the whole camp can be extrapolated.

16. The total surface area of the camp can be determined in a number of ways. It can be determined by measuring the average length and average width of the camp by pacing, or by using a wheel meter or measurement tape (if the camp is small), or by driving (if the camp is large), using the trip meter to estimate distance.

17. If there is a map of the camp, the surface area of the camp can be estimated by overlaying scaled gridlines on the map, and adding up the number of the squares falling within the camp's boundaries.

18. Finally the surface area can be calculated using GPS. GPS is a system which includes a hand-held device (about the size of a large calculator, costing about US $200 in 1999) which displays on a small screen the latitude and longitude of its current position. The device uses satellites to establish its position. It does not work under heavy forest cover or in deep narrow valleys because it needs an unobstructed sightline to several satellites.

19. The GPS Is used to find the geographical coordinates of the camp perimeter. The more irregular the camp shape, the more perimeter points will be needed. Once the camp perimeter is established, the surface area of the camp can be calculated in the following ways:

i. Communicate the perimeter coordinates to Headquarters Mapping Unit where these can be used to calculate the area and the result will be communicated back. Alternatively, perimeter coordinates can be marked on paper which has scaled gridlines, using the X-axis to represent longitude and the Y-axis to represent latitude. A line is drawn joining these points. Counting the scaled squares inside the perimeter will give the total camp area. The distance represented by one degree of longitude varies, getting smaller moving towards the North and South poles and larger towards the equator. In order to use this method, the distance which one degree represents at the exact location of the camp must be found out. This could be scaled off a map of the area, if it has sufficiently large scale;

ii. Computer software (called Geographical Information Systems or GIS) can automatically map and calculate camp area based on the perimeter points established by GPS. Technical assistance for setting up this software can be obtained from Headquarters.

20. Once the surface area has been established, select a minimum of three sample areas within the camp, each representing about one thirtieth of the total camp area.

For example, if the total surface area of the camp is 600,000 sq. meters, then each sample area should be 20,000 sq. meters. Any variation of length or width which yields 20,000 sq. meters could be used for the sample sections. The normal GPS is not sufficiently accurate for use in measuring the size of the sample area and conventional means of measuring should be used instead.

21. Count the number of family shelters in each of the three sample sections. Obtain a figure for the average number of shelters per section (i.e. - in 20,000 sq. meters). Then multiply by 30 to extrapolate this over the entire camp.

For example, if 3 sample sections have 120, 134, and 150 shelters respectively, then the average number of shelters in a sample section will be (120 + 134 + 145) / 3 = 133. Thus the total number of shelters in the 600,000 sq. meters camp will be 133 × 30 = 3,990 shelters.

22. Determine average family size per shelter to estimate the total population. For example, if the average family size per shelter is 5, then the total population is 5 × 3,990 = 19,950.

Aerial Photography

23. Aerial photographs (or sometimes videos) of a camp can be used to count the number of family shelters. This can be accomplished to a limited extent by taking a picture from a nearby hill, tower or tall building. In addition to professional aerial photography, "amateur" photographs taken, for example, from a UNHCR plane can be used for estimation. Flying over the site may require the permission of the authorities.

24. Aerial photographs must be accompanied by a ground survey to establish the average family size per shelter and the percentage of empty shelters.

25. The number of shelters appearing on the photograph (or mosaic of photographs) multiplied by the average family size per shelter will give an estimate of the overall population.

26. It is important to define an appropriate scale for the photography. This will depend, in part, on the size of the camps. High altitude flights produce fewer photographs to handle and interpret, but it will be more difficult to distinguish the shelters.

27. The results of aerial surveys can be integrated within the GIS from which maps can then be produced.

Registration

· Registration provides the more detailed information needed for the efficient management of an assistance operation;

· Registration is carried out over several phases.

Introduction

28. Protection and assistance can be provided more efficiently if it is based on the demographic information which can be obtained through registration. Registration may be required at different phases of an operation, for example: when there is a new refugee influx; when there is a voluntary repatriation operation (see chapter 19 on voluntary repatriation); at any time during an assistance programme to update information on the population, or to collect information on special groups e.g. unaccompanied minors (see the annex to chapter 10 on community services). The information below relates mainly to registration at the time of an influx or for updating.

29. In order to cope with large numbers it is preferable to separate the components of a registration exercise into six distinct phases, according to the immediate needs of the population and the time and staff available to carry out the task. Each phase should be viewed as an entity in its own right, but each leading to the next phase when circumstances permit.

30. The six phases of registration are:

i. Estimating the population;

ii. Planning the registration and informing the refugees;

iii. Fixing the population;

iv. Collecting information and issuing registration cards;

v. Computerization;

vi. Verification and updating.

31. The 'ideal' in registration is to work as closely as possible with the refugee population and its leadership, promoting community responsibility and participation in all stages of the process. Whilst this may not always be possible initially, it should be a major objective for both registration and camp management.

32. Formal registration requires considerable time and personnel resources and needs the active involvement of key partners to supply the necessary personnel. Key partners include government, other UN agencies, NGOs and the authorities responsible for security. Registration should only be carried out when:

i. The safety of the staff and of the refugees can be assured;

ii. The refugees accept the process;

iii. The key partners can supply personnel to help carry out the registration;

iv. There are sufficient quantities of registration materials and other equipment, including logistical support and communications.

Standard UNHCR Registration Materials

33. Standard materials for registration are stockpiled at Headquarters, and are sufficient to register 300,000 refugees. The materials include, for example, standard cards and forms, wristbands, fixing tokens, etc. These materials are included as part of a refugee registration package - see Appendix 2, Catalogue of Emergency Response Resources which has further details of these resources and how to obtain them.

Registration Phases

Phase 1: Estimating the population

34. This is the initial step to determine if there is a need for a full registration and/or to establish the planning figures for the registration exercise. It also provides working figures for the population for operational planning prior to the availability of more detailed population information.

Phase 2: Planning the registration and informing refugees

35. Designate a focal point to take responsibility for planning and executing the registration. A pilot registration in another camp can help identify potential difficulties. Planning should be a joint exercise with the concerned partners, including refugees. Staff training may be required at this stage. Ensure that the necessary staffing, equipment, supplies, security, telecommunications, vehicles and logistical support will be available on the date of the exercise. Decide on the level of information to be collected on a control sheet or registration form, and computerization.

36. At the same time as planning, there should be an intensive information campaign aimed at the refugee population at large (not just the leaders) informing the refugees of the procedures and benefits of registration.

Phase 3: Fixing the population

37. Give each individual in the target population a fixing token (see Annex 2) or wristband.

This defines and temporarily freezes the size of the group on whom more detailed information will be collected later. Without the fixing phase, registration will become a revolving door, open to escalating distortion and abuse. It must be done rapidly (preferably within a few hours, maximum one day) to avoid multiple and/or bogus registration. While the population may be given only short notice of when this will take place, it is necessary to ensure that they understand what is happening.

Phase 4: Collecting information and issuing registration cards

a) Collecting limited information on control sheets and issuing temporary registration cards

38. This phase (including issuing temporary registration cards) should be carried out before the next food distribution because the fixing token or wristband is not linked to verifiable information about persons in need, and cannot be used reliably for food and relief distribution.

39. Usually there will be no time to collect detailed information immediately, yet assistance should be distributed urgently and basic demographic data is needed. The first step therefore is to exchange the fixing token or wristband for a temporary registration card (also used as ration card - see Annex 2) to all heads of family, and collect limited information on control sheets (see Annex 3). In most instances this information will be limited to the name of the head of family, the size and age/sex breakdown of the family and the number of the temporary registration card, with an indication of any immediately visible vulnerable family members (see Annexes 4 and 5).

b) Completing registration forms and distributing of registration cards

40. The second step is to record detailed information about the families on Registration Forms (see Annex 4) and to issue long-term registration cards (also used as ration cards, the standard UNHCR card lasts about one year or 24 to 36 distributions). Where this is done immediately after the fixing phase (without the intervening step of temporary registration cards) there will be time constraints. Where it is done after the issue of temporary cards it can be spread over a longer period of time, with a cut off date for the validity of the temporary cards.

It is the Registration Form that constitutes the core document of a UNHCR registration and which will provide the basis for all future reference, analysis, verification and updating of the registration.

41. This phase provides a verifiable linkage between the identity of persons of concern and the very simple forms of documentation needed for processing large numbers of people for assistance distribution. The two-step process of information collecting is used because the second step can take considerable time, and registration information is needed in the interim for commodity distribution. It is particularly important in this phase to have personnel who speak the language and to ensure there Is a common code for transliteration between alphabets, particularly for names.

Phase 5: Computerization

42. Computerization can either start after registration cards have been distributed or at the same time if there are sufficient resources. Computerization is normally carried out using the "Field Based Registration System" (FBARS). Standard codes are used in UNHCR Registration Forms to facilitate the collection and input of data, particularly data on groups at risk (see Annex 5).

43. Data can be entered on-site by trained data-entry clerks or by out-sourcing to an off-site specialized data entry company. The data should be computerized as soon as possible and not more than a few months after being collected on the registration forms, otherwise it will be outdated and unusable.

44. FBARS can handle two types of registration, either by family unit (control sheet) or by individual (standard registration form). It also has a convoy management module which can be used during organized mass movement. It can be used by both UNHCR Offices and by Governments and implementing partners.

45. FBARS has easy-to-use search and report facilities and can produce information for planning, monitoring and reporting, for example:

i. Data on the numbers and rate of arrival;

ii. Data on refugee groups including on vulnerable groups;

iii. Data consolidated both regionally and globally;

iv. Food distribution lists;

v. Passenger manifests.

46. FBARS is available with the UNHCR registration materials (see above). The software and documentation are currently available in English, French and Russian. Information and support for the use of FBARS is available from the Information and Computing Services Section at Headquarters.

Phase 6: Verification and information updating

47. Registration information will need to be updated as the population changes with births, deaths and population movements. There should be a system to do this from the start. The registered numbers should be cross-checked with other information, for example, births and deaths can be monitored through the health services, and population movement monitored through any of the methods for population estimation described above.

48. Registration documents can acquire monetary value, especially if they are used to access assistance. There should be a system to check these documents, for example random verification at food distribution points to ensure the refugees are not using other people's documents or forged documents.

49. Verification is a continuous process, therefore routine verification, including house to house visits, at food distribution centres, etc., should become a standard, regular and frequent part of monitoring. Shelters should be given an address (section/block/individual shelter number) which will be linked to the individual family registration information.

Key References

Registration - A Practical Guide For Field Staff, UNHCR, Geneva, 1994.

Annexes

Annex 1 - Format for reporting on population in emergency situation reports.

Period: From ___________ to___________






Decreases

Pop. at end of period

Type/
status of
popuation

Current
location

Origin/
from

Pop.
at start
of
period

New
arrivals

Vol. return

Resettlement

Other

Total

% of
total
0-4
years*

%of
total
who are
female*

*Estimate

Main source of information is Government; UNHCR; NGO
Main basis of the information is Registration; Estimate

Annex 2


Figure

Annex 3 - Control Sheet

Feuille de contr/I>


Figure

Annex 4 - Registration Form

Formulaire d'engregistrement


Figure

Annex 5 - Codes for UNHCR Registration Forms

Codes pour les formulaires HCR d'enregistrement

Sex
Sexe

Relation to HOH
Lien de Parentvec CDF

Education
Formation

Vulnerability
VulnbilitB>

F

Female
Fnin

SPO

Spouse
(husband/wife)

Conjoint
(mari/femme)

P

SP

Single Parent
Parent seul(e)

M

Male
Masculin

cm

Child
(son/daughter)

Enfant
(fils/fille)

S

Secondary Secondaire

SF

Single Female
Femme seule

PAR

Parent
(mother/father)

Parent
(m/p)

T

Technical/
Vocational

Technique/
Professionnelle

UE

Unaccompanied
Elder

Personne e
non accompagn/I>

SBR

Sister/Brother


Sœur/Fr

U

University


Universitaire

UM

Unaccompanied
Minor

Mineur
non accompagnI>

GPR

Grandparent
(grandmother/
grandfather)

Grand-parent
(grand-m,
grand-p)

G

Graduate

Dipluniversitaire

PD

Physically Disabled

Handicap) physique

GCH

Grandchild
(grandson/
granddaughter)

Petit-enfant
(petit-fils/
petit-fille)

Informal
Education


Education non
Institutionnalis/I>

Ml

Mentally III

Malade mental(e)

INL

In-laws


Beaux-Parents

N

No Formal
Education

Aucune Education
Institutionnalis/I>

Cl

Chronically III


Malade chronique

OFM

Other family
member

Autre

X

Unknown


Inconnu

MC

Missing Child


Enfant disparu

UNR

Unrelated person
belonging to
the household

personne
ang vivant
avec la famille

0

Others

Autres

A/U

Aunt/Uncle

Tante/Oncle

(introduction...)


Figure

Overview

Situation

Suitable and well-selected sites, soundly planned refugee settlements with adequate shelter and integrated, appropriate infrastructure are essential in the early stages of a refugee emergency as they are lifesaving and reduce suffering. Refugee settlement in emergencies may take the form of dispersed settlements, mass accommodation in existing shelters or organized camps. Initial decisions on location and layout have repercussions throughout the existence of a refugee settlement with long-term effects on protection and the delivery of humanitarian assistance.

Objectives

To provide suitable sites and shelter to accommodate refugees in emergencies.

Principles of Response

· Use longer term planning principles, even when the refugee situation is expected to be only temporary;

· Decisions on site selection and camp planning are very difficult to reverse, therefore when in doubt seek technical support;

· Avoid high population density in settlements and in shelters;

· Avoid very large emergency settlements; refugee camps should normally be considered as a last resort;

· Involve refugees in all phases of settlement and shelter planning and construction;

· Use a bottom-up planning approach, beginning with the smallest social units, preserving traditional social arrangements and structures as far as possible;

· Develop a comprehensive master plan, with the settlement layout developed around sanitation and other services, providing room for expansion.

Action

· Assess the suitability of the refugee site and ensure that it meets the basic criteria;

· Simultaneously assess the most immediate needs for emergency shelter and provide the necessary materials that cannot be met from locally available resources;

· Identify the most urgently required measures to improve site planning and layout, and implement these as soon as possible.

Introduction

1. Providing a place to live is a natural consequence of granting asylum. As the layout, infrastructure and shelter of an emergency camp will have a major influence on the safety and well-being of refugees, these factors must be coordinated with the other vital sectors involved in the humanitarian response: community services, water, environmental sanitation, health, education, food distribution, logistics, forestry, and the environment.

2. Most refugee operations last much longer than initially anticipated, therefore cost-effective and sustainable infrastructure and shelter should be planned from the start. The expected life-span of a camp will influence site selection, camp planning and the implementation of a refugee operation.

3. The role and responsibility of the national authorities in site selection is obvious and of fundamental importance. Equally, the refugees themselves must be involved as early as possible; ideally, the needs of the refugees should determine the location, size and layout of the site. In practice a compromise has to be reached between the needs of refugees and external factors, both practical and political.

4. Good site selection, planning and shelter will:

i. Save lives and reduce cost;

ii. Minimize the need for difficult, corrective measures later;

iii. Make the provision of utilities, services and infrastructure easier and more cost-effective;

iv. Ensure most efficient use of land, resources and time.

5. Emergency refugee settlements generally fall into one of three categories:

i. Dispersed settlement;

ii. Mass shelter;

iii. Camps.

Dispersed Settlement

6. This type of arrangement is where the refugees find accommodation within the households of families who already live in the area of refuge. The refugees either share existing accommodation or set up temporary accommodation nearby and share water, sanitation, cooking and other services of the preexisting households.

7. Accommodation is often found with extended family members or with people of the same ethnic background. This type of arrangement may occur in both rural or urban settings. The advantages of this type of settlement are:

i. Quick to implement;

ii. Limited administrative support is needed;

iii. Low cost;

iv. Fosters self help and independence;

v. It has less impact on the local environment than camps.

8. The disadvantages of this type of settlement are:

i. The host families and communities can become overburdened and impoverished;

ii. It can be difficult to distinguish the host population from the refugees. This may pose problems where population estimation and registration are required;

iii. Protection problems may not be as easy to detect as when the population is more concentrated;

iv. Shelter and other forms of assistance are likely to be needed by the host population as well as the refugees.

Mass Shelter:

Public Buildings and Community Facilities

9. This type of settlement is where refugees find accommodation in pre-existing facilities, for example, in schools, barracks, hotels, gymnasiums. These are normally in urban areas and are often intended as temporary or transit accommodation. The advantages of this type of settlement are:

i. They are not continuously inhabited during normal use and refugees can be accommodated immediately without disrupting accommodation in the hosting area;

ii. Services such as water and sanitation are immediately available, though these may be inadequate if the numbers are large;

iii. The need to construct additional structures specifically for the refugees is avoided.

10. The disadvantages of this type of settlement are:

i. They can quickly become overcrowded;

ii. Sanitation and other services can become overburdened;

iii. Equipment and structure can be damaged;

iv. Buildings are no longer available for their original purpose, thus disrupting public services to the hosting population;

v. Lack of privacy.

Camps

11. This type of settlement is where refugees find accommodation in purpose built sites where a full range of services, for example water, sanitation, are provided, usually exclusively for the population of the site.

12. High density camps with very large populations are the worst possible option for refugee accommodation. However, this may be the only option because of decisions by the host country or simply because of a lack of alternatives. They are common in areas with little or no pre-existing infrastructure or where the size of the refugee population is such that it would put an intolerable strain on the local resources if the two other types of settlement mentioned above were used.

13. The advantages of this type of settlement are:

i. Services can be provided to a large population in a centralized and efficient way;

ii. There may be economies of scale in the provision of some services compared with more dispersed settlements;

iii. The refugee population can be easy to identify and communicate with;

iv. Voluntary repatriation can be easier to organize.

14. The disadvantages of this type of settlement are:

i. High population density seriously increases health risks to the population;

ii. High risk of environmental damage in the immediate vicinity of the camp;

iii. High population concentrations, particularly close to international borders, may make the population vulnerable to protection problems;

iv. Large camps may provide a hiding place and support base for armed groups who should be excluded from refugee status. It may be difficult to distinguish these groups from the normal refugee population and thus they may continue to benefit from assistance.

Organization of Response

· Site selection, planning and shelter have a major bearing on the provision of other assistance.

· This subject must therefore be considered as essential to a problem and needs assessment and response.

· Expertize is necessary, as is swift coordinated planning of a new site or the improvement of existing conditions.

Introduction

15. Site selection, planning and provision of shelter have a direct bearing on the provision of other assistance and will be important considerations in the overall assessment of problems and needs and planning of response. Decisions must be taken as part of an integrated approach and in light of the advice of specialists and views of the refugees.

Contingency Planning

16. Ideally sites should be selected, planned and developed prior to the arrival of the refugees. However, frequently the scale, nature, timing or direction of movement of the refugee flow will mean that some or all aspects of a contingency plan may need to be modified in the face of changing or unforeseen events. The information previously gathered in the contingency planning process, however, will usually be useful.

17. Because of the nature of emergencies, and because practical and political considerations are often the primary determinant of the location of a site, the immediate priority will often be to improve sites where refugees have spontaneously settled.

Information for Site Selection and Planning

18. The information previously gathered from the contingency planning process, and information already available (maps and data) should be reviewed to assist in determining the range of options for sites. Information that is essential for planning will often be in the form of maps, reports surveys and other data and should typically cover such areas as topography, land use, climate, soils, geology, hydrology, vegetation, infrastructure and key natural and cultural resources. Sources of information may include government offices, educational institutions and UN agencies. UNHCR Headquarters, through the focal point on Geographical Information Systems (GIS) can also support operations with maps, aerial photographs, satellite images and a special geographic database.

Expertize and Personnel

19. Expertize may be required in the fields of hydrology, surveying, physical planning, engineering (e.g. water supply, environmental sanitation, road and bridge construction, building materials, etc.), public health, the environment and perhaps social anthropology. Familiarity with conditions in both the country of origin and asylum is very important. Prior emergency experience and a flexible approach are particularly valuable.

20. Expertize and advice should be sought through UNHCR's Engineering and Environmental Services Section, who will advise on the fielding of a specialist to coordinate activities in this sector. Potential sources of the necessary expertize are government line ministries, national and international NGOs, architecture and engineering faculties, local industry and professional organizations, as well as other UN organizations.

21. Site selection and settlement planning require broad consultations with all concerned in the planning, development and use of the site. When appropriate, multi-sector planning teams, work-groups or task-forces might be formed to better structure consultations and better solicit inputs. Consensus should be sought, though it is rare that the needs of all the parties will be fully satisfied.

Criteria for Site Selection

· Land may be scarce in the country of asylum and no site may be available that meets all of the desired criteria. If, however, the site is clearly unsuitable, every effort must be made to move the refugees to a better site as quickly as possible. Both the problems which result from a bad site, and the difficulties inherent in a move, increase with time.

Introduction

22. The social and cultural background of the refugees must be a primary consideration and will be an important determinant of the most appropriate type of site and shelter. In many circumstances, however, choice will be limited and land that meets even minimum standards may be scarce. For uninhabited sites or areas where refugee settlement is proposed, it is wise to establish why the site was not already in use, and examine whether the reason - for example, no water or because it floods in the monsoon - does not also exclude use by the refugees.

Water Supply

23. A specialist assessment of water availability should be a prerequisite in selecting a site.

The availability of an adequate amount of water on a year-round basis has proved in practice to be the single most important criterion, and commonly the most problematic

A site should not be selected on the assumption that water can be found merely by drilling, digging, or hauling. Drilling may not be feasible or may not provide water in adequate quantity and quality. No site should be selected where the hauling of water will be required over a long period.

Size of Camp Sites

24. While there are recommended minimum area requirements for refugee sites, these should be applied cautiously and with flexibility. They are a rule of thumb for an initial calculation rather than precise standards.

Ideally, the recommended minimum surface area is 45 m2 per person when planning a refugee camp (including garden space). However, the actual surface area per person (excluding garden space) should not be less than 30 m2 per person.

The figure of 30 m2 surface area per person includes the area necessary for roads, foot paths, educational facilities, sanitation, security, firebreaks, administration, water storage, distribution, markets, relief item storage and distribution and, of course, plots for shelter. The figure of 30 m2 does not include, however, any land for significant agricultural activities or livestock. Although agricultural activities are not usually a priority during emergencies, small vegetable gardens attached to the family plot should be included in the site plan from the outset. This requires a minimum increase of 15 m2 per person, hence, a minimum of 45 m2 overall land allocation per person would be needed.

25. Large camps of over 20,000 people should generally be avoided.

The size of a site for 20,000 people should be calculated as follows assuming space for vegetable gardens is included:

20,000 people × 45 m2= 900,000 m2 = 90 ha (for example a site measuring 948 m × 948 m).

26. If possible, there should be a substantial distance between each camp. The distance depends on a number of factors: access, proximity of the local population, water supplies, environmental considerations and land use.

27. Refugee settlements should have potential for expansion to accommodate increase in the population due to natural increases or new arrivals. The excess of births over deaths means that the population could grow as fast as 3 to 4% per year.

Land Use and Land Rights

28. In most countries land for the establishment of refugee sites is scarce. Often, sites are provided on public land by the government. Any use of private land must be based on formal legal arrangements in accordance with the laws of the country.

Note that UNHCR neither purchases nor rents land for refugee settlements.

Headquarters should be consulted at once if this is a problem.

29. Once a possible site has been identified, the process of site assessment should always include clarification of land-ownership and land rights. Almost invariably, land rights or ownership are known, even though these may not be well documented in public record, or may not be obvious. Nomadic use of range-land, for instance, requires huge areas and may not look used.

30. The refugees should have the exclusive use of the site, through agreement with national and local (including traditional) authorities. Traditional or customary land use rights are very sensitive issues, and even if there may be an agreement with the national government to use a site, local groups may disagree with the site being used even temporarily. Clarification of access rights and land use restrictions is also necessary to define the rights of the refugees to:

i. Collect fuel-wood, and timber for shelter construction as well as fodder for animals;

ii. Graze their animals;

iii. Engage in agriculture or other subsistence activities.

Security and Protection

31. In principle, the granting of asylum is not an unfriendly act by the host country towards the country of origin. However, to ensure the security and protection of the refugees, it is recommended that they be settled at a reasonable distance from international borders as well as other potentially sensitive areas such as military installations.

The OAU Convention states: "for reasons of security, countries of asylum shall, as far as possible, settle refugees at a reasonable distance from the frontier of their country of origin"1.

1Article II, paragraph 6 OAU Convention.

Exceptions should only be made to this rule where the interests of the refugees would be better served, for example if there are good prospects for early voluntary repatriation, and security and protection considerations allow.

Topography, Drainage and Soil Conditions

32. Where water is readily available, drainage often becomes a key criterion. The whole site should be located above flood prone areas, preferably on gentle (2 to 4%) slopes. Sites on slopes steeper than 10% gradient are difficult to use and usually require complex and costly site preparations. Flat sites present serious problems for the drainage of waste and storm water. Avoid areas likely to become marshy or waterlogged during the rainy season.

33. Soils that allow swift surface water absorption are important for the construction and effectiveness of pit latrines. The subsoil should permit good infiltration (i.e. allowing water absorption by the soil, and the retention of solid waste in the latrine). It should be noted that very sandy soils which are good for infiltration are sometimes poor for the stability of the pit. Where drinking water supplies are drawn from ground water sources, special attention must be given to preventing contamination by pit latrines. The pit latrines must not reach into the ground water. The groundwater table should be a minimum of 3 m below the surface of the site.

34. Avoid excessively rocky or impermeable sites as they hamper both shelter and latrine construction. If possible, select a site where the land is suitable at least for vegetable gardens and small-scale agriculture.

Accessibility

35. The site must be accessible and close to sources of necessary supplies such as food, cooking fuel and shelter material. Proximity to national services is desirable, particularly health care services. Roads must be "all-weather" providing year-round access. Short access roads to connect the main road with the site can be constructed as part of the camp development. There may be advantages in choosing a site near a town, subject to consideration of possible friction between local inhabitants and refugees.

Climatic Conditions, Local Health and Other Risks

36. Settlement areas should be free of major environmental health hazards such as malaria, onchocerciasis (river blindness), schistosomiasis (bilharzia) or tsetse fly. A site may have unseen and/or irregular (but often locally known) risks such as flash flooding, or serious industrial pollution. For sites in dust prone areas, regular dust clouds can foster respiratory diseases. Emergency and temporary shelter need protection from high winds, however, a daily breeze is an advantage. Climatic conditions should be suitable year-round and careful account should be taken of seasonal variations: a suitable site in the dry season may be untenable in the rains. Likewise, mountainous areas may be suitable in summer, while in winter the temperatures may fall way below freezing. Seasonal variation can have a considerable impact on the type and cost of shelter, infrastructure, heating fuel and even diet. As far as possible, refugees should not be settled in an area where the climate differs greatly from that to which they are accustomed. For example, settling refugees from malaria-free high ground in a marshy area where the disease is endemic can be disastrous.

Vegetation

37. The site should have a good ground cover (grass, bushes, trees). Vegetation cover provides shade, and reduces erosion and dust. During site preparation, care should be taken to do as little damage as possible to this vegetation and topsoil. If heavy equipment is used, indiscriminate bulldozing or removal of top-soil has to be avoided at all costs. If wood must be used as domestic cooking fuel or for the construction of shelter, the refugees should be encouraged not to cover their needs at the site or in the immediate vicinity. Rather, a more dispersed pattern of wood collection should be encouraged, in coordination with local forestry authorities (see section on site planning and management of natural resources below). A quick survey of vegetation and biomass availability for these purposes should be undertaken. The site should not be located near areas which are ecologically or environmentally protected or fragile.

Site Selection Methodology

Obtain agreement among the planning team on site selection criteria;

i. Prioritize the criteria list;

ii. Obtain suitable maps and other information showing topography, road networks, land use and water sources;

iii. Determine site characteristics through site visits, identifying any potential flaws that would exclude use of the site (e.g. no water, flood-prone);

iv. Make simple estimates of the surface area of each of the potential sites, e.g. use vehicle trip-meter to estimate distances, or, if feasible, use other methods such as Global Positioning System (see chapter 11 on population estimation and registration);

v. Assess the implications of different layouts on the potential sites and rank the sites on the basis of the criteria list.

Site Planning: General Considerations

· The overall physical layout of a site should reflect a decentralized community-based approach focusing on family, village or other social groups.

· Site planning should use the "bottom up" approach starting from the characteristics and needs of the individual family, and reflect the wishes of the community as much as possible.

Introduction

38. The physical organization of the settlement will markedly affect the health and well-being of a community. Good site planning will also facilitate an equitable and efficient delivery of goods and services.

Whatever the circumstances, the overriding aim must be to avoid high density refugee camps.

Master Plan

39. A "master plan" or overall site plan should show the overall configuration of the site, its surroundings and characteristics, and its location vis-a-vis natural and existing features including settlements. The plan should take into account the social organization of the refugees and principles of module planning, and should cover the following physical features.

40. Natural and existing features:

i. Contours (lines joining points of identical elevation are called contour lines);

ii. Rivers, forests, hills, flood plains, swamps;

iii. Rocky patches, sandy soils;

iv. Existing buildings, roads, bridges;

v. Farm land, electrical power grid, water pipelines.

41. Planned features:

i. Shelter areas, potential expansion areas;

ii. Roads and footpaths;

iii. Drainage system and terracing;

iv. Environmental sanitation plan;

v. Water distribution plan;

vi. Utilities, camp lighting, etc.;

vii. Administration areas;

viii. Educational and health facilities;

ix. Distribution points;

x. Feeding centres;

xi. Markets and recreation areas;

xii. Fire prevention breaks;

xiii. Agricultural plots.

42. A topographical and planimetric survey is crucial as the basis for site planning. The plan or map should have a metric scale between 1:1,000 and 1:5,000, and in case of large camps a scale of 1:10,000 or above. A topographical survey describes the physical features of a landscape (rivers, valleys, mountains). A planimetric survey describes locations within an area (e.g. the camp site).

Services and Infrastructure

43. The following are standards for services and infrastructure and should be referred to when preparing the master plan:

1 water tap

per

1 community (80-100 persons)

1 latrine

per

1 family (6-10 persons)

1 health centre

per

1 site (20,000 persons)

1 referral hospital

per

10 sites (200,000 persons)

1 school block

per

1 sector (5,000 persons)

4 distribution points

per

1 site (20,000 persons)

1 market

per

1 site (20,000 persons)

1 feeding centre

per

1 site (20.000 persons)

2 refuse drums

per

1 community (80- 100 persons)

44. There are two situations for which planning is required:

i. Reorganizing existing spontaneously developed sites;

ii. New sites.

The design standards to be applied should be the same in each case, although methods, approach and timing, may differ substantially.

45. Where refugees have spontaneously settled they may be understandably reluctant to relocate. In such cases involvement of representatives of the refugees in planning will usually facilitate a better understanding and acceptance by the refugees of priority changes. An early and clear demarcation of plots, including areas reserved for services, is advisable.

Comprehensive but swift planning is essential for a new site.

Modular Planning

46. Planning should start from the perspective of the individual refugee family. Begin by considering the needs of the individual household, such as distance to water and latrines; the relationship to other members of the community (other relatives, clan, or ethnic groups); and traditional housing and living arrangements. Developing the community layout in this way, and then considering the larger issues of overall site layout, is likely to yield much better results than beginning with a preconception of the complete site layout and breaking it down into smaller entities.

47. Thus planning and physical organization of the site should start from the smallest module, the family, and then building up larger units as follows:

Module

Consisting of

Aprox. No.
Of persons

Family

1 family

4-6 persons

1 community

16 families

80 persons

1 block

16 communities

1,250 persons

1 sector

4 blocks

5.000 persons

1 camp module

4 sectors

20.000 persons

These figures are indicative and should be adjusted according to actual conditions.

48. Modular planning does not necessarily mean using a grid layout for the site. The linear or grid layout, with square or rectangular areas separated by parallel streets, has often been used for its simplicity of design and speed of implementation. However, every effort should be made to avoid a rigid grid design which promotes high density settlements since environmental health problems and disease are directly proportional to population density. Whatever design is used should take account of the natural features of the site and of the identity of the refugee community.

49. The social organization, background and family structure, are all factors that will influence the physical layout of a site. Initially, this information, which is part of the basic problem and needs assessment should be gathered through discussions with the refugees and others knowledgeable about their society. A full socio-economic survey of the refugee population should be conducted once resources allow, and will be important in subsequent planning, particularly for self-reliance and durable solutions.

Environmental Considerations

50. Environmental considerations have to be integrated into physical planning and shelter from the very start of an emergency. Location and layout of refugee camps, provisions made for emergency shelter, and the use of local resources for construction and fuel, can have a major negative environmental impact. It is in the earlier stages of an emergency where the greatest environmental damage can occur:

This environmental damage has health, social and economic consequences for the refugees and local population, and can have political repercussions.

51.

Rehabilitation effectively starts in the emergency phase, and the costs of environmental damage can be substantially reduced by early environmental action in an emergency.

52. In order to safeguard the welfare of refugees and local population by protecting their environment, the following steps can be taken:

i. Site selection: avoid environmentally protected areas. Where possible, a site should be located a day's walk from protected areas or reserves;

ii. Site preparation: preserve existing vegetation and top-soil;

iii. Camp density and size: generally, the smaller the settlements the better;

iv. Camp layout: the layout (particularly roads) should follow the contour lines. This will reduce erosion and preserve topsoil, and avoid the creation of dangerous gullies. A site layout that encourages clustered living arrangements (which can also promote security) promotes sharing of resources including cooking which reduces fuel consumption;

v. Shelter design (energy saving through insulation): In cold climates, with extended winter seasons where continuous heating is needed, passive energy saving measures, e.g. sufficient insulation of roof, walls, floors can be extremely fuel saving and cost-effective over time;

vi. Shelter and fuel: The materials for these often come from the immediate surroundings of the camp. It is crucial to initiate at the outset a system managing and controlling the use of local natural resources including wood for construction and fuel. Meeting the initial need for shelter materials from the local resources can be particularly destructive - so collection of such materials should be carefully managed, and/or materials should be provided from an alternative source.

53. A simple natural resources management plan should be drawn up as soon as possible. A key feature of a basic plan will be controlled harvesting and collection of fuel-wood and timber. This should be discussed with government bodies, such as forestry departments. Controlled fuel-wood and timber harvesting in the vicinity of the camp can include: defining certain areas and trees (by marking) which should not be harvested, allowing only dead wood to be collected; establishing an environmental awareness programme to define clear rules from the outset regarding harvesting fuel-wood and to encourage respect for the local resources; assigning responsibility for managing and harvesting certain areas to certain groups.

54. The decision on supplying fuel-wood from outside the vicinity of the camp (e.g. trucking in wood), how to supply it and the quantity which is necessary, must be taken according to the specifics of the situation. The organized supply of fuel-wood or other fuel such as kerosene can have complex repercussions and should be instituted with care. Organized supply of free fuel on a regular basis is only appropriate in certain circumstances: for example, where there are severe restrictions on fuel from other sources. Where fuel-wood is also readily available locally, its distribution free of charge from outside the vicinity may actually lead to increased consumption. In addition, refugees rely on local natural resources for income, therefore if free fuel-wood is provided for cooking purposes, collection of wood will continue for income generating purposes (e.g. the sale of fuel-wood or timber, charcoal making, etc.). To retain its value therefore, fuel-wood should generally be supplied in return for work.

55. The source and impact of wood supplied to the refugees needs also to be considered:

i. Is it being harvested sustainably?

ii. Are the environmental problems merely being moved elsewhere?

Care should be taken to prevent emergence of local monopolistic suppliers. Finally, it should be remembered that, if it is necessary to introduce free fuel supply in the initial stages of an emergency, it will be difficult to later modify such arrangements.

56. A more comprehensive natural resource management plan for the site and its immediate surroundings should be drawn up as soon as possible (with specialist advice if necessary).

Such a plan should be based on a baseline environmental survey.

The comprehensive natural resource management plan would cover, in addition to controlled harvesting of timber for fuel mentioned earlier: promotion of fuel saving stoves and fuel efficient cooking techniques, supply of key energy saving devices (e.g. lids with cooking pots, provision of mills or milled grain), awareness raising programmes, identifying the scope for better use of existing natural resources (e.g. using waste water, common areas, and areas around shelters), for kitchen gardens and tree planting, and reforestation where necessary.

Gender Considerations

57. In emergencies there may be a loss of normal community participation and the changes in demographic proportions may have altered values and principles. This may mean disruption of traditional mechanisms for the protection and assistance of women. This change of social patterns in refugee communities may also result in:

i. Increased numbers of female headed households;

ii. Large numbers of unaccompanied children;

iii. Shortage of men;

iv. Disruption of the extended family, with its role as social caretaker.

58. It is important that the needs of women are taken into account in site planning. It may be difficult to reach women if they do not traditionally form part of the leadership structure of the community. In such cases the community extension workers should be able to assist in obtaining views on the protection and security of women.

59. Among the refugees may be those who are unable to build their own shelters because of vulnerabilities. Specific actions should be taken to ensure that the refugee community themselves are organized to assist the more vulnerable refugees with their shelter construction.

Site Planning: Specific Infrastructure

· Under-estimation of surface area required for social infrastructure and communal services is a common problem.

60. At the start of an emergency it may be difficult to foresee all the administrative and communal services that are likely to be required. Where adequate space is available, free areas should be allocated for future expansion of these services. Under-estimation of the space required for future communal needs is a common problem in sites of limited area.

Sanitation

61. While water requirements often determine site selection, sanitation requirements often dictate site layout. High population density together with poor sanitation is a severe threat to health and safety of the refugees. This is often the case when sites have developed in an unplanned way. Minimal organization of basic sanitation should be introduced before reorganizing the site or transferring the refugees to a new site. This should include prohibiting uncontrolled defecation and the establishment of public latrines. Sufficient space must be left for replacement latrines. If communal latrines are unavoidable, there should be a plan for their maintenance and they should be accessible by road to facilitate this.

62. For all sites, new or reorganized, the goal should be one latrine per family. Only if the latrine remains under the control and maintenance of a family group is safety and hygiene assured in the long run. The ideal location of the family latrine is on the family plot, as far as possible from the shelter.

Water Supply

63. Where possible, the maximum distance between any shelter and a water distribution point should be not more than 100 m, no more than a few minutes walk. The layout of the site should contain the water distribution grid as an integral part of the service plan and the pipes should be underground. Water pipes should be kept at a depth that traffic or other surface activities do not cause damage (40 to 60 cm). In countries with very low temperatures, the pipes must be positioned at frost free depth (60 to 90 cm). Experience shows that water distribution to small, socially cohesive groups of 80 to 100 persons reduces water wastage considerably and reduces destruction of taps, standposts and concrete aprons. The water distribution point is more likely to be kept well drained and hygienic and the waste water used to irrigate communal or individual vegetable gardens.

64. Effluent and used water from water supply points should be well drained and eventually absorbed in soakage pits or gardens.

Roads

65. A site should have access and internal roads and pathways connecting the various areas and facilities. Accessroads should be all-weather roads above flood levels and have adequate drainage. If there has to be a significant amount of vehicle traffic on the site, it should be separated from pedestrian traffic. All structures, including fences, should be set back some 5 to 7 m from roads to provide adequate visibility for pedestrians and vehicles.

Fire Prevention

66. As a rule of thumb a firebreak (area with no buildings) 30 m wide is recommended for approximately every 300 m of built-up area. In modular camps firebreaks should be situated between blocks. This area will be an ideal for growing vegetables or recreation. If space allows, the distance between individual buildings should be great enough to prevent collapsing, burning buildings from touching adjacent buildings. The distance between structures should therefore be a minimum of twice the overall height of any structure, if building materials are highly inflammable (straw, thatch, etc.) the distance should be increased to 3 to 4 times the overall height. The direction of any prevailing wind will also be an important consideration.

Administrative and Communal Services

67. Buildings for administrative and communal services should be traditional structures, if possible of a multipurpose design to facilitate alternative uses. For example, buildings for initial emergency services could later be used as schools or other community facilities. The following list includes administrative and communal services most often needed, the division is indicative only - the importance of maximum decentralization has already been stressed. Whether centralized or decentralized, administrative and other facilities should be located and designed so as they are accessible to women as well as men.

68. Services and facilities likely to be centralized are:

i. Site administrative office;

ii. Services coordination offices for health care, feeding programmes, water supply, education, etc.;

iii. Warehousing and storage;

iv. Initial registration/health screening area;

v. Tracing service;

vi. Therapeutic feeding centre (if required).

69. Services and facilities likely to be decentralized:

i. Bathing and washing areas;

ii. Supplementary feeding centres (if required);

iii. Education facilities;

iv. Institutional centres (e.g. for the disabled and unaccompanied children, if required);

v. Recreation areas;

vi. Commodity distribution centres.

70. The location of the centralized services will depend on the specific situation and in particular on the space available. Where sufficient space is available, there may be clear advantages in having the centralized services in the centre of the camp. Where space is scarce, it may be better to have the centralized services located near the entrance to the camp. In particular, this will avoid the trucks delivering supplies having to drive through a densely populated site, with the attendant problems of dust, noise and danger to pedestrians. If some form of closed camp is unavoidable, at least the centralized administrative services will probably have to be located near the entrance. The warehouses should always be near the administrative office for reasons of security.

Shelter

· Refugee shelter must provide protection from the elements, space to live and store belongings, privacy and emotional security;

· Blankets and clothing must be provided if necessary;

· Refugee housing should be culturally and socially appropriate and familiar. Suitable local materials are best, if available;

· Shelter must be suitable for the different seasons;

· Except for tents in certain circumstances, prefabricated or special emergency shelter has not proved to be a practical option on either cost or cultural grounds;

· Wherever possible, refugees should build their own housing, with the necessary organizational and material support.

Introduction

71. Shelter must, at a minimum, provide protection from the elements, space to live and store belongings, privacy and emotional security. Shelter is likely to be one of the most important determinants of general living conditions and is often one of the largest items of non-recurring expenditure. While the basic need for shelter is similar in most emergencies, such considerations as the kind of housing needed, what materials and design are used, who constructs the housing and how long it must last will differ significantly in each situation.

72. Particularly in cold climates or where there are daily extremes of temperature, lack of adequate shelter and clothing can have a major adverse effect on health and nutritional status.

Thus, in addition to shelter, provision of sufficient blankets, appropriate clothing and heaters will be a high priority.

73. The first steps are to assess the adequacy of any emergency shelter arrangements refugees have already made themselves, and to meet immediate needs through provision of simple local materials.

The key to providing an adequate shelter is provision of a roof.

If materials for a complete shelter cannot be provided, provision of adequate roof materials will be the priority, as walls can usually be made of earth or other materials found on site or locally available.

74. Wherever possible, refugees should build or assist in building their own housing, with the necessary organizational and material support. This will help to ensure that the housing will meet their particular needs, will reduce their sense of dependence, and can cut costs considerably.

Type of Shelter

75. Individual family shelter should be always preferred to communal accommodation as it provides the necessary privacy, psychological comfort, emotional safety and a territorial claim for future security. It provides safety and security for people and possessions and helps to preserve or rebuild family unity.

76. Emergency shelter needs are best met by using the same materials or shelter as would be normally used by the refugees or the local population. Only if adequate quantities cannot be quickly obtained locally should emergency shelter material be brought into the country. The simplest structures, and labour-intensive building methods, are to be preferred. Materials should be environmentally benign or gathered in a sustainable manner.

Standards

77. At the beginning of an emergency, the aim should be to provide sufficient materials to the refugees to allow them to construct shelter meeting at least the minimum standards for floor space, which in emergencies are:

i. minimum of 3.5 m2 per person in tropical, warm climates, excluding cooking facilities or kitchen (it is assumed that cooking will take place outside);

ii. 4.5 m2 to 5.5 m2 per person in cold climates or urban situations including the kitchen and bathing facilities.

78. The design of shelter should if possible provide for modification by the occupants to suit their individual needs. In cold climates, for example, it is very likely that people, in particular children and old people, remain inside the shelter throughout the day, hence more space is required.

Plastic Sheeting

79. Plastic sheeting has become the most important shelter component in many relief operations. In urban areas roofs can be repaired with specialized UV-resistant heavy duty plastic sheeting. Windows can be repaired with translucent reinforced panels. Tents and emergency shelters can be covered with highly reflective UV-resistant woven plastic tarpaulins.

80. Wooden support-frames and stick skeletons for these shelters, if collected from surrounding forests, can harm the environment considerably. It is therefore important to always supply frame material (which is sufficient to support plastic). The frame material should come from sustained, renewable supply sources. Bamboo is ideal, if available. Standard specifications for plastic sheeting can be found in Annex 1 to chapter 18 on supplies and transport.

Tents

81. Tents may be useful and appropriate for example when local materials are either not available at all or are only seasonally available or for refugees of nomadic background. The life-span of an erected tent depends on the climate and the care given by its occupants; it may be as long as 2 to 3 years. Where tents are used, repair materials should be provided to the occupants. A group of tents may also serve as transit accommodation while more appropriate shelter is constructed. Standard specifications for tents can be found in Annex 1 to chapter 18 on supplies and transport.

82. Tents should be covered with an outer fly to shade and protect the tent below. The tent should provide free standing height all over the floor area. Tents are difficult to heat as canvas walls and roof cannot provide insulation against heat loss. However, it is possible to some extent to heat a good, well sealed tent, if enough heat is produced in a tent stove. This stove needs fuel (usually wood or kerosene) around the clock to maintain a comfortable temperature. The fuel cost will be high. Therefore tents are not suitable as cold climate shelters, but if there is no choice, they can save lives and bridge the time until more suitable shelters are established.

Prefabricated Shelters

83. Neither pre-fabricated building systems nor specially developed emergency shelter units, even winterized shelter units, have proved effective in large scale refugee emergencies. Reasons include:

i. High unit cost;

ii. Long shipping time;

iii. Long production time;

iv. Transport problems including cost of transport;

v. Inflexibility.

Usually emergency shelter arrangements will have been made before these systems can arrive.

Shelter for Cold Conditions

84. Climates where cold weather with rain and snow prevails over extended periods (3 to 5 months), demand that people live primarily inside a house. In particular, the more vulnerable persons such as the elderly, small children, the sick and the handicapped need heated, enclosed spaces.

85. Shelters which are sufficient to withstand cold conditions have to be of a high standard and are complex and expensive to build. The following should be considered:

i. Wind protection of walls, roofs, doors and windows;

ii. Insulated enclosed space, with simple dividers;

iii. Heating stoves;

iv. Structural stability (to withstand snow- and wind-loads);

v. Protected and heated kitchens and sanitary facilities.

86. To help people survive the impact of cold weather in an emergency, a strategy should focus on the following:

i. Individual survival.

It is extremely important to protect the human body from loss of heat. Particularly during sleep, it is important to be able to keep warm, by being able to generate and retain body heat with blankets, sleeping bags, clothing and shoes, and food with high calorific value;

ii. The living space.

It is very important to concentrate on a limited living space and to ensure that cold air can be kept out of this space. This can be done by sealing the room with plastic sheeting and sealing tapes. Windows and doors should be covered with translucent plastic sheeting, stapled on window and door frames. Large rooms should be subdivided, with the help of plastic sheets or blankets. New structures should be constructed with a sealed space to keep the cold air out. Walls, ceilings and floors of the living space should be designed to insulate from cold air and to retain warm air as efficiently as possible;

iii. Heating.

Keeping the inside of a shelter at a, comfortable temperature (15 to 19° C) depends to a large extent on the outside temperature, the type of construction, the quality of insulation, the orientation of the building, and on the type and capacity of the stove. Depending on these conditions, a stove with 5 to 7 kW performance should have the capacity to heat a space of 40 to 70 m2 in most cold areas. Usually the stove for heating is used for cooking and baking as well.

87. For reasons of safety, convection stoves are recommended over radiation stoves. Fuel efficiency is very important as fuel may not be readily available, and its supply can pose major logistical problems. Overlooking regular fuel supply in the beginning can have very negative environmental consequences.

Reception and Transit Camps

88. Reception and transit camps are used where it is necessary to provide temporary accommodation for refugees. These camps might be necessary at the beginning of a refugee emergency as a temporary accommodation pending transfer to a suitable, safe, longer term holding camp, or at the end of an operation, prior to repatriation, as a staging point for return. Reception and transit camps are therefore usually either intermediate or short term installations.

89. Whether the transit camp is used in an emergency or as part of a repatriation operation, the camp should be designed for short stays of 2 to 5 days and a high turnover rate.

90. The required capacity of a transit camp will depend primarily on how many people will be channelled through the camp and in what time. This will depend on the absorption or reintegration capacity at the receiving end as well as the total time foreseen to carry through the operation.

91. The primary criteria for site selection for a transit camp are:

i. Good access (road, port, airport);

ii. The availibility of water;

iii. Good drainage (minimum 2% slope);

iv. Adequate conditions for sanitation.

92. The transit camp must be strictly functional and equipped with considerably higher construction standards than regular refugee camps. Operational maintenance must be fully supplied through the camp management. In particular, cleaning and disinfection of accommodation and sanitation areas need to be carried out on a regular and ongoing basis. Prepared food should be provided and individual food preparation should be prohibited. The transit camp will therefore need kitchen facilities, wet food distribution and a hall for food consumption. In view of the expected short-term stay, a minimum of 3 m2 per person is needed.

93. Standards for the construction of transit facilities are:

Accommodation: in barracks, long houses (open plan or subdivision for groups/families of 5 persons) heated in cold climates. For example, a tent of 85 m2 can accommodate approximately 14 to 25 persons;

i. Sanitation: 20 persons per latrine, 50 persons per shower. Regular and intensive maintenance is required;

ii. Water supply: absolute minimum provision of 7 litres/person/day plus water required for kitchens, cleaning and sanitation;

iii. Food preparation: approximately 100 m2 per 500 persons;

iv. Storage: 150 to 200 m3 per 1,000 persons;

v. A public address system;

vi. Lighting;

vii. Arrival zones and departure zones which are separated from accommodation zones;

viii. Administrative offices and staff accommodation;

ix. One health post;

x. Security fencing (depending on circumstances).

Public Buildings and Communal Facilities

· Public buildings should be used only as short term accommodation to gain time to provide more suitable shelter;

· Right from the beginning, intensive maintenance of infrastructure and utilities should be provided;

· The UNHCR shelter standards should be applied.

94. Public buildings such as schools are sometimes used initially as shelter. This is particularly the case in cold conditions which demand very rapid shelter response.

95. Where possible such accommodation in public buildings should be a temporary solution. The supporting infrastructure of the building (water, electricity, sanitation) will deteriorate very quickly with concentrated use, to the extent that living conditions can become dangerously unhealthy. The buildings decay rapidly primarily because they are unsuited to such large numbers and lack the necessary infrastructure and utilities. In addition the very low sense of responsibility by its inhabitants contributes to the deterioration.

96. The normal use of the building has to be suspended with various social and economic consequences (the buildings might otherwise be used for example as schools, sanatoria, workers' or students' dormitories, sports halls and hotels). Both local and national governments are therefore reluctant to transform public buildings into humanitarian shelter.

97. In order to ensure a healthy environment, it is particularly important to ensure regular operational and preventive maintenance in public buildings. Neglecting to maintain a building from the outset can have serious health consequences for the refugees, and economic consequences for the host government.

98. The UNHCR minimum shelter standard of some 3.5 to 5.5 m2 per person should be applied, as well as the standard for public sanitation (maximum 20 persons per toilet/latrine). Public buildings, such as schools, are not equipped to serve the sanitation needs of large populations including basic toilet use, as well as personal hygiene such as laundry and cleaning dishes.

(introduction...)


Figure

Overview

Situation

Emergency situations are characterized by an urgent need to distribute life sustaining commodities such as food, shelter materials, cooking implements and fuel. The fair distribution of commodities is often problematic and groups and individuals from among the refugees can use the confusion of the emergency to obtain unfair control over the resources which are distributed.

Objectives

To provide life-sustaining commodities to the refugee families, fairly, according to specified rations, selection criteria and priorities.

Principles of response

· The design of the distribution system should be based on a thorough understanding of the social structure of the refugees;

· The refugees should be kept continuously informed on the design of the distribution system, on the timing of distributions and on the quantity of commodities to be distributed;

· All groups among the refugees should be appropriately involved in the design and operation of the distribution system. Particular care must be taken to involve women;

· The family as the basic social unit plays the key role in meeting basic needs of individuals, therefore, the family unit should be the target of commodity distribution;

· The commodity distribution cycle should be regular and predictable. Irregularities in the distribution cycle increases the tendency of the refugees to circumvent the system.

Action

· Use community services structures (or set up new structures if necessary) to consult the refugees on the design and operation of the commodity distribution system;

· Select and implement a commodity distribution system;

· Set up a system by which information on the operation of the commodity distribution system can be regularly conveyed to the mass of the refugees;

· Allow the refugees themselves to monitor the fairness of the distribution system.

Introduction

· Distribution passes control over a commodity to the intended beneficiaries. Distribution must be fair, and commodities must be distributed according to specified rations, selection criteria and priorities;

· Distribution must be monitored to ensure that it is fair and reaches vulnerable groups;

· However ingenious the distribution system devised, it is unlikely to work fairly without the support of the refugees themselves;

· UNHCR's distribution systems should provide material assistance to and through families.

1. The principles in the chapter apply to the distribution of both food and non-food items, although food often forms the bulk of the commodities distributed. This chapter provides brief guidance on the subject. The handbook "Commodity Distribution: A Practical Guide For Field Staff" is essential reading for those who plan to set up and run a commodity distribution system (see Key References at the end of the chapter).

When to start distribution

2. There is usually a degree of uncertainty when planning distributions. Ideally, distribution of commodities should start only after a full needs assessment has taken place and when the size of the beneficiary population is accurately known. However, the reality of almost all emergency programmes is that distributions must start prior to these ideal conditions being reached. Try not to start distribution until there is at least a minimum framework in place to build upon, and a plan as to how subsequent distributions will be improved.

Choosing a Commodity Distribution System

3. Two basic issues are:

i. How much responsibility should be given to the refugees themselves; and,

ii. What resources are available to set up and run the system (including time, space, experienced staff as well as financial resources (see Table 1).

4. There are three broad categories of distribution system (see Table 1). Note that the head of family can either be a woman or a man.

Distribution systems can be classified according to who receives the commodities.

5. There will probably be a period in the early stages of an emergency when it will not be possible to register or issue ration cards. However, effective distribution of commodities is possible without ration cards.

Table 1 - Commodity Distribution Systems

Through
Group Leadership

Through
Groups of Heads of Family

Through
Individual Heads of Family

System Description

Commodities are given in bulk to
a representative of a large group
of beneficiaries who further
divides it among the group.

All of the commodities for the
group of families are handed
over to a representative of the
group. The group usually con-
sists of about 20 heads of family.
The commodities are then im-
mediately redistributed to the
individual family heads by the
representatives.

Commodities are handed over
directly to each family head.

Types of situation in which these systems have been used

· Early days of an emergency.
· Mass influx of refugees.
· No formal registration.
· Large populations.

· When the population is
comparatively stable, and/or
have ration cards.
· Where the beneficiaries are
living in camps.
· Where the population is
comparatively homogeneous.

· When the population is
comparatively stable, and/or
have ration cards.
· Where the beneficiaries are
living in camps, settlements
or integrated within the local
population.

Amount of resources needed increases


Degree of self regulation by refugees increases

Components of Distribution Systems

General Considerations

6. The ideal distribution system should be safe and easily accessible to the intended beneficiaries.

Safe: Distribution should be organized in such a way that the system is safe for all who use it. Particular attention should be given to women and the vulnerable;

Accessible: Distribution points should be close to where people live and located so that the access of particular groups is not restricted. The timing of distributions should suit the beneficiaries.

7. The refugees themselves can provide the most effective monitoring and control of the distribution system. In order to do this they must be informed as to the type and quantity of commodities to be distributed and method and timing to be used.

A system needs to be put in place whereby the refugees can be continuously informed of changes in the quantity, type or method Of distributions.

8. In the early stages of a new operation, particularly in large emergencies, effective control over distribution may not be possible. However, from the start, each action taken should contribute to a process whereby control by UNHCR is progressively established. For example the provision of plastic sheeting, tents and other shelter material is very important because it reduces the mobility of the population. Once it is issued, the population can settle and commodity distribution and other services will be easier to organize.

Refugee Involvement

9. Ensure the refugees are well informed (both women and men). They must know what they should receive, how much, when and how. This information should come to them directly rather than through their leadership.

The refugees should be able to see the distribution process for themselves as they are the best monitors and controllers of the process.

Ensure that the refugees participate at all levels of the distribution process. However, be aware of the dangers of non-representational leadership (see chapter 7 on coordination and site level organisation).

10. Irregularities in the distribution cycle undermine the confidence of the beneficiaries and increase their need to circumvent the system.

Logistical Considerations

11. In camps, the distribution system should allow beneficiaries to collect rations close to where they live (not more than 5 km away) and at regular monthly intervals. For dispersed populations refugees should not have to travel more than 5 to 10 km to distribution sites.

12. In the case of food distribution, it is usually preferable to distribute dry uncooked rations in bulk. Avoid mass cooked food distribution for the general ration (see chapter 15 on food and nutrition).

Managerial Considerations

13. Distributing relief commodities involves several organizations and many individuals, for example, the government, WFP and NGOs. Co-ordination structures must be put in place, including regular meetings of all interested parties. The frequency of these meetings will depend on the situation. At the start of an emergency daily meetings will probably be needed. As the situation normalizes the frequency of meetings can be reduced to one per month.

14. It is important to understand the roles and responsibilities of the main actors involved at various stages of commodity distribution. In the case of food distribution the modalities of distribution as well as the reporting requirements are set out in a tripartite agreement between UNHCR, WFP and the implementing partner. The respective roles of UNHCR and WFP in relation to food aid are set out in their Memorandum of Understanding (Appendix 3). See Chapter 15 on food and nutrition for more information on food distribution and on of the role of WFP.

15. The family, as a basic social unit, is the target of distribution. This applies to food and non-food items. Providing assistance to and through families is effective as the basis for the distribution system and also supports the family unit. However this does not mean that the ration has to be handed to each family directly. In some situations distribution can be more effective through groups of families or other community structures.

16. Avoid payment in kind to distribution workers. It makes monitoring difficult and, in times of shortages, vulnerable people may be deprived of commodities in order to pay staff.

17. In camps, aim to have at least 1 distribution site per 20,000 refugees.

18. Plan to have a minimum of 2 distribution staff per 1,000 beneficiaries.

The Role of Refugee Women

UNHCR Policy

19. UNHCR's policy is to ensure the maximum possible appropriate involvement of refugee women in all aspects of distribution. Determining the nature of this involvement requires consultation with refugee women and men and a careful evaluation of the totality of the needs and responsibilities of refugee women and their families. Failure to take these considerations into proper account can have negative implications that go well beyond the distribution system itself.

20. In the great majority of refugee communities, the objective of fair distribution will be best served by having an appropriate balance of men and women. However, it is normally women, and in particular single female heads of household, who are either under-represented or excluded.

Areas of Women's Involvement

21. There are three areas where refugee women can be involved:

In the decision-making processes and monitoring;

In the distribution itself (women supervise and/or hand out the commodities); and,

In collecting the commodities (where they are distributed to women not men).

22. Women must be directly involved in decision-making and monitoring, including being involved in planning the system and determining their own participation in its implementation. Women should be members of the commodity distribution or food committees.

23. Women should choose representatives who will be involved in the distribution itself. The extent and nature of this participation will depend on factors specific to that situation.

24. If women themselves feel that the most effective way to ensure that they receive their fair share and to retain control of its use thereafter, is by actually collecting, or at least being present at the distribution of food and non-food items for their household (whether or not they are its head), this should be ensured.

Monitoring

25. Monitoring the distribution system is an important management responsibility of UNHCR. General principles of monitoring are described in chapter 8 on implementing arrangements. Monitoring distribution includes monitoring the actual distribution of the commodity and spot checks in the camps on distribution days. See chapter 15 on food and nutrition, and "Commodity Distribution: A Practical Guide For Field Staff", for more details about monitoring distribution systems.

Key References

Commodity Distribution: A Practical Guide For Field Staff, UNHCR, Geneva, 1997.

Memorandum of Understanding on the Joint Working Arrangements for Refugee, Returnee and Displaced Persons Feeding Operations, UNHCR, Geneva, 1997.

Model Tripartite Agreement: UNHCR, WFP and the Implementing Partner, WFP/UNHCR, March 1998.

UNHCR Training Videos: Under Watchful Eyes, UNHCR, 1995 - Sorting it Out, UNHCR, 1993.

(introduction...)


Figure

Overview

Situation

It is well known from experience that emergencies result in excess loss of life (high mortality) and increased incidence of diseases (high morbidity). The diseases mainly responsible for high mortality and morbidity are measles, diarrhoeal diseases (including cholera), acute respiratory infections (pneumonia), malnutrition and malaria. The factors which increase the risk of disease and which should be addressed in any emergency response include an unfamiliar environment, poverty, insecurity, overcrowding, inadequate quantities and quality of water, poor environmental sanitation, inadequate shelter and inadequate food supply.

Objectives

· To promote the enjoyment of the highest attainable standards of physical and mental health1, and to prevent excess mortality and morbidity.

Principles of Response

· Priority should be given to a Primary Health Care (PHC) strategy focusing on the vital sectors of water, food, sanitation, shelter and physical planning. In addition, preventive and basic curative health services should be provided. The health of the majority of the refugees is more likely to be affected by these measures than by individual care;

· Refugee participation in the development and provision of health services is essential;

· Services provided for refugees should be at a level equivalent to that appropriate to host country nationals - i.e. there must be parity;

· The health programme should also be sustainable. It is sometimes better not to start activities which cannot be maintained, than to cease supporting activities which both implementing partners and beneficiaries have come to take for granted;

· The health services must be of a quality that ensures that programmes, providers and institutions respect patients' rights and comply with nationally and internationally accepted health standards and principles of medical ethics;

· Many countries will not have sufficient human and material resources to respond adequately to the extraordinary needs generated by an emergency. Experienced national and international NGOs should be mobilized to initiate urgent life saving measures. Rapid integration with the Ministry of Health (MOH) is essential;

· Health services should take into account the particular vulnerability of children under five years during emergencies. Priority should be given to immunizations, feeding programmes, oral rehydration therapy, Vitamin A prophylaxis, basic curative care and family health;

· Health services should also take into account the special needs of women who play a central role as primary health care providers and at the same time bear a disproportionate share of suffering and hardship;

· A UNHCR Health Coordinator should be appointed with responsibility for the health programme and for ensuring that nationally and internationally accepted standards and best practice are adhered to, in close coordination with the national health authorities and other organizations.

Action

· Assess the health and nutritional status of the population and identify the critical health risk factors in the environmental conditions;

· Establish priority needs, define the required activities to meet those needs and determine the required human, material and financial resources to perform these activities;

· In accordance with these activities, set up community-based health services and devise the appropriate organizational and coordination mechanisms both with the health partners and the other relevant sectors of assistance;

· Promote basic health education for the refugees and train refugee health workers;

· Monitor and evaluate the effectiveness of the services and adjust as necessary;

· Ensure that decisions about the health services are based on proper assessment and surveillance;

· Communicate information about the emergency situation and the health services for advocacy purposes.

1 International Covenant on Economic, Social and Cultural rights", 1996, Article 12.

Introduction

1. Good health, depending as it does on so many non-medical factors, is too big a subject to be left only to medical workers. This chapter is directed at non-specialist staff in the field. It does not pretend to give "medical answers" to health problems. It does however seek to show that proper assessment of problems, needs and resources, appropriate organization and coordination of public health and medical services based on a Primary Health Care (PHC) strategy are more important to the overall health status of refugees than curative medicine alone, see figure 1. These crucial organizational factors are often the responsibility of non-medical UNHCR staff.

2. In an emergency, many refugees will be exposed to insecurity, poor shelter, overcrowding, lack of sufficient safe water, inadequate sanitation, inadequate or inappropriate food supplies and a possible lack of immunity to the diseases of the new environment. Furthermore, on arrival, refugees may already be in a debilitated state from disease, malnutrition, hunger, fatigue, harassment, physical violence and grief. Poverty, powerlessness and social instability, conditions that often prevail for refugees, can also contribute to increased sexual violence and spread of sexually transmitted diseases including the Human Immuno-deficiency Virus (HIV).

3. The World Health Organization (WHO) has summarized the concept of Primary Health Care as follows: "PHC is essential health care made accessible to everyone in the country; it is given in a way acceptable to individuals, families, and the community, since it requires their full participation; health care provided at a cost the community and the country can afford. Though no single model is applicable everywhere, Primary Health Care should include the following: promotion of proper nutrition, an adequate supply of safe water, basic sanitation, reproductive and child care, including family planning, appropriate treatment for common diseases and injuries, immunization against major infectious diseases, prevention and control of locally endemic diseases, education about common health problems and what can be done to prevent and control them".

At the heart of such a strategy there is an emphasis on preventive, as against curative care alone.


Figure

Health Assessment, Planning, Monitoring and Surveillance

· An assessment of the health and nutritional status is an essential start to the provision of health services;

· This must be done by experts with experience of emergencies and, if possible, local knowledge;

· The factors affecting the health of the refugees must be identified and a surveillance and reporting system established.

Initial Assessment

4. First, information should be obtained on the number of refugees2 segregated by age (percentage of children under five years of age) and sex (male/female ratio). See chapter 11 on registration for more information on estimating the total number of refugees.

Age/sex breakdown can be estimated from:

i. Information collected during surveys;

ii. Information collected during mass immunization campaigns;

iii. Mass health screening on arrival;

iv. Information collected by community health workers.

5. The aim of the initial health assessment is to identify basic problems and needs and to establish priorities. It should be carried out by people with appropriate qualifications and relevant experience. There are obvious advantages in using national or locally-based personnel, but appropriate outside expertise can be made available quickly and should be requested through the Health and Community Development Section at Headquarters if necessary.

6. The priority should be to evaluate the incidence of the major causes of excess mortality and morbidity - measles, diarrhoeas, pneumonia, malaria and malnutrition.

7. Relevant information can be obtained from:

i. Direct observation;

ii. Reviewing baseline information regarding the country/areas of origin and asylum;

iii. Analyzing records at health facilities and interviewing health workers;

iv. Undertaking sample surveys (nutrition and mortality). These must be done by experts;

v. Population estimation and registration (see chapter 11 on population estimation and registration);

vi. Mass health and nutrition screening on arrival. This should focus on: (i) nutrition screening through visual inspection and measurement of the Mid Upper Arm Circumference ("MUAC"), (see chapter 15 on food and nutrition), (ii) checking for communicable diseases and vaccination coverage, and (iii) identifying patients in need of urgent referral. It is usually impractical to try to provide treatment in the screening line itself.

8. Figure 2 illustrates key management considerations for action in light of the initial assessment.

2 Health experts sometimes call this number "the denominator".


Figure 2 - Assessment and Response

Monitoring and Surveillance: The Health Information System

9. From the earliest stages of an emergency, a health information system should be put in place under the responsibility of the UNHCR Health Coordinator. The health information system should be simple, reliable, and action oriented, and its use will be essential to:

i. Quantify the health and nutritional status of the refugee population;

ii. Follow trends in health status and monitor the impact and outcomes of the relief programme;

iii. Detect epidemics;

iv. Evaluate programme effectiveness and service coverage;

v. Ensure that resources are targeted to the areas of greatest needs;

vi. Re-orient the programme as necessary.

10. Annex 1 sets out the tables and forms for collecting health-related information. However, to have a more comprehensive idea of the situation, information regarding water, food, sanitation, shelter and availability of soap should also be collected and analyzed (see the relevant chapters on water, nutrition, sanitation, and physical planning).

11. The health information system should be kept simple. The information to be collected should be adapted to suit the collectors' qualifications. Overly detailed or complex reporting requirements will result in non-compliance. In addition, only data that can and will be acted on should be collected. Communication and exchange of views among all the actors in the health information system are essential to secure the functioning of the system.

Only simple arrangements are effective in emergencies.

12. Health information in the initial stages of an emergency should concentrate on:

i. Demography (see chapter 11 on registration, also paragraph 4 above, and table 1 of Annex 1);

ii. Mortality and its causes (see tables 2.1 and 2.2 of Annex 1 and paragraph 14 below);

iii. Nutritional status (see Annexes 4 and 5 of chapter 15 on food and nutrition);

iv. Morbidity (see below, and table 3.1 of Annex 1).

13. Only when the situation stabilizes can the system be made more comprehensive. Information on mortality and morbidity should be collected as follows:

Mortality

14. Each health facility should keep a log of all patient deaths with cause of death and relevant demographic information. This information should be summarized in tables 2.1 and 2.2 of Annex 1, reported centrally and consolidated with other data. Because many deaths occur outside the health-care system, a community-based mortality surveillance system should also be established. Such a system requires identifying sites which people are using as cemeteries, employing grave watchers on a 24 hours basis, routinely issuing burial shrouds, and using community informants. Deaths that occur outside hospitals with unknown causes should be validated through verbal autopsy by health workers specifically trained for this task.

Morbidity

15. Each health facility providing out-patient services (including clinics for under five's and selective feeding programmes) should keep daily records. These records should be in the form of a log book or tally sheets at least, and should at least record the patient's name, age, sex, clinical and laboratory diagnosis and treatment. This information should be summarized in the forms set out as tables 3.1. in Annex 1 and reported centrally.

16. Diseases recorded in the health information system must have a case definition (i.e. a standard description) which will guide health workers in their diagnosis and ensure the consistency and validity of data. Where possible, case definitions that rely on clinical signs and symptoms (e.g. malaria) should be checked against a laboratory standard test (e.g. blood test for malaria).

17. In addition, the patient should be issued a health record card (or "Road to Health" card) on which the date, diagnosis, and treatment are recorded. Every contact a patient has with the health-care system, whether for curative or preventive services, should be noted on the health record card retained by the patient.

18. The health information system should be periodically assessed to determine its accuracy, completeness, simplicity, flexibility, and timeliness. The way programme planners and key decision-makers use the information should also be assessed. The system should evolve as the need for information changes.

19. Camp and centrally controlled monitoring of health and nutritional status is essential if problems are to be identified in time to allow preventive and/or corrective actions to be taken and to adjust resource allocation. The refugees' health status should improve as public health services start to function adequately and the refugees adjust to their new environment.

20. However, a vigilant surveillance system must be maintained. Seasonal changes will affect health (for example temperature changes, and especially the rainy season) so seasonal variations in the incidence of disease will remain. The UNHCR Health Coordinator and her/his counterparts in the government and other partners will be responsible for the quality of this surveillance, the data required, who will interpret it and how to ensure action on the results and feed-back to all actors.

Mortality

21. The most important and specific indicators of the overall status of the refugee population are the Crude Mortality Rate (CMR), for the whole population and Under-5 Mortality Rate (U-5MR) for children under five years of age. These indicators are of crucial importance to managers of the operation and are also of great interest to the media, donors and relief agencies. A priority for the health surveillance system is to produce reliable information on death rates.

22. During the emergency phase, mortality rates should be expressed as deaths/10,000 persons/day so that sudden changes can be detected.

Crude Mortality Rate is

deaths/10,000/day.

This is calculated as follows:

23. The objective of the overall assistance programme in the emergency phase should be to achieve CMR of <1/10,000/day and U-5MR of <2/10,000/day as soon as possible. These rates still represent approximately twice the "normal" CMR and U-5MR for non-displaced populations in most developing nations and should not signal a relaxation of efforts.

24. Age and sex-specific mortality rates have to be collected systematically and may indicate the need for targeted interventions. Table 1 below shows some benchmarks against which the daily Crude Mortality Rate (CMR) can be compared. Under-5 Mortality Rate benchmarks are usually twice the CMR.

Table 1 - Crude Mortality Rate Benchmarks

Average rate
in most developing
countries

0.5
deaths/10,000/day

Relief programme:
under control

<1.0
deaths/10,000/day

Relief programme:
very serious
situation

>1.0
deaths/10,000/day

Emergency:
out of control

>2.0
deaths/10,000/day

Major catastrophe

>5.0
deaths/10,000/day

Morbidity (incidence and types of disease)

25. Knowing the major causes of illness and the groups at greatest risk helps efficient planning of intervention strategies and the most effective use of resources. Morbidity incidence is the number of new cases of a given disease among the population over a certain period of time, usually expressed per 1,000. It is more useful to follow this than to keep a simple tally of cases, as trends can be followed over time, or compared with other situations. Morbidity incidence should be recorded as set out in Tables 3.1 and 3.2 in Annex 1.

Main Health Programmes

· The main causes of death and diseases in emergency situations are measles, diarrhoeas (including cholera), acute respiratory infections, malnutrition and malaria (where prevalent). Priority should be placed on programmes to reduce the negative impact of these diseases;

· Other causes of morbidity include tuberculosis, meningitis, vector-borne diseases, sexually transmitted diseases including HIV/AIDS, pregnancy and obstetric3 complications, and childhood vaccine-preventable diseases;

· The emotional stress of displacement, often compounded by harassment, violence and grief suffered by the refugees will combine to deplete their physical and emotional reserves and reduce their natural resistance to diseases;

· Experience underlines the importance of meeting the reproductive health needs of refugees, and most particularly of women and adolescents;

· Early emphasis should be placed on correcting environmental factors which adversely affect health.

3 Obstetrics: the branch of medicine concerned with childbirth and the treatment of women before and after childbirth.

Curative care

26. The peak of curative medical care is at the early stage, when refugees are most vulnerable to their new environment with the health hazards it poses and before it has been possible to achieve any major public health improvements. Even though curative care alone will not meet the objective of reducing excess loss of lives, it will create confidence among the refugees towards the health services.

27. Appropriate diagnosis and treatment protocols of major diseases must be defined in accordance with national protocols, if they are suitable to the refugee context. There may be some exceptions to this rule, but implementation of refugee specific protocols should always be previously agreed upon with national authorities.

28. Remember to take into account deaths occurring outside the health care system. A commonly documented error, committed by even excellent clinicians who have become absorbed in a health facility, is to fail to notice that cemeteries are being filled by refugees dying in their shelters, without having been identified or referred to receive appropriate curative services.

Immunization

29. Measles has been documented as being responsible for excess loss of lives, particularly but not exclusively among children under five years of age.

Immunization against measles for young children is the only essential immunization in the early stages of an emergency.

UNHCR advocates the immunization of children from 6 months up to 12 or even 15 years (rather than the more usual 5 years) because of the increased risks from the living conditions in refugee emergencies.

30. The decision as to whether or not to undertake a measles vaccination campaign at the onset of an emergency should be the responsibility of an expert. The campaign should ideally be associated with, but not delayed by, distribution of Vitamin A. The decision will be based on the vaccination coverage reported in the country and area of origin and its reliability, and whether there has been a recent epidemic or vaccination campaign. If there is a need for a measles vaccination campaign, it should not be delayed until other vaccines are available, and it should have appropriate mechanisms to ensure new arrivals are vaccinated. The provision of vaccines should be discussed with UNICEF (see the MOU between UNICEF and UNHCR, Appendix 3).

31. There are strong reasons, both medical and organizational, not to have a mass immunization programme with all vaccines. The most common causes of disease and death in the emergency phase cannot be cured or prevented by immunizations (except measles). Mass immunization programmes require a large number of workers, and vaccines need careful handling and controlled, refrigerated conditions. Therefore undertaking such a campaign may represent a misuse of time and resources in an emergency.

32. As soon as the emergency has stabilized there should be a complete Expanded Programme of Immunization (EPI), which should form an integral part of the ongoing long-term health programme. A standard EPI includes diphtheria, pertusis and tetanus toxoid (DPT), oral polio (OPV), and BCG (Bacille Calmette-Guerin) vaccines as well as measles. However, there should not be a vaccination campaign against any of these (apart from measles), nor should there be a complete EPI, unless the following criteria are met: the population is expected to remain stable for at least 3 months; the operational capacity to administer vaccine is adequate, and the programme can be integrated into the national immunization programme within a reasonable length of time (see the MOU between UNICEF and UNHCR, Appendix 3).

33. It is essential that adequate immunization records be kept. At the very minimum, personal immunization (or "Road to Health") cards should be issued. In addition, an independent central register of all immunizations is desirable, to enable analysis of vaccination coverage.

Communicable Disease Control

· Emergency conditions, particularly overcrowding, poor sanitation etc. will facilitate the spread of communicable diseases;

· The aim is to prevent, detect, control and treat diseases;

· Refugees are at greatest risk if they are exposed to a disease against which they have not acquired immunity (e.g. measles, malaria etc.);

· Communicable disease outbreaks require an immediate on-the-spot expert investigation and close coordination of the response with the national authorities, WHO and partners as appropriate.

34. The main causes of death and morbidity among refugees in emergencies are:

i. Measles,

ii. Diarrhoeal diseases,

iii. Acute respiratory infections,

iv. Malaria (where prevalent).

Moreover, the interaction between malnutrition and infection, particularly among young children, contributes to increased rates of mortality.

Other communicable diseases - meningococcal meningitis4, tuberculosis, sexually transmitted diseases (STDs), hepatitis, typhoid fever, typhus and relapsing fever - have also been observed among refugee populations. However, the contribution of these illnesses to the overall burden of disease among refugees has been relatively small.

4 See World Health Organization. Control of Epidemic Meningococcal Disease: WHO Practical Guidelines, 1995.

Diarrhoeal Diseases

35. Diarrhoeal diseases represent a major public health problem and acute epidemics of shigellosis (causing bloody diarrhoea dysentery) and cholera, have become common in refugee emergencies and have resulted in excess loss of lives. In risk areas, it is essential to set up appropriate preventive measures as soon as possible. These measures include:

i. Adequate supply of potable water and an appropriate sanitation system;

ii. Provision of soap and education on personal hygiene and water management;

iii. Promotion of food safety and breast-feeding;

iv. Reinforced home visiting and early case detection;

v. Identification of an area ("cholera management unit") to manage patients with cholera in case an epidemic occurs.

36. It is not possible to predict how a cholera outbreak will develop. If proper preventive measures are taken less than 1% of the population should be affected. Usually however, 1 to 3% are affected but in extreme cases it can be more-even as much as 10%.

37. To be prepared to respond quickly to an outbreak, the above preventive measures should be accompanied by the establishment of appropriate protocols on case management. These protocols should be based on National or WHO protocols and should be founded on rehydration therapy, continued feeding and appropriate antibiotics (especially for shigellosis5). In addition, there should be a reliable surveillance system for early detection of cholera cases, to follow trends and determine the effectiveness of specific interventions.

38. A significant amount of material, financial and experienced human resources are likely to be needed to respond to a cholera outbreak and reduce the case fatality rate.

39. To facilitate an immediate response, cholera kits can be obtained from the Supply and Transport Section at Headquarters at short notice. Each kit can cover the overall management of some 500 cases. No efficient vaccine to prevent cholera outbreaks is as yet available.

5 See World Health Organization. Guidelines for the control of Epidemics due to Shigella Dysenteriae Type 1, 1995.

Measles

40. WHO has classified refugees and displaced populations, especially in camps, as groups at highest risk for measles outbreaks. Indeed, this disease has been devastating in many refugee situations. Measles vaccination coverage should be as close as possible to 100%, if not, measures should be taken immediately to control the situation (see the MOU between UNICEF and UNHCR, Appendix 3, and paragraphs on immunization above).

Malaria

41. Malaria can also pose major problems. Its appropriate management and control is also a matter for experts and is based on the following:

i. Early case detection and appropriate treatment. It may be necessary to study drug resistance;

ii. Preventative treatment (chemoprophylaxis) particularly for pregnant women;

iii. Elimination of vector breeding sites;

iv. Vector control, including the distribution of insecticide-impregnated mosquito nets and periodic spraying, as indicated.

42. Chemical control measures such as spraying, or impregnated mosquito nets, may seem quite attractive but should only be taken upon expert advice as several factors must be considered such as: the habits of the refugees, seasonal variations, mosquito biting habits, transmission levels, national protocols about chemicals and registered lists of chemicals, and cost. Please see chapter 17 on environmental sanitation for guidance on vector control.

Acute Respiratory Infections

43. Pneumonia is the acute respiratory infection that has been documented as a cause for excess mortality, most particularly in the under five population. It is therefore essential to make sure that refugees are provided with adequate shelter and blankets as soon as possible. Health staff must be appropriately trained to diagnose and treat respiratory infections.

44. The more common diseases are outlined in table 2 below which illustrates the environmental impact on disease and indicates those improvements in living conditions which will bear directly on the health of the refugees.

Table 2 - Common diseases

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
12 on site planning
· immunization of children with distribution of vitamin A.
Immunization from 6 months up to 12-15 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 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 en-
demic 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 pro-
tection against the spread of the disease

Worms
especially
hookworms

Overcrowding
Poor sanitation

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

Scabies6

Overcrowding
Poor personal hygiene

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

Xerophthalmia
Vitamin A
deficiency

Inadequate diet
Following acute prolonged
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
· availability of condoms
· treat partners

6 Scabies: skin disease caused by burrowing mites

Reproductive Health7

7 See: United Nations High Commissioner for Refugees. An Inter-agency Field Manual on Reproductive Health in Refugee Situations, 1995.
UNFPA have developed a set of reproductive health kits which can be used as part of a programme to deal with reproductive health problems and the Health and Nutrition Unit or the Supplies and Transport Section at Headquarters should be contacted for details.

45. Reproductive health care in refugee situations should be provided by adequately trained and supervised staff and should be guided by the following principle:

Reproductive health care should be available in all Situations and be based on refugee, particularly women's, needs and expressed demands. The various religious, ethical values and cultural backgrounds of the refugees should be respected, in conformity with universally recognized international human rights.

46. The provision of quality reproductive health services requires a collaborative effort by a number of sectors (health, community services, protection, education) and organizations, which should provide reproductive health services based on their mandates.

47. While resources should not be diverted from addressing the problems of the major killers (measles, diarrhoeal diseases, acute respiratory infections and malaria), there are some aspects of reproductive health which must also be dealt with in the initial phase of an emergency. The major objectives of reproductive health care in an emergency are to:

i. Prevent and manage the consequences of sexual violence;

ii. Decrease HIV transmission by respecting universal precautions8 and guaranteeing the availability of free condoms;

iii. Prevent excess neonatal and maternal morbidity and mortality by providing clean home delivery kits, ensuring clean and safe deliveries at health facilities and managing emergency obstetric complications by establishing a referral system;

iv. Plan for provision of comprehensive reproductive health services, integrated into Primary Health Care, as soon as possible;

v. Identify a person responsible to coordinate reproductive health activities under the responsibility of the overall health coordinator.

48. As soon as feasible, when the situation has stabilized, comprehensive reproductive health services based on the needs of refugees should be put in place. These services should be integrated within the primary health care system and should address the following aspects:

8 "Universal precautions" means procedures and practices by health workers to limit transmission of disease.

Safe Motherhood

49. This should cover antenatal care, delivery care and postnatal care. All pregnant women should receive antenatal care services during pregnancy. All deliveries should be accompanied by a trained health care provider. A referral system to manage obstetric emergencies should be put in place. Within the first 4-6 weeks, mothers and their new babies should visit the health services and receive nutritional supplements, counselling on child spacing, and education about breast-feeding and infant care.

Prevention and Response to Sexual Violence

Please refer to chapter 10 on community services.

Sexually Transmitted Diseases including HIV/AIDS9

50. Experience shows that HIV spreads fastest in conditions of poverty and social instability - conditions which typify refugee emergencies. The priority should be on preventing HIV transmission: ensure there is respect for universal precautions and work closely with the community to promote HIV prevention strategies including condom education and distribution. Where blood transfusions are provided, ensure they are safe. Treatment of sexually transmitted diseases should be a routine part of the health services and should include appropriate follow up of partners.

Mandatory HIV testing in refugee circumstances, with the single exception of testing blood for transfusion, is not justified, and WHO has determined that, as a matter of policy, such testing should not be pursued.

9 United Nations High Commissioner for Refugees, UNAIDS and WHO. Guidelines for HIV Interventions in Emergency Settings, 1996.

Family Planning

51. Family planning services should be initiated as soon as feasible. Ensure that the refugees are informed and understand their free choice in the matter.

Other Reproductive Health Concerns

52. Women who have complications such as spontaneous or unsafe abortion should be cared for by the referral system.

53. Programmes to eradicate harmful traditional practices including female genital mutilation should be implemented once the situation has stabilized. It is crucial to work closely with the refugee community in tackling this issue10. Culturally appropriate sanitary supplies should be distributed to women as soon as possible. Inadequate sanitary protection may prevent women from collecting material assistance.

10 See IOM/FOM (83/97: 90/97), Policies on Harmful Traditional Practices, UNHCR, 1997.

Reproductive Health and Young People

54. Health workers should pay particular attention to meeting the reproductive health needs of young people as they may be at greater risk and have more limited access to appropriate services.

55. It is important to ensure that sufficient female health workers are trained in reproductive health in order to provide culturally appropriate health services including education in the community and at the health facilities. At least some of these health workers should be recruited from among the refugee community.

Tuberculosis control11

56. The prevalence of Tuberculosis (TB) has significantly increased in recent years worldwide, but a TB control programme is not a priority in the early stages of an emergency when mortality and malnutrition rates are very high.

57. Expert advice and involvement of the National TB control programme (often supported by WHO) are needed before starting a TB programme. Bad planning and poor implementation could result in more harm than good.

58. To increase the chances of success, TB programmes should only be started in stable situations, when Directly Observed Therapy12 can be implemented, when funds, drugs, reliable laboratory services and trained staff are available.

11 World Health Organization and United Nations High Commissioner for Refugees. Guidelines for Tuberculosis Control in Refugees and Displaced Populations, 1996.

12 Directly Observed Therapy is where the health worker is able to observe the treatment including that the medication is taken correctly.

Mental Health13

59. The psychosocial needs of refugees have often been neglected or even forgotten. However, health services should aim to promote the highest standard of both physical and mental health. It is easy to recognize that there is a heavy burden placed upon refugees from, for example, physical violence, grief and bereavement, fear and stress, an uncertain future and a sense of powerlessness.

60. Experience in identifying and dealing with the psychosocial problems of refugees (including Post Traumatic Stress Disorders) is limited, even so the following general guidance can be given. Any programme dealing with mental health must be community-based with the refugees themselves playing a major role. The programme must be based on a solid knowledge and understanding of the refugees' cultural background and integrated with the other services provided to refugees, and, from the outset, its long term sustainability must be ensured.

13 World Health Organization and United Nations High Commissioner for Refugees. Manual of Mental Health of Refugees, 1996.

Capacity building

Health Education

61. The importance of health education is widely recognized. However, there are significant difficulties in persuading those most at risk to change long-established habits.

In the emergency phase, the priority topics should be those directly related to the immediate public health problems.

62. Health education should therefore focus on the disposal of human excreta and refuse, water management and personal hygiene. Many governments and organizations produce simple health education materials that may be useful. Trained refugee teachers and respected elders are likely to be more effective than outsiders in communicating the basic principles and practices of health to their own people. At a later stage, information, education and communication should also be a major tool for the prevention and reduction of sexually transmitted diseases including HIV.

Training

63. As suggested by the definition of "emergency", extraordinary mobilization of resources, including human, will be needed to cope with the situation. Annex 2 sets out a suggested structure of the health service and numbers and qualifications of staff needed. Full staff support including community health workers, and health workers, doctors and nurses at health centres, health posts and clinics, with the necessary qualifications and experience, will not be instantly available.

Training will therefore be a cornerstone of an effective health and relief programme.

64. Training activities must be well targeted to meet the objective of the programme, and this is dependent on definition of roles and responsibilities among various levels of health care and identifying the necessary qualifications. Training must be part of the main health programme.

Medical supplies

65. There must be a policy on essential drugs. The aim of the policy will be to ensure a supply of safe, effective and affordable drugs to meet priority needs of the refugees. The Health and Community Development Section and the Supply and Transport Section at Headquarters issued an essential drugs list which is used to order drugs for UNHCR operations.

66. In order to foster the appropriate use of drugs, standard treatment protocols should be established. This will help rationalize prescription habits among the various partners and organize training activities. Protocols are usually based on national standards.

67. In the early stage of an emergency, it is often useful to resort to pre-packaged emergency health kits. The best known is the New Emergency Health Kit which has been developed through collaboration among many agencies (WHO, UNICEF, MSF, ICRC, UNHCR and others). The contents of the kit are intended to cover the needs of 10,000 people for 3 months during an emergency. The kit can be obtained at short notice through the Supply and Transport Section at Headquarters and can be used at the community level of health care and at health centres. The emergency health kit should only be used in the early stage of an emergency and not relied on for longer term needs.

68. As soon as possible, arrangements should be made for a regular supply of appropriate quantities of essential drugs from the UNHCR essential drugs list. The requests should be based on epidemiological surveillance and disease patterns. The Supply and Transport Section can also provide support for the purchase of drugs and their transport to the field.

69. It is of utmost importance to establish a system to monitor drug consumption. In major operations, a full time pharmacist may be needed to work with UNHCR. Over-prescription of medicines by health workers following pressure by refugees is not uncommon in refugee emergencies.

70. Donations of unsolicited drugs are often a problem during emergencies. A number of agencies (UNDP, UNHCR UNICEF, WHO, MSF and others) have jointly developed guidelines on drug donations14 that provide donors and users with a list of drugs and supplies which can be sent to emergency situations. This is to help ensure that personnel in the field do not waste time sorting out "useless" donations (small quantities of mixed drugs, free samples, expired medicines, inappropriate vaccines, and drugs identified only by brand names or in an unfamiliar language). UNHCR's policy is that overseas medical supplies should be sent only in response to a specific request or after expert clearance. The WHO Representative, local diplomatic missions and all others concerned should be briefed accordingly.

14 WHO, Guidelines for Drug Donations, May 1996.

Laboratory Services

71. Refugees are often remote from laboratory facilities. However, very simple laboratory services at the site level are usually adequate.

72. Reference laboratory services are required for epidemic management and control, (e.g., meningitis, shigellosis, cholera, hemoragic and relapsing fevers, high malarial endemicity, hepatitis etc.) to confirm/clarify diagnosis and perform antibiotic sensitivity. This should be discussed with the national authorities and WHO. Where blood transfusions are provided, laboratory services will be absolutely essential to test all blood for HIV before transfusion.

Organization of Refugee Health Care

· There is no single model for organizing health services in refugee situations, but it is usually structured on three levels: community health posts and clinics, health centres, and referral hospitals;

· It is of the utmost importance to ensure good communication and feed-back between the various levels of health care;

· Priority should be given to using host country health facilities as referral centres and support should be agreed upon and provided to the facilities (see MOU between WHO and UNHCR, Appendix 3).

Introduction

73. The three levels of health care are summarized in Annex 2. The first level is at the community level with health posts, clinics and outreach services. At the second level is a health centre with basic facilities for out and in-patients departments, dressing and injections, a pharmacy, and a basic laboratory. At the third level is a referral hospital for emergency obstetric care and surgery, management of very complicated cases, performance of laboratory tests etc. Referral hospitals are usually national facilities at the district, regional or national level.

74. The refugees must have easy access to appropriate treatment. If the local national health facilities cannot be strengthened to meet the needs, alternative arrangements will be required. Unless treatment is provided at the right level, the hospitals or health centres will be swamped by refugees demanding treatment for simple conditions. Thus, a community-based health service is required that both identifies those in need of health care and ensures that this is provided at the appropriate level. Close coordination with community services is essential.

Community Level Health Care

75. Whether refugees are in camps or spontaneously settled among local villages, community level services are essential.

Community-level health care must be the mainstay of health services from the very beginning of the emergency.

76. This means basic health care is to be delivered at the community level in a decentralized manner with two components: (i) a peripheral clinic/health post and (ii) outreach services delivered by Community Health Workers (CHWs) and Traditional Birth Attendants (TBAs). TBAs might be recruited among traditional midwives in the community. In order to be effective, CHWs and TBAs must be trained, supported and closely supervised. The role of CHWs and TBAs includes:

i. home visiting, identification and referral of sick people and malnourished children;

ii. identification of pregnant women and referral for antenatal, delivery and post natal care;

iii. basic health education;

iv. data-gathering for the health information system (deaths and their causes and the incidence of major communicable diseases);

v. responding to the needs of refugees who have been sexually assaulted.

As a guide, 1 CHW per 1,000 population and 1 TBA per 3,000 population should be the goal. Ideally, 50% of those trained should be women as same sex care is often preferred.

77. The clinic or health post will cater for the needs of approximately 5,000 refugees in crowded conditions but otherwise in reasonably good health. This should be a simple building with facilities for consultation, basic curative care (drugs from the New Emergency Health Kit), oral rehydration therapy, clinical procedures such as dressings (but not injections because of the risks of HIV transmission), a small lock-up pharmacy, simple equipment and sterilization facilities (electricity may not be available), data collection (log books to record patients and activities). Water and sanitation are essential in all health facilities.

The Health Centre

78. In support of the clinics/health posts, there should be a health centre for each refugee settlement (approximately 10,000 to 20,000 people). Very large settlements may require more than one. The health centre should be able to handle all but the most complicated medical, obstetric and surgical cases. More facilities should be available than at the clinics, including basic laboratory services, a central pharmacy and some beds for in-patients, in the range of one per 2,000 to 5,000 refugees. The health centre should collect and consolidate health information from the various clinics and health posts. The health centre should also organize the main health programmes (EPI, reproductive health, tuberculosis) and the supervision and training of staff (at both first and second level).

79. An indication of the number and qualifications of health staff required is given in Annex 2.

Referral Services

80. The health centre must be able to refer patients to hospitals for treatment. Referral hospitals should provide emergency obstetric and surgical care, treatment for severe diseases, laboratory and x-ray services as well as supply and support for nationally controlled programmes (TB, leprosy, HIV/AIDS).

81. Only a small proportion of patients will require referral services. These services will usually be organized in national health facilities at the district, regional or national level, and ideally, referral should be made to the nearest national hospital. This has obvious advantages, not least the fact that the infrastructure already exists.

The programme should compensate the national referral structures for services provided to refugees.

82. The hospital(s) should be expanded or supported as necessary, for example with tents and additional health personnel as well as some financial and/or material support (drugs, supplies, food). Care must be taken not to swamp the local hospital. Close and direct coordination with the district or regional medical officer is essential.

83. An agreement should be signed between the parties, under the aegis of the Ministry of Health, which clarifies the conditions of assistance including cost per patient per treatment and in kind support (food and drugs). A written agreement is essential to avoid controversies.

84. It is only in certain circumstances that special refugee hospitals will need to be established, but generally this should be avoided. They should only be established when the needs cannot be met by existing or strengthened national hospitals, for example when refugee numbers are very large (much larger than the local population), when the nearest national hospitals are too far away, or for security reasons. The Supply and Transport Section and the Health and Community Development Section should be consulted prior to establishing or acquiring refugee specific field hospitals.

85. Whatever arrangements are made for hospital treatment and referral, there must be suitable transport to and from the referral hospitals. Facilities at the hospital must also provide for the needs of relatives and allow parents to be with young children.

86. Arrangements for referral must be such that only those patients specifically referred from the health centres are attended, with no refugees presenting themselves directly to the hospital.

87. Refugee emergencies are not usually characterized by large numbers of injured persons. However, when this is the case, there may be an initial requirement for the rapid deployment of a surgical unit which is normally quickly available. Pre-packaged (expensive) surgical kits can be obtained through Supply and Transport Section at short notice.

88. The UNHCR Health Coordinator should ensure that there is a system to record referrals and subsequent treatment and follow-up of the patients.

Human Resources and Coordination

· The health services must be developed with and not just for the refugees and in accordance with their needs and demands;

· The early appointment of a suitably experienced health coordinator to UNHCR's staff has proved essential. A reproductive health focal point should also be identified as early as possible;

· While the use and development of local expertise is preferable, it is often necessary to mobilize outside assistance in an emergency;

· The issue of staff salary and incentives should be discussed and solved from the outset;

· The Ministry of Health at all levels must be as closely involved as possible.

The Refugees

89. The refugees must be given responsibility for their own health. Outside health workers must understand the refugees' own concepts of health and disease. From the beginning, health services should be developed and operated with, rather than for, the refugees. If not, the services will be less effective, may be distrusted and poorly used, and are unlikely to be sustainable.

90. Preventive services should always be free. In most situations, other health services are also offered free of charge. While this may well be justified, it should not be considered as a policy as it is often based on paternalistic attitudes. The issue of cost-recovery or payment for services should be regularly analyzed and most particularly when refugees are integrated within the local population (which may have to pay for services) or when refugees are benefiting from local integration and sources of income.

Staffing Needs

91. As a general principle, the order of preference for selecting health personnel, in cooperation with the national authorities, is:

i. Refugees;

ii. Experienced nationals or residents;

iii. Outsiders.

Most emergencies will require some combination of these sources.

92. Strong emphasis should be placed on the training, supervision and upgrading of medical skills of selected refugees, particularly in their former roles within the community. When selecting refugees, care must be taken to include women who may not come forward as readily as men. Full account should be taken of the experience of the traditional healers and midwives. Refugees may seek traditional treatments and experience has demonstrated the advantages of encouraging traditional methods of health care which complement other organized health services.

93. An important consideration may be the government's attitude to foreign medical personnel, including, for example, recognized qualifications and permission to practice medicine.

94. The issue of staff salary and incentives should be addressed at the onset. All agencies and organizations involved in the refugee programme should adhere to the same standards. The determination of salaries and incentives should be based on the national (or country of origin) standards and due account should be taken of assistance (free food, water, shelter etc.) received by refugees. In principle, all staff performing work on a daily basis, with clearly identified responsibilities and strict working hours, should receive a salary or an incentive.

95. Special attention should be given to the recruitment of local staff. The salary or incentive offered to them should be in line with national standards. Very frequently, refugee emergencies attract national personnel (commonly referred to as "brain drain") at the expense of national services which can create serious tension.

The National Health Authorities

96. Early involvement of the host government's central, provincial, and district health services is essential. To the extent possible, services provided to refugees should be integrated with national services. It will be particularly important to ensure integration and compatibility with certain treatment protocols, immunization programmes, communicable disease control and surveillance practices. Promoting good health for the refugees is clearly in the interest of the local population. In addition, supporting existing structures will help ensure that health services for refugees are sustainable and are at a standard equivalent to that of the host country nationals.

UNHCR Health Coordinator

97. In major emergencies, (e.g. when there is a prevalence of epidemics, many partners, large numbers involved) UNHCR must ensure that a Refugee Health Coordinator is appointed. The Health Coordinator should be a key member of the UNHCR programme staff. The person should take the lead role in this sector, or play a key supporting role to the national institution which takes the lead role.

98. The Health Coordinator's primary responsibility will be to ensure that the level and quality of services provided adhere to nationally and internationally accepted standards and medical ethics.

Other main tasks and duties include:

i. Participating and facilitating the consultation process among all concerned parties in order to carry out an appropriate problem, needs and resources assessment;

ii. Participating in, and facilitating the creation of, health and nutrition committees with the Ministry of Health, other UN agencies and non-governmental organizations (NGOs) where coordination will take place to jointly identify priority activities, and to plan for their implementation by defining needed human, material and financial resources;

iii. Facilitating cooperation among all partners to ensure an appropriate implementation and monitoring of the programme as agreed upon at the coordination committee meetings;

iv. Setting up and participating in the implementation of an effective Health Information System;

v. Ensuring that joint protocols for medical treatment, staffing and training are established and that implementing partners adhere to them;

vi. Ensuring the identification of a qualified and experienced person to coordinate reproductive health activities at the start of the relief programme;

vii. Facilitating inter-sectoral coordination;

viii. Consolidate the reporting about the refugees' health and nutritional status;

ix. Assisting in setting up a medical evacuation plan for UNHCR staff.

99. Experience shows that it is in the first days and weeks of an emergency that excess mortality is recorded.

It is therefore vital that a UNHCR Health Coordinator is fielded immediately, at the very start of the emergency.

100. The quickest and most practical way to deploy a Health Coordinator is usually to send UNHCR staff or consultants. Headquarters should be consulted immediately on this. At a later stage, posts can be created or staff seconded from other UN agencies (UNICEF or WHO), or from the Ministry of Health.

Other Specialized Staff

101. The need for specialized staff should be carefully assessed by the UNHCR Health Coordinator or by the Health and Community Development Section at Headquarters. Such specialists include epidemiologists, specialists in public, reproductive and mental health, nutrition, tropical medicine, paediatrics, midwifery, pharmacy etc.

Experienced personnel with the right personality are more important than highly trained Specialists, whose skills are often inappropriate.

102. Familiarity with the local culture, patterns of disease and the public health services and previous experience in emergencies are as important as an advanced knowledge of medicine and medical techniques.

Role of the UN and Specialized Agencies

103. WHO. The World Health Organization works directly with the Ministry of Health in almost every country in the world. The response to the health needs of the refugees and surrounding local populations should be closely coordinated with WHO. Details of this collaboration are described in the WHO and UNHCR Memorandum of Understanding, Appendix 3.

104. UNICEF. Collaboration with UNICEF in emergencies will focus on supply of measles vaccines and delivery/midwifery kits, as well as on health education (see Memorandum of Understanding between UNICEF and UNHCR for more details, Appendix 3)

105. UNFPA. Collaboration with UNFPA focuses on reproductive health matters and demography and there is a Memorandum of Understanding between UNFPA and UNHCR which details this collaboration, Appendix 3.

106. UNAIDS. UNAIDS is an inter-agency mechanism created in 1995 to support national HIV/AIDS programmes. Refugee health services must be integrated in these national programmes.

107. Through a standby arrangement with UNHCR, the Centre for Disease Control and Prevention (CDC Atlanta, USA) can supply, at short notice, experts for rapid health and nutritional assessment, improvement of epidemic preparedness and response in emergencies and set up Health Information Systems. Deployments are usually limited from four to eight weeks and can be arranged upon request through the Health and Community Development Section at Headquarters.

Role of NGOs

108. Operational and implementing partners are essential collaborators for UNHCR. All collaborators in the emergency health programme must be brought together to form health sub-committees at the central and field level as appropriate. Initially, these committees may have to meet daily or at least weekly, usually under the chairpersonship of a representative of the Ministry of Health, supported by the UNHCR Health Coordinator. Ideally, members of the committee should have been identified at the contingency planning stage.

109. Activities of the health sub-committee include: allocation of tasks, exchange and pooling of information on health activities and with other sectors (e.g. food, water, sanitation etc.), setting up jointly agreed protocols for medical procedures, staffing levels and training, and problem-solving in general.

110. In emergencies, urgent outside assistance in the health sector is almost invariably necessary. This is because the immediate and specialized attention needed represents a burden that existing local structures are not designed to bear. District health services will almost never have the needed reserve capacity in terms of staff at all levels, infrastructure, medical supplies and technical expertise. This capacity can be developed over time, with the support from the central government and other UN agencies.

111. NGOs (international, regional or national) must be chosen with care and this is usually done by the government of the country of asylum. However, it is also the responsibility of UNHCR to advise the government on which organizations have proven competence in emergencies. Some agencies have experience in long-term situations but less in emergencies; others may be too narrow in focus, preferring to do purely curative work to the exclusion of public health, prevention, sanitation etc.

112. Small NGOs, especially those created in response to a specific situation, should first demonstrate appropriate competence before being engaged in the emergency phase.

The number of agencies involved should be kept to a minimum.

113. During the early stages of an emergency it is essential that the numbers of NGOs involved should be kept to the minimum necessary, and that those chosen should be professional, capable of deploying experienced personnel and with proven past experience in collaborating with both governments and UNHCR in the effective management of an emergency.

Organization of Response

114. A possible hierarchy of health services is outlined in Annex 2. It is based on a large-scale emergency involving a great number of health staff, both national and international. A smaller emergency will require fewer levels of organization. Note that the numbers and qualification of staff suggested is no more than an indication. Actual needs will depend on the health problems, the degree of isolation of the area and so on.

115. Once the pattern of disease and overall needs have been determined, situation-specific guidelines on standard procedures for health workers should be prepared, based on national or internationally recognized standards. These should cover all aspects of the services, including such subjects as basic principles, how the services are to be organized, including any selective feeding programmes, standardized treatment protocols, drug lists and supply, vaccination and reporting. The guidelines should be prepared by the UNHCR Health Coordinator in consultation with all concerned, issued under the aegis of the Ministry of Health if possible, and reviewed periodically, for example by a health coordination sub-committee. At least part of the guidelines should be translated into the language of the community health workers.

All organizations providing health care to the refugees should be involved in the preparation and required to observe standard guidelines.

Key References

An Inter-agency Field Manual on Reproductive Health in Refugee Situations, 1995. United Nations High Commissioner for Refugees, Geneva. To be updated in 1999.

Essential Drugs Manual: Guidelines for the Use of Drugs in Refugee Settings and UNHCR List of Essential Drugs, Geneva, 1989.

Famine-affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues, July 24, 1992/Vol.41/No. RR-13. The Centers for Disease Control, (CDC).

Guidelines for Tuberculosis Control in Refugees and Displaced Populations, 1996 World Health Organization and United Nations High Commissioner for Refugees.

Guidelines for HIV Interventions in Emergency Settings, 1996 United Nations High Commissioner for Refugees, UNAIDS and WHO, Geneva.

Manual of Mental Health of Refugees, 1996 World Health Organization and United Nations High Commissioner for Refugees.

Sexual Violence against Refugees, Guidelines on Prevention and Response, 1995 United Nations High Commissioner for Refugees, Geneva.

UNHCR, IOMIFOM (83/97; 90/97), Policies on Harmful Traditional Practices, 1997 United Nations High Commissioner for Refugees, Geneva.

Vector and Pest Control in Refugee Situations, April, 1997 United Nations High Commissioner for Refugees, Geneva.

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

(introduction...)


Figure

Overview

Situation

In emergencies, food and nutritional security is often severely threatened. This causes increased risk of malnutrition, disease and death. Therefore, refugees will need partial or full food support. Some may also need nutritional rehabilitation.

Objective

To provide the refugees with sufficient quantities of appropriate food to maintain their health and nutritional status and, where necessary, to improve the condition of those who are already malnourished.

Principles of Response

· Measures to meet food needs should be appropriate and standardized, with responsibilities clearly defined, and the overall co-ordination ensured by a single organization;

· Whenever possible use familiar foods that meet nutritional requirements and maintain sound traditional food habits;

· The food distribution system should allow families to prepare their own meals;

· Pay particular attention to infant feeding and the needs of children, women and others prone to malnutrition;

· Maintain close co-ordination with the other vital sectors (health, water, environmental sanitation, etc.) and aim for maximum integration in existing services;

· Ensure the active involvement of a nutritionist.

Action

· Assess health and nutritional status and food needs as soon as possible;

· Ensure the availability of appropriate food and the necessary transport, storage, cooking fuel and utensils;

· Organize a general feeding programme for all refugees and, if necessary, selective feeding programmes to meet the additional needs of children, women and others;

· Monitor effectiveness of feeding programmes and make necessary changes.

Introduction

1. In an emergency, refugees may be completely dependent on external food sources. An initial assessment of their health and nutritional condition and their numbers must be made as soon as possible. The types of programmes needed will be determined by this initial assessment. Continuous monitoring of nutritional status will ensure that the emphasis on different programmes can be adjusted in order to reflect changing conditions.

2. The causes of malnutrition are often complex and multi-sectoral (see Fig 1). Therefore coordinating the food and nutrition programmes with health and other vital sectors is essential.

3. Assistance must be appropriate to the nutritional needs of the refugees and be culturally acceptable. Foods prepared locally with local ingredients are preferable to imported foods. Infant feeding policies require particular attention.

4. Certain groups are more at risk of malnutrition than others. These include infants, children, pregnant women and nursing mothers, the sick and the elderly. Special action is required to identify the malnourished and vulnerable and to meet their additional needs. Where the refugees have already suffered a prolonged food shortage, many will be malnourished by the time of the first assessment.

5. If the refugees are already suffering the effects of severe food shortage, immediate action must be taken to provide food available locally which is acceptable to the refugees.

6. If insufficient acceptable food is available locally, it must be brought in from outside, initially by air if necessary. Flexibility and improvisation will be required, and time may be needed to develop the full response set out in this chapter.

7. This chapter should be read in conjunction with "Nutrition Guidelines" Mcins Sans Frontis (MSF), 1995, and UNHCR/WFP Guidelines for Estimating Food and Nutritional Needs, 1997 and Selective Feeding Programmes, 1999.

Organization of Food Support

· The World Food Programme (WFP), the food aid arm of the United Nations system, shares with UNHCR responsibility for meeting the food and nutritional needs of refugees;

· The Memorandum of Understanding (MOU) signed between WFP and UNHCR establishes the division of responsibilities and coordination mechanisms for refugee, returnee and internally displaced persons feeding operations;

· The aim of the food programme is to ensure the restoration and maintenance of sound nutritional status through a food ration that meets the assessed requirements, is nutritionally balanced, palatable and culturally acceptable;

· In most refugee emergencies a UNHCR food and nutrition co-ordinator should be appointed, who will have overall responsibility for co-ordination of all aspects of the food and nutrition programme;

· The refugees, and in particular refugee women, must be involved in the organization of these programmes;

· Simple nutrition education is an integral part of effective food support.


Figure 1 - The Complex causes of malnutrition

Adapted form: UNICEF Conceptual Framework of Malnutrition, 1997.

WFP/UNHCR Co-operation

The objective of WFP/UNHCR co-operation is the timely provision of the right amount of food, to ensure the restoration and maintenance of sound nutritional status.

8. The means to achieve this is through a food ration that meets the assessed requirements, is nutritionally balanced, palatable, culturally acceptable, and promotes gradual self-reliance of the beneficiaries. Essential to this objective is joint UNHCR/WFP planning, from the start of the emergency.

9. A Memorandum of Understanding (MOU) (see Appendix 3) exists between UNHCR and WFP covering cooperation in the provision of food aid. Under the terms of the MOU, WFP meets the emergency food needs of refugees, returnees, and, in specific situations, internally displaced persons, and provides associated logistic support. The terms of the MOU only apply when the beneficiaries in the country of asylum number more than 5,000, irrespective of their country of origin or their location within the country of asylum. UNHCR will meet the food needs of persons of its concern who are outside the scope of the MOU.

10. Within the scope of the MOU, WFP has the lead responsibility for mobilizing the following food commodities (whether for general or selective feeding programmes) and the resources to deliver them.

WFP resourced commodities include:

i. Cereals;

ii. Edible oils and fats;

iii. Pulses and other sources of protein;

iv. Blended food;

v. Iodized salt;

vi. Sugar;

vii. High energy biscuits.

11. WFP is also responsible for arrangements for milling cereals and transporting WFP commodities to agreed extended delivery points (EDPs), and for the operation and management of the EDPs. UNHCR is responsible for the transportation of all commodities from the EDP to the final destination and for final distribution.

12. Under the MOU, UNHCR is responsible for mobilizing and transporting complementary food commodities and for the provision of the necessary micronutrients (vitamins and minerals) when they cannot be met through the ration.

UNHCR resourced commodities include:

i. Local fresh foods;

ii. Spices and Other condiments;

iii. Tea;

iv. Dried milk;

v. Therapeutic milk.

13. UNHCR and WFP have developed a common set of guidelines for estimating food and nutritional needs in emergencies and in selective feeding programmes2. These guidelines should be used to assess the food needs for both the general and selective feeding programmes.

Extended delivery Points (EDP)

An EDP is the location at which WFP hands over a consignment of food to UNHCR or its implementing partner. WFP is responsible for the consignment and all costs incurred in moving and storing it, until UNHCR or its representative collects it from the EDP. In all cases the location of EDPs must be agreed jointly by UNHCR and WFP.

EDPs should be positioned to give cost effective and logistically practical delivery, while avoiding the imposition of undue hardships on the beneficiaries because of travel distance and/or difficult access. Whenever possible the EDP should be at the same place as the final distribution point, or, if not, then as near as possible to it. An EDP should be established for approximately every 10,000 beneficiaries.

1 WFP/UNHCR Guidelines for Estimating Food and Nutritional Needs in Emergencies, UNHCR/WFP, 1997.

2 UNHCR/WFP Guidelines for Selective feeding Programmes in Emergencies, WFP, UNHCR, Geneva, 1999.

Joint Assessment and Planning

14. UNHCR and WFP should carry out a joint assessment of the overall food, nutrition and related requirements in consultation with government authorities, operational partners and experts.

The first requirement is a knowledge of the numbers, nutritional status and food habits of the refugees.

Assessing nutritional status is discussed in detail below. The joint UNHCR/WFP assessment for the food assistance programme should cover the following:

Basic Information

i. Numbers and demography (see chapter 11 on registration);

ii. Current nutritional status;

iii. Milling possibilities;

iv. Food commodity preferences of the beneficiaries;

v. Capacity of the family to prepare, store, and process the food;

vi. Access to cooking fuel, utensils and distribution containers;

vii. Food availability now and over time;

viii. Availability of local food for purchase;

ix. Ease of access to food supplies;

x. Groups at risk - identify who and how many;

xi. Degree of and prospects for self-reliance;

xii. Coping strategies.

Other Important Information

i. Health status and health services;

ii. Environmental health risks;

iii. Community structure;

iv. Food distribution systems;

v. Socio-economic status;

vi. Availability of human resources;

vii. Logistics constraints;

viii. Storage capacity and quality;

ix. Delivery schedule of food and non-food commodities;

x. Other agencies' activities and assistance currently provided: quantity, items and frequency, and selective feeding programmes.

15. WFP and UNHCR should draw up plans covering: the number of beneficiaries, the composition of the food basket, ration size, duration of assistance, and directly related non-food inputs which may have an impact on the nutritional status of the beneficiaries (for example, cooking utensils, cooking fuel and milling equipment).

16. The main considerations to take into account when responding to food and nutritional needs of refugees are set out in figure 1.

17. Special consideration should be given to the needs of women, children and groups-at-risk. The views of the beneficiaries, especially those of women, should be sought. The proposed food assistance programme should also take into account the need to minimize the environmental impact of cooking the food provided.

Coordination

18. A UNHCR coordinator should be appointed as focal point for food and nutritional issues. In smaller operations, either the programme officer or the logistics officer could be appointed as food coordinator. If technical expertize is not available initially within UNHCR then assistance should be sought from government nutritionists, UN agencies or NGOs.

19. The food and nutrition coordinator's responsibilities are to establish standard procedures, including procedures for general food distribution, coordinate feeding programmes, monitor and evaluate the feeding programmes, and ensure close coordination and integration with community services, health and other sectors. The coordinator should art as the focal point within UNHCR for coordination with WFP and NGO's. Where the food coordinator is not her/himself a nutrition specialist, an experienced nutritionist will also be needed to provide the food coordinator with the necessary technical advice.

Role of Refugees and Nutrition Education

20. The refugees must be involved from the start in the organization and management of the feeding programmes. Special training will be necessary for refugees.

21. The provision of simple nutrition education for the refugees is always necessary when unfamiliar foods or new methods of cooking cannot be avoided. This should be organized in conjunction with nutrition education activities and provide guidance on: proper infant feeding, feeding sick children, treating diarrhoea, basic food hygiene and preparing available foods for maximum nutritional benefit.

Cooking Fuel

22. Particular attention must be paid to the provision of cooking fuel and the control and management of the natural resources in the vicinity of the camp. Failure to deal with this can quickly lead to destruction of the vegetation in and around the site causing lasting damage to the environment, with direct effects on the health and well-being of refugees and local people and friction with the local population. Fuel needs and consumption vary considerably3-factors affecting the use of fuel include:

i. food preparation, cooking techniques, fuel type and preparation. Soaking beans prior to cooking, ensuring lids are used on pots, ensuring wood is dry and chopped, and that fires are put out after cooking - all these make considerable fuel savings and can be incorporated into environmental awareness raising and training programmes. Other steps to facilitate efficient fuel use are to ensure that the pots supplied have lids.

ii. type of stove. It may be possible to use local technology to modify existing types of wood or charcoal burning stoves in order to make them more fuel efficient. Simple improvements and local technologies are best. Note that the social and economic implications of a new technology are usually more important in determining whether it will be adopted than the effectiveness of the technology itself. The promotion and use of improved stoves must closely involve the refugees.

iii. type of food. Freshly harvested foods take less cooking time, also using milled rather than whole grain and using pre-cooked food make considerable fuel savings. The environmental implications of the food basket need to be taken into account with WFP.

iv. availability (or "price") of fuel itself. This is often the most significant factor affecting per capita fuel consumption. The provision of fuel wood and managing and controlling the use of natural resources around a refugee camp is discussed further in chapter 12 on site planning.

3 Average fuel-wood consumption per person per day in different refugee camps has varied from 0.9 kg to 4kg.

Nutritional Assessments

· The nutrition assessment should be carried out as soon as possible by an experienced nutritionist;

· Nutritional assessment should include anthropometric surveys as well as food security information;

· Regular assessment is necessary both to monitor the nutritional status of the community as a whole and identify individuals and groups who need special care and food assistance;

· Information must be gathered on mortality and morbidity in addition to malnutrition rates, in order to understand the underlying causes of malnutrition and to identify people who are most affected.

Introduction

23. An initial assessment of the nutritional status of the refugees should be made as soon as possible and should be carried out by an experienced nutritionist. The extent of malnutrition has important implications for what form the emergency response will take, and will enable early decisions to be taken on the components of the rations and on the requirement for any additional selective feeding programmes.

24. The nutritional assessment should be followed by regular nutrition surveys under specialist supervision to monitor the condition of the population as a whole.

25. Where conditions and/or results of the initial assessment or later surveys indicate a need for selective feeding programmes, individuals will need to be identified and registered for these programmes. Their individual progress should then be monitored through periodic measurements at the feeding centres.

26. The initial nutrition assessment and the periodic nutrition surveys of the population as a whole should be done by measuring the weight and height of a random sample of the child population (as explained below). Initially such surveys should be carried out every two to three months. When conditions have stabilized, once every six to twelve months is sufficient. Any change or trend in nutritional status can thus be detected and appropriate adjustments made in the assistance programmes.

There is a serious nutritional emergency where the malnutrition rate is either over 15%, or over 10% with aggravating factors (e.g. an epidemic). Such a situation requires I urgent action.

Recognizing and Measuring Malnutrition

27. Malnutrition can be recognized by clinical signs (such as oedema and micronutrient deficiencies) and by anthropometry (body measurements). Measurements such as weight-for-height are used as an objective assessment of nutritional status, which quantifies the nutritional situation at one point in time, and allows comparisons over time.

28. Mortality and morbidity information will assist in understanding the underlying causes of malnutrition and identify people who are most affected. Child mortality rates are particularly important.

In an emergency a high child mortality rate is very often associated with high levels of malnutrition.

Death rates among children who are severely malnourished can be about six to ten times greater than those who are healthy and well nourished in the same population.

29. Weight-for-height in children, is the best indicator to assess and monitor nutritional status of populations. The actual weight of a child is calculated as a percentage of the standard weight for a normal child of that height, or as a Z score. It is the most sensitive indicator of acute malnutrition and is preferred for nutrition surveys and for measuring individual progress in feeding programmes. It is usually young children aged between 6 and 59 months who are measured in nutrition surveys, because young children are the first to show signs of malnutrition in times of food shortage and are the most severely affected. When the ages of children are not known, 65 cm and 110 cm height are used as the cut off points instead of 6 and 59 months.

30. Body mass index (BMI) (Weight in kg)/ (Height in m)2, is used for assessing the nutritional status of adults by assessing the degree of thinness (see table 1).

31. Oedema is an essential nutrition indicator and indicates kwashiorkor (see Annex 3). Oedema is characterized by swelling in both feet due to an abnormal accumulation of fluid in intercellular spaces of the body.

32. Mid-upper-arm-circumference

The mid upper arm circumference (MUAC) is measured on the left arm, at the mid-point between elbow and shoulder. MUAC should only be used as part of a two-step screening exercise. In the first step the MUAC of children is measured. Those falling below a certain cut-off circumference are then channelled to weight-for-height measurement to determine their nutritional status and whether they should be included in selective feeding programmes.

33. Weight-for-age and height-for-age are not such useful assessment indicators in emergencies as age is often difficult to determine. This can be used for growth monitoring of individual children, and in assessing long-term (chronic) malnutrition.

Moderate and Severe Malnutrition

34. The standard cut-off points to describe malnutrition, are between 70% and 80% weight-for-height (or between -3 and -2 Z scores) for moderately malnourished and less than 70% weight-for-height (or < -3 Z scores) for severely malnourished.

Children with oedema are always classified as severely malnourished.

Table 1 summarizes the key malnutrition indicators.

Table 1: Key Nutritional Indicators*

Malnutrition

Children under 5 years

Adults BMI


Weight-for-
height (W/H)%
of median value4

Weight-for-
height (W/H) in
Z scores or SD’s5

MUAC


Moderate

70% to 79%

-3 to -2 Z

110mm to <125mm

16-17

Severe

less than 70%

less than -3 Z or oedema

< 110mm, oedema

less than 16

* Results expressed by different methods are not directly comparable

4 Percentage below the median "reference" weight-for-height values.

5 Standard deviations (SDs, or Z score) below the median "reference" weight-for-height values.

General Feeding Programme

· A mean figure of 2,100 kcal per person per day is used as the planning figure for calculating the food energy requirements of refugees in emergencies in developing countries6;

· Everyone in the population, irrespective of age or sex, should receive exactly the same general ration (i.e. same quantity and type of foods);

· The food basket should be nutritionally balanced and suitable for children and other groups at risk;

· Every effort should be made to provide familiar foodstuffs and maintain traditional food habits;

· The level of fat intake should provide at least 17% of the dietary energy of the ration. Protein intake should provide at least 10-12% of the total energy;

· The diet must meet essential vitamin and mineral requirements;

· Particular attention should be paid to locally prevalent nutrient deficiencies.

6 The Management of Nutritional Emergencies in Large Populations, WHO, Geneva, 1978.

General Ration

35. Every effort should be made to provide familiar foodstuffs and maintain sound traditional food habits. Expert advice on the ration size and composition is essential and should take full account of local availability of food commodities. Staple food should not be changed simply because unfamiliar substitutes are readily available. Inappropriate foods often lead to waste and lower the morale of the refugees.

36. The first concern is to ensure that energy and protein requirements are met. The planning figure for the average minimum daily energy requirement per person per day for a developing country population at the beginning of an emergency is 2,100 kcal. See Annex 1 for examples of rations which meet this requirement. This average requirement is calculated on an average population containing men, women and children of different age groups. However, a complete ration should be provided to each refugee without distinction.

A minimum requirement of 2,100 kcal per person per day is used as the planning figure for a developing country population at the beginning of an emergency.

A population which contains mostly active adults may require considerably higher average energy intakes. In addition, a higher ration is vital for survival in a cold climate.

37. The daily energy requirement can be adjusted when the situation has stabilized7 and detailed data is available. Factors to be taken into consideration are:

i. Age and sex composition of the population;

ii. Activity level;

iii. Climatic conditions;

iv. Health, nutritional and physiological status;

v. People's access to other food sources e.g. agriculture, trade, labour.

38. The food basket should comprise: a staple food source (cereals), an energy source (fats and oils), a protein source (legumes, blended foods, meat, fish), salt and possibly condiments (such as spices). Fresh foods should be included in the food basket for essential micronutrients. The level of fat intake should provide at least 17% of the dietary energy of the ration, and protein intake should provide at least 10-12% of the total energy.

39. When certain food commodities are not available, they can be replaced for a maximum of one month by other available food items in order to maintain the adequate energy and protein level. Substitution in energy value, should an item not be available, is:

Corn Soy Blend (CSB) for beans

1:1

Sugar for oil

2:1

Cereal for beans

2:1

Cereal for oil8

3:1

E.g. the energy from 20 g of sugar can substitute for that from 10 g of vegetable oil.

40. Cereal flour, rather than whole grain, should be provided, especially at the beginning of an emergency. Considerable fuel savings are made by using milled rather than whole grain. If whole grains are provided, local milling should be made available and the cost compensated for.

41. Essential vitamin and mineral requirements must also be met. The basic food commodities distributed through the general ration do not normally cover the required amounts of vitamins and minerals. Therefore, deficiencies often arise among populations entirely dependent on external food aid and within a population among vulnerable groups like infants, pregnant women and nursing mothers. Particular attention should also be paid to locally prevalent nutrient deficiencies.

42. The risk of specific nutrient deficiencies can be estimated from the composition of the general ration and access the population has to other food sources in the area. Possible options for providing vitamins and minerals are:

i. Provide fresh food products;

ii. Promote the production of vegetables and fruits;

iii. Add to the ration a food rich in a particular vitamin and micronutrient such as fortified cereals, blended foods, or condiments;

iv. Provide supplements in tablet form, which is the least preferred option.

43. Wherever possible the refugees should be encouraged to grow vegetables themselves: the production of fresh food by refugees not only improves and diversifies the diet but saves fuel and provides an opportunity to generate some income. Larger plot sizes and the provision of appropriate seeds would facilitate this, however, it can be difficult to encourage refugees to produce fresh food because of their uncertainty as to the length of their stay and problems of access to land.

7 See for further information: WFP/UNHCR Guidelines for Estimating Food and Nutritional Needs in Emergencies, 1997.

8 One way only, note that oil cannot be used in place of cereal.

Food Distribution

44. The need for a fair, efficient and regular food distribution cannot be over-emphasized. This is discussed in chapter 13 on commodity distribution. There are two main types of distribution: dry ration and cooked meals.

45. Dry food distribution (which is taken home) has major advantages over cooked food distribution. It allows families to prepare their food and to use their time as they wish, permits them to continue to eat together as a unit and is more culturally and socially acceptable. It also reduces the risk of the spread of infectious diseases.

46. Cooked meal distribution requires centralized kitchens with adequate utensils, water and fuel (the requirement is less than the amount required for family cooking), and trained personnel. The refugees usually sit together in a feeding compound, although in some circumstances families can carry the cooked meal to their accommodation. At least two meals must be served each day.

Cooked meals are much more difficult to organize efficiently than dry ration distribution, particularly for large numbers.

Cooked meal distribution to the whole population is therefore only provided under exceptional circumstances when the refugees do not have access to adequate water and/or cooking fuel and in insecure situations.

47. In addition to cooking pots, fuel and utensils, the refugees must have containers and sacks to protect and store their food rations. Oil tins and grain bags will be useful, and contracts with suppliers, at least for initial deliveries, should not require their return.

Monitoring the General Feeding Programme

48. The general feeding programme can be monitored by:

Food basket monitoring: Comparing the quantity and quality of food collected by the refugees at the distribution site on distribution days compared with the planned ration, Also by monitoring after the distribution at household level through house visits (on distribution day);

Discussing the quality and quantity of the rations regularly with the refugees;

Investigating complaints.

For more information on how to monitor the general food programme see UNHCR's Commodity Distribution: A Practical Guide For Field Staff, and MSF's Nutrition Guidelines.

Selective Feeding Programmes

· The objective of a selective feeding programme is to reduce the prevalence of malnutrition and mortality among the groups at risk;

· Selective feeding programmes provide extra food for the malnourished and at-risk groups - this food must be in addition to (not a substitute for) the general feeding programme;

· The programme must actively identify those who are eligible for the selective feeding programmes, using criteria described in this chapter.


Figure 2 - Response to food and nutritional needs

General Principles of Selective Feeding Programmes

49. Where malnutrition exists or the needs of the groups at risk cannot be met through the general ration, special arrangements are required to provide extra food. This is organized through different types of selective feeding programmes which take into account the degree of malnutrition and associated risks. In the emergency phase of an operation, selective feeding programmes are part of an emergency measure to prevent excess mortality. However, preventing excess mortality should be a combined strategy of selective feeding, public health and emergency health care. Ref. Figure 2.

The organization of these programmes should be integrated from the beginning with community and health services and especially with Mother and Child Health Care programmes (MCH).

50. Malnutrition develops particularly among infants, children, pregnant women, nursing mothers, the elderly and the sick. Their vulnerability stems from the greater nutrient requirements associated with growth, the production of breast milk, repair of tissues and production of antibodies. Malnutrition results in lower resistance to infection, which in turn results in further malnutrition. Small children are particularly susceptible to this cycle of infection and malnutrition. Sick children must eat and drink even if they do not have an appetite, are vomiting, or have diarrhoea. Because children are unable to eat a large volume of food, it is necessary to prepare food in a concentrated form (giving the required nutrients in less volume), and to provide more frequent meals.

51. Certain other groups or individuals may be at risk of malnutrition for social or economic reasons. These include unaccompanied children, the disabled, single-parent families, and the elderly, particularly those without family support. In some communities specific social or cultural practices and taboos may put constraints on meeting the nutritional needs of certain persons, for example pregnant women and nursing mothers or even sick children.

52. Even if the overall quantity of food is sufficient there may be other causes such as:

i. Inequities in the distribution system reducing access to food for certain groups;

ii. Inaccuracies in registration or unfair distribution of ration cards;

iii. Infections;

iv. Faulty feeding or food preparation habits.

Selective feeding programmes are not a substitute for an inadequate general ration.

53. The following types of selective feeding programmes are contemplated:

i. Supplementary Feeding Programmes (SFP)

a) Targeted SFP

b) Blanket SFP;

ii. Therapeutic Feeding Programmes.

To be effective, the extra ration provided must be additional to, and not a substitute for, the general ration.

Supplementary Feeding Programmes (SFP)

54. Targeted and blanket supplementary feeding programmes provide extra food to groups at risk, in addition to the general ration, as dry take-home or wet on-the-spot feeding for a limited period of time.

55. A targeted SFP aims to rehabilitate those who are moderately malnourished. These could be children adults or older persons and/or individuals selected on medical or social grounds, e.g. pregnant and nursing women and the sick. This is the most common type of supplementary feeding programme.

56. A blanket SFP provides a food (and/or micronutrient) supplement to all members of a certain vulnerable group regardless of their individual nutritional status in order to prevent a deterioration in the nutritional status of those groups most at risk (usually children under five, pregnant women and nursing mothers.

57. Supplementary feeding programmes can be implemented either by giving wet or dry rations.

Therapeutic Feeding Programmes (TFP)

58. A TFP aims to reduce deaths among infants and young children with severe protein-energy malnutrition (PEM). The forms of PEM are described in Annex 3. Generally the target group is children under 5 years with severe malnutrition. Therapeutic feeding can either be implemented in special feeding centres or in a hospital or clinic. TFP involves intensive medical and nutritional treatment. Therapeutic milk (TM) is used for treatment of severely malnourished children. However if TM is not available, high protein milk can be used (dried skimmed milk, oil and sugar) mixed with vitamin mineral supplements.

Starting a Selective Feeding Programme

59. The decision to start a selective feeding programme is based on the prevalence of malnutrition and other aggravating factors. Aggravating factors include high mortality (more than 1 person per 10,000 per day), measles epidemic, high prevalence of infectious diarrhoea, general ration below minimum requirements. The prevalence of malnutrition is assessed from the initial and ongoing nutrition assessments and surveys.

In all situations, remember that it is more important to address the root causes of malnutrition than to address symptoms through selective feeding programmes.

60. The effectiveness of these programmes will be severely compromised if an adequate general ration is not provided.


Figure 3 - Selective Feeding Programmes

61. Figure 3 provides guidance on deciding when to initiate selective feeding programmes. Clear criteria for the termination of these programmes should be defined from the beginning.

Identifying Those Eligible

62. Selective feeding programmes must be based on the active identification and follow up of those considered at risk. Beneficiaries can be identified by:

House to house visits to identify all members of a targeted group (e.g. children under five, elderly people);

Mass screening of all children to identify those moderately or severely malnourished;

Screening on arrival (for example with the registration exercise);

Referrals by community services and health services.

63. Table 2 below summarizes the main objectives, target groups and criteria for selection of beneficiaries of selective feeding programmes.

Table 2 - Types of Selective Feeding Progammes

Programme

Objectives

Criteria for selection and target group

Targeted SFP

· Correct moderate malnutrition
· Prevent moderately malnourished
from becoming severely
malnourished
· Reduce mortality and morbidity
risk in children under 5 years
· Provide nutritional support to
selected pregnant women and
nursing mothers
· Provide follow up service to
those discharged from therapeutic
feeding programmes

· Children under 5 years moderately malnourished:
- between 70% and 80% of the median
weight-for-height or:
- between -3 and -2 Z-scores weight-for-height
· Malnourished individuals (based on weight-for-height,
BMI, MUAC or clinical signs):
- older children (between 5 and 10 years)
- adolescents
- adults and elderly persons
- medical referrals
· Selected pregnant women (from date of confirmed
pregnancy) and nursing mothers (until 6 months after
delivery), for instance using MUAC <22 cm as a cut-off
indicator for pregnant women · Referrals from TFP

Blanket SFP

· Prevent deterioration of
nutritional situation
· Reduce prevalence of acute mal-
nutrition in children under 5 years
· Ensure safety net measures
· Reduce mortality and morbidity risk

· Children under 3 or under 5 years
· All pregnant women (from date of confirmed
pregnancy) and nursing mothers (until maximum
6 months after delivery
· Other at-risk groups

TFP

· Reduce excess mortality and
morbidity risk in children under
5 years
· Provide medical/nutritional
treatment for the severely
malnourished

· Children under 5 years severely malnourished:
- < 70% of the median weight-for-height and/or
oedema or:
- < -3 Z-scores weight-for-height and/or oedema
· Severly malnourished children older than 5 year adolescents and adults admitted based on available
weight-for-height standards or presence of oedema
· Low Birth Weight babies
· Orphans < 1 year (only when traditional care
practices are inadequate)
· Mothers of children younger than one year with breast
feeding failure (only in exceptional cases where
relactation through counselling and traditional alternative
feeding have failed)

64. The links between different selective feeding programmes and the criteria for entry and discharge from a programme are shown in figure 4 below.

Planning and Organizing a Selective Feeding Programme.

Organizing a Supplementary Feeding Programme

65. Supplementary feeding programmes can be implemented either by providing wet rations or dry rations.

i. Wet rations are prepared in the kitchen of a feeding centre and consumed on-site. The beneficiary, or child and caretaker, have to come for all meals to the feeding centre every day;

ii. Dry rations are distributed to take home for preparation and consumption. Rations are usually distributed once a week.

66. In most situations dry take-home SFP programmes are preferable. The advantages of dry instead of wet rations for SFP include:


Figure 4 - Admission and discharge Criteria

i. Much easier to organize;

ii. Fewer staff are needed;

iii. Lower risk of transmission of communicable diseases;

iv. Less time-consuming for the mother;

v. The mother's responsibility for feeding the child is preserved.

The ration for dry feeding however has to be higher than for wet feeding in order to compensate for sharing and substitution. Wet rations are typically given in situations where insecurity prevents dry rations from being taken home safely or where access to cooking facilities are limited. See Table 3 below for some of the main considerations when organizing a selective feeding programme.

Organizing a Therapeutic Feeding Programme

67. Therapeutic feeding programmes are either implemented in specially organized feeding centres or in hospitals or clinics. They involve intensive medical and nutritional treatment as well as rehydration. The programme should be easily accessible to the population, near to or integrated into a health facility. The treatment should be carried out in phases (see Table 3), the length of which depend on the severity of malnutrition and/or medical complications. At least during the first week of a TFP, care has to be provided on a 24-hour basis.

Table 3

Organization of Selective Feeding Programmes


Supplementary Feeding Programme

Therapeutic Feeding Programme

Organization

· On site wet feeding
· Same medical care

On site feeding
would usually only be
considered for
targeted SFP

· Take home dry
feeding

This is the preferred
option for both blanket
and targeted
programmes

· On site wet feeding
+
· Intensive medical care
+
· Psychological stimulation during
rehabilitation phase

Size of
extra ration

· 500-700kcal/
person/day, and

· 15-25 g protein

· 1,000-1,200
kcal/person/day, and

· 35-45 g protein

· 150 kcal/kg body-weight/day/
patient.
And
· 3-4 g protein per kg body-
weight/day/patient

Frequency
of meals

Minimum 2
meals/day

Ration distributed
once per week

Frequent meals.
Phase 1:8-10 meals over a 24 hour
period
Rehabilitation phase: 4-6 meats

68. One of the main constraints to the implementation of a TFP is the lack of experienced or insufficient staff to manage the programme. Proper training of both medical and non-medical personnel is essential before starting the programme. The refugees, particularly the mothers of patients, must be involved in managing the TFP centres.

Planning the quantity of food needed for selective feeding

69. The amount of food needed for the selective feeding programme will depend on:

i. The type of selective programme;

ii. The type of commodities;

iii. The expected number of beneficiaries.

70. This information should be based on precise demographic information and on the prevalence of malnutrition taken from the results of the nutritional survey. The nutritionist will advise on the appropriate commodities and type of programme.

71. However, in some circumstances, estimates on the prevalence of malnutrition and expected number of beneficiaries may need to be made for planning purposes, when for example a registration and nutrition assessment have not yet been carried out. See table 4 below for a projected demographic breakdown for a typical population.

72. If it is apparent that there is, or is likely to be, a major nutritional emergency, the following assumptions can be made for planning purposes:

i. 15 to 20% may suffer from moderate malnutrition;

ii. 2 to 3% may be severely malnourished;

iii. The breakdown of a typical population, by age, is as follows:

Table 4

Projected Breakdown by Age

age groups

% total population

0-4 or under 5

15-20%

Pregnant

1.5-3%

Lactating

3-5%

73. For example, to estimate the number of beneficiaries for a targeted SFP and TFP, both for children under 5 years:

If the total population = 30,000

Estimated number under 5 yrs = 4,500 -6,000(15-20%)

Estimated prevalence of moderate malnutrition (15%) gives 675-900 children

Estimated prevalence of severe malnutrition (2%) gives 90-120 children

With these numbers the estimated food requirements can be calculated by multiplying the estimated number of beneficiaries for each programme by the ration scale appropriate for each beneficiary, as follows:

Quantity of Commodity req. = Ration / person / day × no. benef. × no. days

Monitoring Selective Feeding Programmes

74. The effectiveness of impact of the selective feeding programme should be monitored at regular intervals.

75. Selective feeding programmes should be monitored and evaluated to assess their performance in relation to the established objectives9. Monitoring and evaluation will involve the regular collection and analysis of:

Process indicators such as attendance, coverage and recovery rates, to evaluate the success in implementation and trends in the programme over time;

Impact indicators such as malnutrition prevalence, mortality rate and numbers served, to evaluate the effectiveness and efficacy of the programme.

76. The effectiveness of selective feeding programmes can be measured through nutrition surveys and the regular collection of feeding centre statistics. Specific forms for monthly reporting on supplementary and therapeutic feeding programmes are attached as Annexes 4 and 5. A nutrition survey results form (weight-for-height) is also attached (Annex 6).

77. Trends in health and nutrition indicators can be related to many different factors. Actions in other sectors such as water, shelter, or community services may help explain a positive outcome.

9 For further reference, consult Chapter 8: Evaluation of Feeding Programmes in the MSF Nutrition Guidelines.

Criteria for Closing Programmes

78. Once the number of malnourished is significantly reduced, it may be more efficient to manage the remaining severely malnourished individuals through health facilities and through community based programmes. The specific criteria for closing each selective feeding programme will depend on the degree of success in reducing the main aggravating factors mentioned in Figure 3 and on the degree of integration between these feeding programmes and mother and child health (MCH) activities and other support services offered by the refugee community.

79. After closing selective feeding programmes, any deterioration of the situation should be detected by nutrition surveys undertaken at regular intervals and review of morbidity and mortality data. This is especially important if the overall situation remains unstable.

Infant Feeding and use of Milk Products

· Breast-feeding is best for babies and must be promoted and continued for as long as possible;

· Ban baby bottles completely;

· Weaning foods must be appropriate; foreign baby foods and special foods often are not;

· Infant formulae should be avoided and used only under strictly controlled conditions, with a cup and spoon;

· Re-stimulate lactation10 in cases where milk production has been affected by stress and use wet nursing where appropriate;

· Milk products, especially powdered milk, and infant formulae can cause health problems (as described below) and they are often inappropriate.

80. Human milk is the best and safest for infants and children under two years. Breast-feeding provides a secure and hygienic source of food, often initially the only source of food, as well as antibodies giving protection against some infectious diseases. Breast feeding must be encouraged for as long as possible. Every effort must be made to promote or re-stimulate lactation even among sick and malnourished mothers. Experience has shown that this can be done. Mothers may need to receive extra food to encourage breast-feeding and provide the additional calories and nutrients required. This should be done through the feeding programmes.

81. The problems associated with infant formulae, milk products and feeding bottles are exacerbated in a refugee emergency. Clean boiled water is essential but rarely available, careful dilution of the feeds is of critical importance but difficult to control, mothers are unlikely to be familiar with the use of infant formulae, and the instructions are often in a foreign language. Infant formulae, if unavoidable, should be distributed from health or feeding centres under strictly controlled conditions and proper supervision. Infant feeding bottles must never be distributed or used; they are almost impossible to sterilize and keep sterile under emergency conditions and are therefore dangerous. Babies should be fed by clean cup and spoon if necessary. Appropriate weaning foods should be introduced while breast-feeding is continuing. Weaning foods should be locally available foodstuffs and as far as possible be prepared in the traditional manner. Overseas donations of tinned baby foods are rarely appropriate.

10 Re-stimulate lactation refers to the re-establishment of an adequate volume of milk release. This is achieved by increasing suckling and through social peer support.

Policy On Use of Milk Powder11

i. Never distribute milk powder, by itself, to take home. It should be mixed with cereal flour, six parts cereal to one part milk powder;

ii. Never let liquid milk be carried home;

iii. Only use dried milk in supervised wet feeding programmes as a high energy drink mixed with oil and sugar;

iv. Dried skimmed milk should always be fortified with Vitamin A and have a Shelf-life Of more than six months.

11UNHCR IOM 88/89/FOM 76/89 Policy Directive for acceptance, distribution and use of milk products in refugee feeding centres, UNHCR, Geneva.

Key References

Calculation of Nutritional value of Food Commodities (NUT-VAL), an EXCEL spreadsheet which can be used to calculate the nutritional value of ration scales, UNHCR, Geneva, 1998.

Commodity Distribution: A Practical Guide For Field Staff, UNHCR, June 1997.

IOM 88/89 - FOM 76/89 Policy for acceptance, distribution and use of milk products in refugee feeding programmes, UNHCR, Geneva, 1989. Also available in French.Memorandum of Understanding (MOU) on the Joint Working Arrangements for Refugee, Returnee and Internally Displaced Persons Feeding Operations, Also available in French. WFP/ UNHCR, 1997.

Nutrition Guidelines, Mcins Sans Frontis (MSF), 1995. Essential Reading.

Nutrition Surveys in Emergency Situations, (Video, PAL, 38 min), UNHCR Geneva.

WFP/UNHCR Guidelines For Estimating Food and Nutritional Needs, Also available in French. WFP/UNHCR, 1997.

WFP/UNHCR Guidelines For Selective Feeding Programmes in Emergency Situations, WFP/ UNHCR, 1999.

Glossary

Anthropometric
measurements

Assessment of body size and composition which reflects food intake, physical activity and disease. Most common anthropometric indicators include weight, height and arm circumference.

Baseline data

Data collected at the beginning of a programme that can be compared with similar data collected later and so used to evaluate the impact of interventions or to monitor trends.

Body Mass Index (BMI)

(weight in kg)/ (height in m)2 which is used for assessing the nutritional status of adolescents and adults.

Fortified blended food

A flour composed of pre-cooked cereals and a protein source, mostly legumes, fortified with vitamins and minerals, e.g. corn soya blend (CSB), wheat soya blend (WSB) used for feeding programmes.

Fortification

Adding micronutrients to foods, e.g. iodized salt and fortified blended food.

Kilocalorie

Unit of energy used in nutrition, 1 Kcal = 4.17 kilojoules.

Kwashiorkor

Severe form of malnutrition characterized by oedema (swelling) particularly of the lower parts of the arms and legs.

Marasmus

Severe form of malnutrition in which the person becomes wasted.

Micronutrients

Minerals and vitamins.

Mid-upper arm
circumference (MUAC)

Circumference at the mid-point of the left upper arm, which is an indicator of malnutrition and used as a tool for screening.

Nutrients

Those parts of food that are absorbed and/or used by the body i.e. carbohydrate, protein, fat, alcohol, vitamins and minerals.

Oedema

An abnormal accumulation of fluid in intercellular spaces of the body. In case of nutritional oedema this is oedema due to a deficiency in the diet.

On-site feeding

Cooked meal eaten at the feeding centre.

Stunting

Low height for age. Comparing the height of a child of a certain age with the height of reference (healthy) children of the same age indicates the level of chronic malnutrition.

Take-home rations

Dry rations that are given to people to take and prepare at home.

Therapeutic milk

Special milk used for rehabilitation of severely malnourished persons.

Wasting

Abnormal loss of fat and/or muscle tissue which is indicated by a low weight for height, a low body mass index or observation (thinness).

Xerophthalmia

Clinical signs in the eye caused by Vitamin A deficiency.

Weight-for-Height

The weight of a person at a certain height compared with the reference weight for that height.

Annexes

Annex 1 - Basic Facts About Food and Nutrition

All foods are made up of five basic types of nutrient in addition to variable amounts of water.

Carbohydrates, the main source of energy, provide 4 kcal/g. They are mostly starches and sugars of vegetable origin, and are a major component of cereals and tubers.

Fats and oils provide the most concentrated source of energy, and have more than twice the energy content per weight of carbohydrates and proteins (9/kcal/g).

Proteins are body-building substances required for growth and tissue repair. Protein is found in foods of animal origin and in cereals and legumes and provide 4 kcal/g.

Vitamins and minerals are needed in small quantities for the adequate functioning of the body and protection against disease. Fresh vegetables and fruits are a good source of vitamins. Water soluble vitamins are fragile and cannot be stored (Vitamins Bs and C), whereas fat soluble vitamins can be stored in the body (Vitamin A and D). Important minerals are iron, sodium, iodine, zinc, magnesium, potassium, etc. Individual vitamins and minerals or combinations are found in all foods in very variable amounts.

Energy and Protein Intakes

If the energy intake is inadequate, some protein will be burnt to provide energy. That is, it will be used in the same ways as carbohydrate or fat. More than 20% of the energy requirement should be supplied from fats and oils which greatly enhance the palatability of the diet and increase energy density (important for younger children). Energy requirements vary widely even in normal individuals. They are also increased by physical activity. Much higher energy and protein intakes are required for the treatment of malnutrition, when the aim is rehabilitation rather than maintenance.

Food and Diets

Most diets in most countries contain adequate amounts of all the nutrients required for good health if enough of the diet is taken to satisfy the individual's energy requirements. Even a growing child, if healthy, requires no more than 10% of total calories to be supplied from protein sources.


Figure

Annex 1 (cont.) - Nutritional Value Of Food Commodities

COMMODITY

Nutritional Value/100 g



Energy
Kcal

Protein
(g)

Fat
(g)

Price per MT
in US$

Cereals


Wheat

330

12.3

1.5

165

Rice

360

7.0

0.5

280

Sorghum/Millet

335

11.0

3.0

200

Maize

350

10.0

4.0

170

Processed Cereals

Maize meal

360

9.0

3.5

225

Wheat flour

350

11.5

1.5

240

Bulgur wheat

350

11.0

1.5

220

Blended Food

Corn Soya Blend

380

18.0

6.0

320

Wheat Soya Blend

370

20.0

6.0

390

Soya-fortified bulgur wheat

350

17.0

1.5

240

Soya-fortified maize meal

390

13.0

1.5

270

Soya-fortified wheat flour

360

16.0

1.3

240

Soya-fortified sorghum grits

360

16.0

1.0

190

Dairy Products

Dried Skim Milk (enriched)

360

36.0

1.0

1,900

Dried Skim Milk (plain)

360

36.0

1.0

1,800

Dried Whole Milk

500

25.0

27.0

2,200

Canned cheese

355

22.5

28.0

1,850

Therapeutic milk

540

14.7

31.5

2,200

Meat and Fish

Canned meat

220

21.0

15.0

1,950

Dried salted fish

270

47.0

7.5

1,500

Canned fish

305

22.0

24.0

2,000

Oils and Fats

Vegetable oil

885

-

100.0

750

Butter oil

860

-

98.0

2,300

Edible fat

900

-

100.0

950

Pulses

Beans

335

20.0

1.2

440

Peas

335

22.0

1.4

375

Lentils

340

20.0

0.6

500

Miscellaneous

Sugar

400

-

-

350

High Energy Biscuits

450

12.0

15.0

1,250

Tea (black)

-

-

1,235

Iodized salt

-

-

-

150

Dates

245

2.0

0.5

1,900

Dried fruit

270

4.0

0.5

1,200

Note: The prices quoted are free-on-board (FOB) and therefore do not include transportation costs. The prices shown are as of 1998 and will vary over time. This information is regularly updated and published by WFP and is available from WFP HQ's or from their offices in the field.

Annex 1 (cont.) - Characteristics of Common Foods

Food type

Vitamins and minerals

Comments

1.

Cereal grains (rice, corn, sorghum, oats, etc.)

Contain vitamin B and iron.
However these are reduced
by milling, i.e. the whiter the
flour the greater the loss of
vitamins.

The main source of both
energy and protein in most
diets.

2.

Legumes/oilseeds (beans, peas, soya, groundnuts, etc.)

B complex vitamins. Most
contain significant quantities
of iron and calcium.

Legumes are particularly
useful when eaten with
cereals as the proteins
complement each other.

3.

Whole tubers and roots (yams, taro, cassava, sweet potato, potato, etc.)

Variable but generally low,
except for potatoes which
are rich in vitamin C.

Bulk and low protein content
makes them unsuitable as
staple foods in emergencies.

4.

Vegetables and fruits

Important source of vitamins
and minerals. Variable quantities
of B and C vitamins. Dark green
leaves or yellow/red
pigmentation usually indicates
vitamin A compounds.

5.

Meat, milk and dairy products, eggs, etc.

Good sources of B vitamins.
Whole milk and eggs also good
source of vitamin A.
Milk and eggs provide significant
amounts of calcium.

Usually consumed in very
small quantities in normal
times. They are more readily
used by the body than
proteins of vegetable origin.
Therefore small quantities
useful to improve the quality
and palatability of diet.

6.

Fish, dried

Rich source of calcium and
iron. Contains B Vitamins.

A concentrated source of
protein for those who like it.
Therefore acceptability trials
essential before use.

7.

Fats and oils

Fats derived from milk are
sources of vitamin A and D,
while vegetable fats contain
no vitamin A and D, except
for red palm-oil.

Useful way to increase
energy intake without
increasing bulk of diet.
Improves palatability and
helps in food preparation.

Annex 2 - Examples of Food Rations

Examples of adequate full rations for the affected population entirely reliant on food assistance12

Five types of rations are shown to illustrate differences due to such factors as the food habits of the population and the acceptability and availability of the commodities in the region.

Items

Rations
(quantity in grams per person per day)

Type 1*

Type2*

Type 3*

Type 4**

Type 5*

Cereal flour/rice/bulgur

400

420

350

420

450

Pulses

60

50

100

60

50

Oil (vit. A fortified)

25

25

25

30

25

Canned fish/meat

-

20


30

Fortified blended foods

50

40

50

-

-

Sugar

15

20

20


20

Iodized salt

5

5

5

5

5

Fresh veg./fruits

-

-


100

Spices

-

-

-

-

5

Energy: kilocalories

2113

2106

2087

2092

2116

Protein (in g and in % kcal)

58 g; 11 %

60 g; 11 %

72 g; 14%

45 g; 9%

51 g; 10%

Fat (in g and in % kcal)*

43g; 18%

47 g; 20%

43 g; 18%

38 g; 16%

41 g; 17%

* For rations 1, 2, 3, & 5 the cereal used for the calculation is maize meal

** This ration has rice as a cereal; the low percentage energy for protein is acceptable due to its high quality; the slightly low fat content is in line with food habits in rice-eating countries

Examples of Typical Daily Rations for SFPs (in grammes per person per day)

Take-home
or dry ration

On-site feeding or wet ration

Item

Ration 1

Ration 2

Ration 3

Ration 4

Ration 5

Ration 6

Ration 7

Blended food, fortified

250

200

100


125

100

Cereal


125

High Energy Biscuits (HEB)

12513


Oil, fortified with vitamin A

25

20

15

20


10

10

Pulses


30

30


Sugar

20

15


10

10

Salt, iodized

5


Energy (Kcal)

1250

1000

620

560

700

605

510

Protein (g)

45

36 25


15

20

23

18

Fat % Kcal

30

30

30

30"

28

26

29

12 WFP/UNHCR Guidelines for estimating food and nutritional needs. December, 1997.

13 WFP Specification.

14 High Energy biscuits with 15% fat meet the energy density requirement.

Annex 3 - Main Nutritional Deficiency Disorders in Emergencies"

Protein-energy malnutrition (PEM) is likely to be the most important health problem and a leading cause of death during an emergency. There are several forms:

Marasmus is marked by the severe wasting of fat and muscle, which the body has broken down for energy, leaving "skin and bones". It is the most common form of PEM in nutritional emergencies.

Kwashiorkor is characterized essentially by oedema (swelling which usually starts in the feet and legs), sometimes accompanied by a characteristic skin rash and/or changes in hair colour (reddish). The hair becomes sparse.

In Marasmic kwashiorkor there is a combination of severe wasting and oedema.

Children under 5 years are usually the most affected, but older children and adults are also often at risk or affected. The treatment of severe forms of PEM is presented in the section on selective feeding programmes.

Vitamin and mineral deficiencies can cause long-lasting or permanent disabilities and can be fatal. The deficiencies most likely to occur include:

Iron deficiency (1) causes anaemia. (signs: pallor of skin and eyelids, fatigue, weakness and shortness of breath); (2) increases the risk of haemorrhage, infection and death associated with childbirth; (3) increases rates of low-birth-weight and (4) impairs the cognitive development of infants and children.

Iodine deficiency causes not only goitre but also some impairment of intellectual development of children and of reproductive performance in women. Severe maternal deficiency can cause cretinism in the offspring. Best prevented in emergencies by the use of Iodized salt.

Vitamin A deficiency causes Xerophthalmia, blindness and death. Eye signs: poor vision in dim light, dryness of conjunctiva or cornea, foamy material on the conjunctiva or clouding of the cornea itself. These signs may appear after several months of an inadequate diet, or following acute or prolonged infections, particularly measles and diarrhoea.

Vitamin B1 (Thiamine) deficiency causes beri-beri. Symptoms and signs: loss of appetite, malaise and severe weakness, especially in the legs; may also lead to paralysis of the limbs or swelling of the body, heart failure and sudden death. Beri-beri occurs when the diet consists almost exclusively of white polished rice or starchy staple such as cassava.

Vitamin C deficiency causes scurvy. Signs: swollen gums which bleed easily, swollen painful joints, easy bruising. This occurs due to a lack of fresh vegetables and fruits.

Niacin deficiency causes pellagra. Signs: skin rash on parts of body exposed to sunlight; diarrhoea; and mental changes leading to dementia. This occurs especially where maize and sorghum are the staples and there is a lack of other foods.

Prevention involves ensuring that people receive or have access to a variety of foods that contain sufficient quantities of essential vitamins and minerals. This also includes fortified food items distributed in food aid, access to local markets, and produce from home gardens.

Treatment consists of administering therapeutic doses of the missing nutrients. The distribution of multi-vitamin tablets to the entire refugee population is a waste of time and money, since they contain insufficient quantities of individual vitamins to correct deficiencies.

15 Adapted from: The Management of Nutritional Emergencies in Large Populations, WHO, Geneva, 1999 (in press).

Annex 4 - Reporting Form: Supplementary Feeding Programme

Country: Location: Agency:




Period:




Total population:
Under (<) 5 population
Moderate malnutrition rate:
Target <5 (moderate malnutrition rate *<5 pop):
Theoretical coverage <5 (new total (J)/Target):


CATEGORIES


< 5 years

³ 5 years

Pregnant

Lactating

TOTAL



M

F

M

F

women

women


Total at end of last
month (A)


New Admissions:


< 80% WFH or
< -2 Z-score


Others


Total New
Admissions (B)


Re-admissions
(C)


Total Admissions
(D=B+C)


Discharged
in this period:

percentage
for <5 yrs
(target):

Discharges (E)


E/I*100%=
(>70%)

Deaths (F)

F/l*100%=
(<3%)

Defaulters (G)

G/l*100%=
(<15%)

Referrals (H)

Total Discharged
(I=E+F+G+H)


New Total at end
of this month
(J=A+D-I)


Average length of stay in the programme

(from all or a sample of 30 recovered children) (target <60 days) =

Total No of days of admission of all (or 30) recovered children

No of recovered children (or 30)

Comments:

Annex 5 - Reporting Form: Therapeutic Feeding Programme

Country:
Location:
Agency:




Period:




Total population:
Under (<) 5 population
Moderate malnutrition rate:
Target <5 (moderate malnutrition rate *<5 pop):
Theoretical coverage <5 (new total (J)/Target):


CATEGORIES

< 5 years

³ 5 years

Adults

TOTAL



M

F

M

F

M

F


Total at end of last
month (A)


New Admissions:


< 70% WFH or
< -3 Z-score









Kwashiorkor




Others


Total New
Admissions (B)


Re-admissions (C)


Total Admissions
(D=B+C)


Discharged
this month:

percentage
for <5 yrs (target):

Discharged (E)








E/l*100%= (>75%)

Deaths (F)

F/l*100%= (<10%)

Defaulters (G)

G/l*100%= (<15%)

Referrals (H)

Total Discharged (I=E+F+G+H)


New Total at end
of this month
(J=A+D-I)


Causes of death:

Average weight gain during last month (from all or a sample of 30 children) (target: >8 g/kg/day) =

weight at end of month (or on exit) - lowest weight recorded during month

lowest weight recorded in last month × No of days between lowest weight recorded and end of month (or on exit)

Average weight gain for marsmus (include only children in phase II) =

Average weight gain for kwashiorkor (include only children in phase II after complete loss of oedema) =

Average length of stay in the programme (from all or a sample of 30 recovered children) (target <30 days) =

Total No of days of admission of all (or 30) recovered children

No of recovered children (or 30)

Annex 6 - Nutrition Survey Reporting Form

Country:
Camp:
Date of reporting:

Population

Male

Female

Total


number

%

number

%

number

total population

under five population

Survey

date:

............/............/............/

method:

random - systematic - cluster

sample size:

under five population

Male

Female

Total

(6-59 month or 65-110 cm)

number

%



number

%



number







Results

weight-for-height
% median

weight-for-height
Z-score

category

number

%

confidence
interval

category

number

%

confidence
interval

<70% and/or
oedema

£ 3 and/or
oedema

>70
and >80%

³3 and ³2

total

total

Other results:

(mean Z-score, mean SD, family size, % children in each category that is attending feeding center)

Comments/Observations:

Action/Intervention:

(introduction...)


Figure

Overview

Situation

Water is essential to life and health. In emergencies, it is often not available in adequate quantity and quality, thus creating a major health hazard.

Objective

To provide sufficient safe water for the refugees and to meet communal needs in the most cost-effective way.

Principles of response

· Give priority to quantity while respecting quality;

· Refugees should be directly involved in the development and operation of the water supply;

· Ensure consideration of water supply at the site selection and planning stages and coordinate response closely with physical planning, public health and environmental sanitation measures;

· If at all possible, avoid the need to treat water - it is better to use a source that does not need treatment. Treatment plants must always be correctly operated and maintained. If large numbers of refugees are concentrated in camps, disinfection of drinking water is absolutely necessary. Other types of treatment should be considered according to the characteristics of the raw water;

· Provide a reserve supply and spare capacity to meet temporary difficulties and the needs of new arrivals;

· Take account of seasonal variations in water quantity and quality;

· Seek expert advice and coordinate closely with the appropriate national services.

Action

· Calculate the water requirement and organize an immediate assessment of water supply possibilities;

· Make an inventory of water sources and assess all sources in terms of their water quality and yield;

· Protect existing water sources from pollution and provide good quantities of water of a reasonable quality;

· Improve access to supplies by developing sources and a storage and distribution system to deliver a sufficient amount of safe water, including a reserve supply;

· Ensure regular testing of water quality;

· Set up infrastructure for operation and maintenance;

· Maintain and update information on water resources obtained during needs assessment; planning, construction, operation and maintenance.

Introduction

1. People can survive longer without food than without water.

The provision of water demands immediate attention from the start of a refugee emergency. The aim is to assure availability of enough water to allow its effective distribution in the required quantities, and to ensure that it is safe to drink.

Adequate storage capacity and back up systems for all components of a water system must be assured; interruptions in the supply may be disastrous.

2. If it is evident that available sources are inadequate (in terms of yield or water quality), arrangements must be made to find alternative sources. If necessary, water may have to be imported to the site (by truck, barge, pipelines, etc.). Where even the most basic needs for water cannot be safely met by existing resources, or when time is needed for further exploration and development of new sources, refugees should be moved to a more suitable location.

3. Water quality is difficult to assess. Always assume that all water available during emergencies is contaminated, especially if it is taken from surface water bodies (lakes, ponds, rivers, etc.). All sources of water used by refugees must be separated from sanitation facilities and other sources of contamination. In many circumstances, treatment will be needed to make the water safe to drink. Safety of the water must be assured right through to its consumption in the household.

4. As it is difficult to predict the life-span of a refugee camp, it is best to plan on a cost-effective, long-term basis.

5. Figure 1 (a and b) shows some of the considerations for planning an emergency water supply system.

6. The sectors of water, sanitation and site planning are highly interdependent. This chapter should be read in conjunction with the chapters on these topics.

Assessment and Organization

· An immediate, on the spot, assessment of local water resources in relation to needs is essential;

· Technical expertize is required and local knowledge is most important. Outside expertize should be brought in only when clearly necessary;

· Involve the refugees, use their skills and train them to operate and maintain the system;

· Technology and equipment should be simple, reliable, appropriate and familiar to the country;

· Refugees may compete with the local population for water resources. This may cause problems between the two groups;

· Available sources must be protected from pollution at once;

· The water supply system must be supported by appropriate environmental health measures and hygiene.

An immediate, on the spot assessment in relation to needs is essential.

7. The government's central and local authorities should be involved as much as possible in this assessment. Knowledge of the local terrain and conditions is indispensable and expertize from outside the country should be brought in only when clearly necessary.


Figure 1a - Needs and Resources Assessment

General considerations for planning an emergency water supply system


Figure 1b - Needs and Resources Assessment

General considerations for planning an emergency water supply system

8. Available sources must be protected from pollution at once. Rationing of scarce water may be needed initially in order to ensure survival of the weak and equity in distribution to the rest of the refugee population. The design and construction of a water supply system should be cost-effective and efficient bearing in mind long term needs, and should use simple but appropriate technology to facilitate operation and maintenance.

Assessment

9. The objective of an assessment of water resources for human consumption is to ascertain the availability of water (its quantity and quality) in relation to the demand.

10. Estimating the need, or demand, for water does not require special expertize, however, the assessment of supply possibilities does. Assessing the supply means identifying possible sources, and assessing the potential for developing and exploiting those resources.

11. Sources of water can be identified by: the local population, the refugees themselves, the lie of the land (groundwater is often near the surface in the vicinity of rivers and in other low places; its presence at shallow depths is usually indicated by some types of vegetation); maps (topographical, geological), remote sensing imagery (satellite images, aerial photography), previous surveys of water resources; national or foreign experts (hydrologists, hydro-geologists); and water diviners.

12. Assessing the water resources requires expertise in for example water engineering, sanitation and in some cases logistics. It includes assessing topographical advantages (gravity) and disadvantages (pumping requirements), and analysing the overall environment of the refugee sites. Further surveys will be necessary to organize the water supply system and should cover relevant information on the refugees, other beneficiaries, and the socio-economic characteristics of the host community. The results of such assessments and surveys should be systematically filed to ensure that such data will be available for future reference.

13. UNHCR maintains a standby arrangement with certain organizations whereby qualified and experienced water engineers and other experts can be provided at short notice for deployment to emergencies. (See Appendix 1, Catalogue of Emergency Response Resources, for further details). If it becomes clear that locally available expertize will not suffice, assistance from the Programme and Technical Support Section at Headquarters should be requested without delay.

14. Seasonal factors must always be carefully considered.

Supplies that are adequate in the rainy season may dry up at other times.

Local knowledge, historical and hydrological information and statistical interpretation should all be taken into account to determine the seasonal patterns.

Organization

15. Bear in mind that the economic and social bases of refugee groupings differ from those of the host communities. In addition, an influx of refugees may over-strain water resources used by the local population and lead to tension between the two groups. Special arrangements should be made with local authorities and other implementing partners for adequate operation and maintenance arrangements; the technology used in the water supply systems should be carefully evaluated to ensure it is appropriate and that long term operational needs (fuel, spare parts, management, etc.) will be within reach of the refugees and camp managers.

16. The provision of safe water could become impossible without the beneficiaries' understanding and cooperation. To the extent possible the system should be developed in collaboration with the refugees who should be involved with its operation and maintenance from the start.

Even the best system needs continuing maintenance, otherwise it will break down.

Refugees without prior experience should be trained.

17. In order to be effective, water quality control and treatment have to be combined with improved personal hygiene and environmental health practices. Basic public health education stressing the importance of avoiding pollution of the water by excreta and of the use of clean containers in the household, will be essential. The water supply system design and construction must be closely coordinated with site planning and layout and must be supported by health, education and environmental measures, in particular sanitation.

As a general rule, technology should be kept simple. It should be appropriate to the country and should draw on local experience.

Where pumps and other mechanical equipment are necessary, supplies should be standardized as far as possible.

Locally available material and equipment should be used as much as possible.

Local familiarity, availability of spare parts, fuel and ease of maintenance are priority considerations.

18. Both organizational and technical aspects of the complete water supply system need to be carefully monitored. The use of the system must be controlled and water wastage or contamination prevented. Maintenance must be assured, and technical breakdowns quickly repaired.

The Need

· Demand: Calculate on at least 15 litres per person per day. Absolute minimum survival allocation is 7 litres per day.

· Quality: To preserve public health, a large amount of reasonably safe water is preferable to a smaller amount of very pure water;

· Control: The water must be safe: test the physical, chemical and bacteriological quality of new sources before use and regularly thereafter, and immediately following an outbreak of a disease which might be caused by unsafe water.

Quantity

19. Minimum water needs vary: it increases with air temperature and physical exercise. As a general indication, the following amounts of water are desirable:

Minimum daily requirements:

Minimum survival allocation: 7 litres per person per day. This should be increased to 15-20 litres per person as soon as possible.

Communal needs and a spare capacity for possible new arrivals should be added.

Health centres: 40-60 litres per patient per day;

Feeding centres: 20-30 litres per patient per day.

20. Further needs may include: livestock, sanitation facilities, other community services, irrigation and construction of camp infrastructure (e.g. roads or concrete structures). The more convenient the supply, the higher will be the consumption.

21. Give priority to quantity while respecting quality. A reduction in the quantity of water available to individuals will directly affect the overall health status of the refugee population. As supplies are reduced, personal and domestic hygiene suffers, and the reduction is reflected in increased incidence of parasitic, fungal and other skin diseases, and diarrhoeal diseases. Even those individuals who may have traditionally lived on less than the normally recommended amount of water will require more water when living in a refugee camp, because of crowding and environmental factors.

22. The availability of water will be a factor in deciding on a sanitation system. Pit latrine systems do not need water to function; but showers, washing, laundry or pour-flush toilet facilities all require water.

23. Water will also be needed for livestock in many refugee situations. Take great care to avoid pollution or depletion of scarce water resources by livestock, separation of human water supply points from those used by animals is a must. As a rule of thumb, cattle need about 30 litres of water daily. Water will also be needed to irrigate food (vegetable gardens, crops) cultivated by refugees. Annex B of UNHCR's Water Manual provides additional indicative figures on water requirements including livestock and agricultural crop needs.

24. Water will probably be of little use in controlling major fires on refugee sites owing to a lack of sufficient quantity and pressure.

If more refugees are expected to arrive, plans must allow for a substantial spare capacity over the initially assessed needs.

Quality

25. The water must be both acceptable to the refugees and safe to drink. Water that tastes and looks acceptable will be drunk by refugees who may unknowingly expose themselves to the dangers from microbiological organisms. Water-borne diseases are not usually as serious or widespread a problem as the water-washed diseases such as skin and eye infections which result from insufficient water from personal hygiene.

Thus, a large quantity of reasonably safe water is preferable to a smaller amount of very pure water.

26. The most serious threat to the safety of a water supply system is contamination by faeces; once the water has been contaminated it is hard to purify it quickly under emergency conditions.

27. Water may contain pathogens, particularly certain viruses, bacteria, protozoan cysts and worm eggs which are transmitted from faeces to mouth. Water contamination by human faeces is the major concern, although animal faeces in water may also cause disease transmission. Water contamination by urine is a significant threat only in areas where urinary schistosomiasis (Schistosoma haematobium) is endemic.

By far the greatest risk associated with polluted drinking water is the spread of diarrhoea, dysentery and infectious hepatitis (Hepatitis A).

28. Diarrhoea and dysentery are caused by a variety of viruses, bacteria and protozoa. The numbers of viruses and protozoa in water will always decrease with time and will always decrease most rapidly at warm temperatures. Bacteria behave similarly, but in exceptional circumstances may multiply in polluted water, The infectious dose of the viruses and protozoa is typically very low, whereas the dose of bacteria needed to establish an infection in the intestine may be large.

29. New water supplies should be tested for bacteriological quality before use and existing ones checked regularly and tested again immediately following any outbreak of disease which might be caused by unsafe water.

30. Potability analysis involves studying the chemical, physical and bacteriological characteristics of the water. Although it is possible to examine water for a specific pathogenic organism, a much more sensitive test for routine analysis uses an indicator organism, called Escherichia coli (coliform, or E-coli), which is a normal inhabitant of the intestine of warmblooded animals and is excreted in large numbers. If these bacteria are found in water, faecal pollution is indicated and the sample is therefore potentially dangerous.

31. Concentrations of faecal coliform are usually expressed per 100ml of water. As a guide:

Faecal
Coliform/100 ml 1-10

Water Quality reasonable quality

10-100

polluted

100-1000

very polluted

> 1000

grossly polluted

32. In cases where the water is disinfected by chlorination, it is easier and more appropriate to test for the presence of free available chlorine than for bacteria. The presence of free chlorine in the range between 0.2 mg/l and 0.5 mg/l at the distribution point shows that the bacteria have almost certainly been killed and that the water cannot be heavily polluted with faecal or other organic matter.

33. The water must, of course, be safe at the time of consumption or use in the household, not just at the distribution point. Domestic hygiene and environmental health measures to protect the water between collection and use are important. The water in storage tanks and any tanker trucks should also be tested periodically.

34. Where drinking water is scarce, use non-potable, brackish or salty water for washing.

Immediate Response

· If even the minimum amount of water cannot be made available in time from local sources, the refugees should be moved.

· Whatever the water source, take immediate action to prevent pollution by excreta. (See chapter 17 on environmental sanitation for further details).

· Organize a distribution system that prevents pollution of the source and ensures equity if there is insufficient water.

35. Short-term emergency measures may be necessary while the longer term supply system is being developed or pending the move of the refugees to a more suitable site. If the locally available water supply is insufficient to meet the minimum needs of the refugees, arrangements must be made to bring in water by truck.

36. If this is not possible, the refugees must be moved without delay. Often, however, the quantity of water available will meet initial minimum needs; the immediate problem would be water quality.

37. The refugees will be using either surface water or, less often, ground water (well or springs) - usually whatever water is closest, regardless of quality. Whatever the water source, take immediate steps to prevent pollution by excreta.

The best immediate response is likely to be organizational.

38. Work with community leaders to organize the refugee community and make the community aware of the possibilities and dangers of existing water sources and convey the idea of trying to prevent pollution of these sources by excreta. If the source is flowing, supplies must be drawn off upstream and a special area set aside for this. Then allocate an area for washing, and finally downstream of the settlement, allow any livestock to drink (see figure 2). Fence off parts of the river banks as necessary, and beware of any dangers in the water, such as reptiles.

39. Where the source is a well or spring, fence off, cover and control the source.

Prevent refugees from drawing water with individual containers that may contaminate the source.

40. If possible, arrange to store water and to distribute it at collection points away from the source. Not only does this help avoid direct contamination but storage can make water safer.

41. From the start, families will need to be able to carry and store water at the household level. They must be able to transport at least 10 litres (from water distribution points to the household) and store at least 20 litres per household (1 household = 5 persons). Suitable containers (10-20 litres) are essential. Collapsible jerry-cans are recommended, especially when their transportation to the site may involve airlifts. Jerry-cans must have narrow inlets to prevent contaminating objects getting in. For this reason, buckets and other wide necked containers are not recommended. Sometimes empty cooking oil containers or the like are available which may be appropriate.

If the immediately available supplies of water are insufficient, action to ration supplies and to ensure equitable distribution will be a priority.

42. Rationing is difficult to organize. The first step is to control access to the sources, using full-time guards if necessary; uncontrolled distributions are open to abuse. Distribution at fixed times for different sections of the site should be organized. Vulnerable groups may need special arrangements. Every effort must be made to increase the quantity of water available so that strict rationing is unnecessary.

43. In parallel to these steps, action must be taken to improve the quantity from existing sources and the effectiveness of any distribution system. Plan how the need for water may best be met in the longer term. The following sections outline the main considerations.

Water Supply Systems

(See Water Manual, Chapter 12)

· A water supply system is a combination of structures (intakes, pumping sets, treatment, storage and distribution facilities and drainage outlets) necessary for the production (collection, treatment, storage) and distribution of potable water;

· Ensure the system components are compatible with each other and appropriate in view of the supply and demand, and can be maintained from locally available resources and at the lowest possible cost;

· The system will have to be planned, designed, constructed and put into operation in a short period of time (involving the refugee population as much as possible). The complexity of the task requires professional expertize which should be sought at the beginning of the project. Pay attention to long-term operation and maintenance requirements from the start.

44. As soon as possible, make an overall plan for the longer term water supply system. At least some elements of the plan will be problematic - there is often a lack of basic data or difficulty in obtaining the planning or design tools (cartography, hydrological data, etc.). The following steps should be taken:

i. Search for adequate sources;

ii. Preliminary surveys. Assess water quantity and quality (see above). Assess topographical advantages (gravity) and disadvantages (pumping requirements). Collect additional, relevant information on the refugee community, on any other beneficiaries, on the social and economic characteristics of the host community, on the overall environmental framework of the refugee sites;

iii. Implementation arrangements. Analyze the possibilities and constraints of all parties interested in the project and allocate responsibilities for project implementation, including operation and maintenance. Clarify arrangements for funding, contractual procedures, project monitoring, financial matters and reporting;

iv. Production of the design concept (see Chapter 12, paragraph 2, UNHCR's Water Manual). Consider the alternatives, taking into account implementation time, technology considerations and cost-effectiveness;

v. Detailed surveys. To refine all aspects and details of the adopted design. These include further water analyses, identifying building materials, further measurements of water production at sources, detailed topographical surveys of the position of water sources, storage tanks and distribution points;

vi. Production of final designs;

vii. Organization of refugee involvement on the project. Identify relevant skills and expertize among the refugees. Organize refugee committees;

viii. Implementation of the project. Besides construction, other inputs are required, such as the technical supervision to ensure that construction is carried out in accordance with previously approved plans and that payments for construction reflect the real value of the works accomplished;

ix. Organization of operation and maintenance, including the organization of a committee in which refugees and relevant assistance sectors are represented (health, sanitation, community services). Ensure there is continuous engineering support and employ a caretaker or a group of caretakers to carry out the operation and maintenance tasks.

45. See UNHCR's Water Manual for additional information and details on these issues (chapter 6, paragraphs 1, 36; chapter 11, paragraphs 2, 3, 11; chapter 12, paragraphs 5, 12-8,16).

46. An ill-conceived or badly managed water supply system will soon create problems. The long-term needs of the refugees should be considered while searching for solutions to the emergency needs. All efforts to avoid long-term problems will prove, with time, very valuable.

Water Sources

(See UNHCR Water Manual Chapter 6)

· Rain water, groundwater from springs and wells or water from municipal and private systems are usually of better quality than surface water from sources such as rivers, lakes or dams and should be used if available;

· Surface water should be considered to be contaminated and must be treated prior to use;

· Physical protection of the source from pollution will be essential;

· New or repaired sources and equipment should be disinfected before use;

· Develop a data bank of water sources.

Introduction

47. There are three main natural types of fresh water: surface water (streams, rivers, lakes), groundwater (underground or emerging as springs) and rain water.

48. Considerations in choosing between alternative sources of water in an emergency include:

i. Speed with which source can be made operational;

ii. Volume of supply;

iii. Reliability of supply (taking into account seasonal variations and, if necessary, logistics);

iv. Water quality, risk of contamination and ease of treatment if necessary;

v. Rights and welfare of local population;

vi. Simplicity of technology and ease of maintenance;

vii. Cost.

49. Take careful account of systems and methods already in use locally. Adoption of well-proven and familiar techniques, combined with action to improve protection against pollution is often a sound solution.

50. Besides organizational measures to protect the water supply, some form of treatment may be necessary. However, if possible use sources that do not require treatment. The treatment of unsafe water, particularly in remote areas, can be difficult and requires trained supervision to be reliable.

51. Gather as much technical information as possible on the different water sources to allow a simple cost-benefit analysis of alternative solutions. The decision on which sources to develop and the technological approaches to be used should take into account the need to develop systems to efficiently cover both immediate and longer-term needs.

Surface Water

Water from streams, rivers, ponds, lakes. dams and reservoirs is rarely potable; its direct use is likely to require treatment measures that may be complicated to plan and implement during most refugee emergencies.

Rainwater

52. Reasonably pure rain water can be collected from the roofs if these are clean and suitable. This method can only be the major source of water in areas with adequate and reliable year-round rainfall; it requires suitable shelter and individual household storage facilities. It is, therefore, not a suitable solution in most refugee emergencies.

Every effort should be made to collect as much rainwater as possible.

53. Small rainwater collection systems, for example using local earthenware pots under individual roofs and gutters, should be encouraged. Allow the first rain after a long dry spell to run off, thus cleaning the catchment of dust, etc. The supply of water that may be collected by this method is estimated as follows:

54. One millimeter of yearly rainfall on one square metre of roof will give 0.8 litres per year, after allowing for evaporation. Thus, if the roof measures 5 × 8 metres and the average annual rainfall is 750 mm, the amount of rain water which may be collected in a year equals: 5 × 8 × 750 × 0.8 = 24,000 litres per year or an average of 66 litres per day (on many days there will be none).

55. Rain water may be a useful supplement to general needs, for example through special collection for community services such as health and feeding centres, where the safety of water is most important. It should also be noted that surface water is particularly likely to be contaminated in the rainy season. Thus rain water may be a useful source of safe water for individual use at a time when other water is plentiful but unsafe.

Groundwater

56. Groundwater is contained in aquifers. Aquifers are rocks or groups of rocks capable of transmitting, storing and yielding water.

They may be formed by loose sediments (silt, sand, gravel), fractured rocks or otherwise porous rocks (fractured lavas, granites, metamorphic rocks, sandstones, etc.). The microbiological quality of groundwater is usually very good in view of the filtration undergone by water in its transit through rock pores (An exception to this filtering effect is when the size of the fractures in the rock is large.)

57. The use of groundwater during refugee emergencies would almost always be the preferred solution: if available, groundwater usually provides the most cost-effective alternative to obtain quickly the necessary quantity and the best quality. However, the decision to use it for long term needs should be made after a detailed assessment of the aquifer and all factors relating to the recharge, transmission and release of water and on the availability of relevant expertize and equipment.

Springs are the ideal source of groundwater.

58. Water from a spring is usually pure at the source and can be piped to storage and distribution points. It should be taken off from above the refugee camp site if possible. Care should be taken to check the true source of spring water, as some apparent springs may really be surface water which has seeped or flowed into the ground a short distance away. The yield of water from a spring may vary widely with the seasons. It will be at its minimum at the end of the dry season and early in the rainy season. Seek local advice.

It is essential that spring water be protected against pollution at the source.

59. This can be by a simple structure built of bricks, masonry or concrete, from which the water flows directly through a pipe to a tank or collection point. Care must also be taken to prevent contamination above the take off points.

If the need for water cannot be met by springs, the next best option is to raise groundwater.

60. Groundwater can be raised by infiltration galleries, tube wells, dug wells or boreholes. (Infiltration galleries extract ground-water horizontally, for example through tunnels and/or ditches). The choice of method will depend on the depth of the water table, yield, soil conditions and availability of expertize and equipment.

61. Without good groundwater resource surveys, preliminary test drilling, or clear local evidence from nearby existing wells, there is no assurance that new wells or boreholes will yield the necessary amount of water of the right quality. They can also be expensive.

A hydrogeological survey must be undertaken before starting any extensive drilling programme.

62. The yield of infiltration galleries, wells or boreholes depends on the geological formation in which they are constructed, the topographical characteristics of the site, the construction techniques and the pumping equipment to be used. Any new well or borehole must first be developed to full yield by an initial period of pumping at a fast rate. This pumps out finer soil particles, allowing water to pass more easily into the well. Yields can be raised by increasing the size of the well below the water table, for example in the case of a shallow well, by an infiltration gallery across the line of groundwater flow. If wells are sited too close together, yields will be reduced.

63. Wells, boreholes, infiltration galleries and pumps should be disinfected immediately after construction, repair or installation, as they may have been polluted during the work -two or three buckets of a 2.5% chlorine solution in water would be a suitable disinfectant. They should be located where surface water and, in particular, any seasonal rain or flood water, will drain away from the well head. They should be above and at least 30 metres away from any sanitation facilities and their discharge. Special techniques are used in the design and construction of these facilities to avoid the pollution of their water.

Sea Water

64. Sea water can be used for almost everything but drinking, thus reducing fresh water requirements. In locations where no adequate sources of fresh water exist but where sea water is near, desalinisation is one possible but costly option. Neither of the two basic methods - distillation using the sun's heat nor the use of modern desalinisation plants - is likely to meet immediate fresh water requirements in a major refugee emergency, and is therefore strongly discouraged. If no fresh water sources are available at a given site, relocation of the refugees must be considered as a matter of urgency.

Municipal and Private Systems

65. Existing municipal and private water supply systems in the vicinity of the refugees, for example those belonging to industrial or agricultural establishments, may be able to meet part or all of the need during the emergency phase and should be used where possible before taking unnecessary measures to develop other sources. A substantial increase in the yield and quality of such systems may be possible.

Pumping Equipment

(See UNHCR Water Manual, chapter 7)

· Pumps will generally be needed in refugee emergencies. Seek expert local advice on what is suitable and remember that operators, fuel and spare parts will be needed;

· As much as possible, use gravity rather than pumps for water distribution and treatment systems;

· Emergency water supply solutions involving pumps should be designed to ensure long-term and effective operation: avoid ad-hoc solutions;

66. Once an adequate source of water has been established, arrangements are needed to store and distribute the water to meet minimum needs.

The distribution system should use gravity whenever possible: gravity fed systems are much less costly and easier to maintain than pumping systems.

67. In areas subject to seasonal flooding, or where the level of a river source varies markedly, great care must be taken in placing any pumps, distribution, storage and treatment systems. It may even be necessary to mount a pump on a raft.

68. Water can be raised in two basic ways: by hand, using some kind of water container or bucket, or by using pumps (which may be driven by hand or engine). Nobody should be allowed to put individual containers into the source. A captive rope and bucket carries a low pollution risk. In this system, only the single rope and bucket that is fixed to the well is used to draw water - refugees fill their own containers from this captive bucket. The system is more reliable and much cheaper than a pump.

Where it can meet the demand, a hand operated system is to be preferred. Not more than 200 people should depend on a well with one rope and bucket

69. The main uses of pumping equipment in refugee water supply systems are:

i. Pumping water from wells or boreholes;

ii. Pumping water from surface water intakes;

iii. Pumping water into storage reservoirs.

70. Additionally there may be a need to use pumping equipment for other purposes, for example, feeding water treatment plants, boosting the flow through long pipelines, feeding water tankers. Gravity flow systems should be used as much as possible for these purposes as a way to minimize pumping requirements.

71. All pumps have moving parts and require regular maintenance. Professional advice should be sought on the selection and placing of pumps. Local familiarity, fuel supplies, spares, ease of maintenance and, above all, reliability, will be the major considerations in pump selection. Hand-pumps may be appropriate because they reduce dependence on outside supply of spare parts and fuel. However, in a refugee emergency, the sudden and large concentration of people requires maximum output of available water. Motorized pumps have a far greater output and may, therefore, be indispensable.

72. In some circumstances, pumps powered by solar panels may be suitable. The currently available pumps are expensive for their output but very reliable and involve no direct running costs. The pumps naturally work best in direct sunlight but will still work with light cloud cover. A solar pump might be a solution when the output of a handpump would be insufficient but large mechanised pumps are not necessary.

73. The theoretical capacity required of the pump depends on available storage, likely demand, and variations in demand throughout the day. A reserve for breakdowns, new arrivals, etc. should be provided. The minimum daily period during which a pump should be idle is that required to allow the level of water in the source to recover to its old level. Pumps should not be operated at night. Always have a pump on standby in a major supply system to cover repairs and maintenance.

Treatment

(See Water Manual, Chapter 8)

· The most serious threat to safety of a water supply is contamination by faeces;

· Only treat water to the extent necessary. Disinfection of drinking water is required if large numbers of refugees are concentrated in camps;

· All water treatment methods require some expertize, regular attention and maintenance;

· In refugee emergencies, the priority is to improve the physical and the bacteriological characteristics of drinking water. Only under very special circumstances would the improvement of chemical quality be considered;

· Cloudy or turbid water should be clarified before disinfection because chlorinating cloudy or turbid water is ineffective;

· Water purification tablets or boiling are not generally appropriate for large scale water treatment.

Introduction

74. The potability of any source has to be assessed before a decision to use it for human water supply is taken.

75. The importance of trying to find a source that does not require treatment is obvious.

If treatment is necessary it should be the minimum required to ensure acceptably safe water, using appropriate technology and a reliable operational and maintenance system.

76. Correct plant operation and maintenance must be assured. If large numbers of refugees are concentrated in refugee camps, disinfection of drinking water is absolutely necessary. Other types of treatment should be considered in accordance with the characteristics of the raw water

77. Determining how to treat water on a large scale is best done by experts. However, simple and practical measures can be taken before such help is available. Full explanations of all treatment methods applicable in refugee emergencies are given in Chapter 8 of UNHCR's Water Manual. All methods require regular attention and maintenance.

78. Besides the physical measures to protect water at its source and initial disinfection of water sources (usually by chlorine), there are four basic methods of treatment: storage, filtration, chemical disinfection and boiling. These can be used singly or in combination.

Storage and Sedimentation

79. Storage is the simplest method of improving water quality. It causes some pathogens to die off and any heavy matter in suspension to settle ("sedimentation").

Leaving water undisturbed in containers, tanks or reservoirs improves its, quality.

80. Storage of untreated surface water for 12 to 24 hours will already cause considerable improvement in its quality; the longer the period of storage and the higher the temperature, the greater the improvement. Be aware, however, that in refugee emergencies, it is very seldom that the amount of water available would be enough to allow the water intended for drinking purposes to be stored for more than a few hours before it is distributed to users. Where sedimentation tanks are used, their capacity alone should equal one day's consumption, thus allowing sedimentation to take place overnight.

81. Longer storage time can help control schistosomiasis (bilharzia), as the parasites die if they do not reach the fresh water snail within 24 hours of excretion by an infected person, or if they do not reach a human or animal host within 48 hours of leaving infected snails. Thus two day's storage would provide an effective barrier to transmission of the disease, provided snails do not enter the tank.

82. Sedimentation clarifies cloudy water which can be greatly speeded up by the addition of aluminium sulphate (Alum). A two-tank system is often used, the first tank being a settling tank with the second storing the clarified water. If additional treatment (e.g. chemical disinfection) is required, it can be done in the second tank, and a third one used for storage if necessary.

83. Great care should be taken to prevent pollution of stored water. Storage tanks must always be covered: the dangers of contamination of open tanks more than offset the advantages of direct sunlight. The storage area should be fenced off, and if necessary guarded, to prevent children playing or swimming in the water.

Filtration

84. Sand filtration can be an effective method of water treatment. A proper slow sand filter works in two ways. Passage of the water through the sand physically filters out solids, and, more importantly, a thin and very active layer of algae, plankton, bacteria and other forms of life develops on the surface of the sand bed. This is called the "schmutz-decke", where micro-organisms break down organic matter.

85. The rate of filtration depends on the surface area, depth and type of sand through which water is passed, and the depth of water above the level of the sand surface. The usual size range of the sand is 0.3 - 1 mm. Provided the rate of filtration is slow enough, the quality of the treated water is very good.

86. Many types of sand filters are described in the available technical guides (See key references). A packed drum filter can be improvized if drums and sand are available and this may be a good way of providing limited quantities of safer water quickly, for example for a health centre. The water passes down through sand on a 5 cm layer of gravel and is drawn off at a rate that should not exceed 60 litres per hour for a 200 litre drum. If a tap is used, unfiltered water equal to the amount drawn off is simply added to the top. Other types of sand filters include the slow sand filters, the horizontal sand filters and the river bed filters or infiltration galleries (suitable only where the bed is permeable). These can be used to treat larger amounts of water but are likely to be more difficult to set up quickly and effectively. For a river source a possible intermediate measure is to dig a well close to the bank. The water recovered will be river water but will have been filtered through the bed and bank.

Chemical Disinfection

87. Disinfection of water on a large scale is a rule in all refugee emergencies. Purification of wells, sand filters, pumps and piped water systems will be required initially. Iodine or various forms of chlorine can be used for disinfection and purification. Chlorine is more widely used, cheaper and often more readily available. The most generally suitable form of chlorine for refugee emergencies is calcium hypochlorite powder. Expert advice is essential for large-scale chlorination. As with all other water treatment methods, disinfection requires regular attention; it will be of little value if it is not fully reliable. Whilst clear water usually only requires chlorination, turbid water usually requires sedimentation and/or filtration before the chemical disinfection. Chlorination should therefore take place after any sedimentation or filtration process has been undertaken. It requires at least thirty minutes to act.

88. Care must be taken to ensure strict control of any chemical disinfection process and particularly to test the water for chemical residual levels after each disinfection and before distribution. After chlorination, and once chlorine has reacted, (about 30 minutes after dosage) there should be at least 0.5 mg/l (0.5 parts per million) of free available chlorine left in solution, in other words, still available to kill bacteria. The amount of chlorine required to achieve this is usually a broad indication of the level of pollution. If the amount of free available chlorine is much above 0.5 parts per million, people may not be prepared to drink the water; over-chlorinated water tastes unpleasant and will have the reverse of the desired effect if people therefore prefer untreated water.

89. A pocket size chloroscope (chlorine comparator kit, preferably of the DPD1 type) tests for residual chlorine levels. It consists of two tubes, each containing a measured quantity of the water under test, which can be visually compared for colour. One of the two tube samples is coloured by the addition of a chlorine sensitive reagents (o-toludine, a common reagent, should be avoided, as it decomposes in hot climates; it is also a poor indicator if the water has been over-chlorinated). The other tube is looked at through a range of standard coloured glass slides; the chlorine concentration can be read-off directly after matching the colour of the tube with the added reagent with that of the nearest standard. This test is simple and all treatment plant attendants should be trained to use it to check frequently the water quality. In view of the fact that water may be kept in storage, after chlorination, for some time before distribution, and bearing in mind that residual chlorine levels tend to drop with time, it is important to ensure any water leaving the plant should have, at least, a residual chlorine content of 0.4 mg/l (or parts per million) of free available chlorine to be regarded as safe.

90. When chlorination equipment is not working, the water should not normally be distributed. Therefore to ensure a continuous water supply, back-up chlorination equipment should be available in any water treatment plant.

91. Chlorine and iodine water purification tablets are also available, but are rarely suitable for water treatment for large populations. They may be used in health or supplementary feeding centres.

1 DPD is Diethyl-P-Phenylene Diamine.

Boiling

92. Boiling is the surest method of water sterilization. At low altitudes, water that is simply brought to the boil can be assumed to be free of pathogenic bacteria. Boiling should, however, be continued for one minute for every 1,000 metres of altitude above sea level, as the boiling temperature reduces with altitude. Prolonged vigorous boiling is often recommended but is not necessary to destroy the faecal-orally transmitted pathogens; it wastes fuel and increases the concentration of nitrates in the water. Water with high nitrate content is dangerous for very young babies. Domestic fuel supplies may, in the longer term, be the determining factor: boiling requires about 1 kg of wood per litre of water. However, if the refugees have traditionally boiled their water and can continue to do so, this should be encouraged and, at least initially, might make the need for other types of treatment less urgent.


Figure

Storage

· All refugee sites must be provided as soon as possible with adequate water storage facilities;

· Water storage may be the only means of ensuring a constant availability of water to cover the needs of a camp population at a given site;

· In general, use local technology for the design and construction of storage tanks or reservoirs. However, using prefabricated tanks may sometimes be the only way to provide water quickly enough;

· Ensure that the size, location and overall design of storage tanks are compatible with all other system components and design characteristics.

93. In nearly all systems, it will be necessary to store water in covered tanks between the sources and distribution points. As well as providing an essential reserve both during the emergency and for long-term use, storage will facilitate monitoring, collecting, treating and distributing safe water.

All refugee sites must be provided as soon as possible with facilities to store an adequate reserve of water.

94. The size of the reserve to be used will depend on the number of people and on the nature of the water supply system.

Water can be stored in various locations:

i. At the water collection point in tanks;

ii. In central storage tanks (before or after treatment) to balance supply with demand and to allow for gravity-fed distribution;

iii. At distribution points in tanks, including public stand-pipes or other service points at health centres, camp administration facilities, staff houses, etc.;

iv. At the refugee household level in small containers. These containers should not be the same as the ones used to collect and transport water from distribution points.

95. Whatever the type of storage needed, adequate enclosure should be provided to prevent any contamination from humans, animals, dust or any other source. A tight cover and dark storage also prevent algal growth and breeding of mosquito larvae.

96. In areas with pronounced dry and rainy seasons, the construction of a reservoir to collect water may be an option, despite the dangers of pollution and of mosquito breeding. An erosion-protected overflow spillway should always be provided in this case. Catchment tanks for the collection of surface water can also be considered. Pits are dug in the ground to catch and hold the water which runs off hard ground during heavy storms. They need special lining to hold the water and should be covered if possible.

97. Tanks above ground may be needed where the water table is very high and contamination cannot otherwise be avoided. Many types of simple, air portable, butyl rubber storage tanks are available, and some can be supplied with a complete distribution system. Headquarters' advice should be sought if local resources cannot meet this need.

Distribution

(see Water manual, Chapter 10)

· An appropriate water distribution system should ensure an even coverage of water needs among camp beneficiaries;

· Keep the distribution system simple;

· Under normal circumstances, water distribution in refugee camps should be carried out through public distribution stand-pipes;

· The water distribution system should minimize waste.

Refugees must have easy but controlled access to water.

Ideally, no dwelling should be further than 100 metres or a few minutes' walk from distribution points.

98. Experience has shown that where people have to fetch water from considerable distances, they tend either not to fetch enough to limit water-washed diseases or to collect water from closer but contaminated sources. Water distribution will be an important consideration in the layout of the site. The areas round the distribution points should be paved with stones or gravel, or protected by boards, with a run off structure to allow proper drainage.

99. Water can be distributed to individual users in many ways, depending on local conditions. Uncontrolled access by individual co sumers to primary water sources should be avoided.

A distribution system should have a sufficient number of outlets to ensure that people do not need to wait for long periods to have access.

100. Service and administrative buildings should be provided with private connections.

Equity in the distribution of scarce water is an extremely important consideration.

101. While vulnerable groups (the sick, wounded, most severely malnourished, children, pregnant and lactating women and the disabled) should have adequate and assured allocations, scarce water must be evenly shared among the rest of the population. Refugees should be encouraged to assume responsibility for equitable distribution. Arrangements should be carefully monitored to detect and prevent abuses. In some situations, water meters have proved a cheap and effective way of identifying excessive use and reducing consumption.

102. The main components of a water distribution system are the pipes themselves. Between source, storage and distribution points, water for domestic use should flow only in pipes to protect its quality. Other system components are break-pressure tanks, valves, service reservoirs and the watering points.

103. Standpipes and push taps are recommended to be used as outlets where possible. Multiple tap standpipes are normally constructed, each installation having usually between 5 and 10 individual taps. Taps are very vulnerable and spares must be available. Where water supplies are limited and the site is crowded, valve distribution points which can be chained shut may be the only effective solution.

There should be at least one tap per 80-100 refugees and no more than 200 refugees per handpump or per well with one rope and bucket.

104. The larger the number of people using a single source or outlet of water, the greater the risk of pollution and damage. Whatever the final distribution system, this must be carefully controlled and supervized - guards are often needed.

105. The design, construction, operation and maintenance of the water supply system should be carried out bearing in mind the need to minimize water wastage (from taps, pipes etc.) This is particularly important in systems based on low yield water sources or on those requiring treatment or pumping.

106. The community itself will also generate a certain amount of waste water. This must not be allowed to become a danger to public health, and it may instead be usefully recycled, for example to water livestock, irrigate vegetable gardens or in pour-flush latrines.

Key References

Assisting in Emergencies, A resource Handbook for UNICEF Field Staff, Emergency Operations Unit, UNICEF, New York, 1986.

Community Water Supply. The Handpump Option, A Joint Contribution by the United Nations Development Programme and the World Bank to the International Drinking Water Supply and Sanitation Decade, World Bank, Washington, 1987.

Emergency Water Sources, Guidelines for Selection and Treatment, S. House & B. Reed, Water Engineering Development Centre (WEDC), Lough-borough University, 1997.

Engineering in Emergencies, A practical Guide for Relief Workers, Davis J., Lambert R., IT Publications on behalf of RedR. Intermediate Technology Publications Ltd., London, 1995.

Environmental Health Engineering in the Tropics:

An Introductory Text, Cairncross S., Feachem R., John Wiley & Sons, Chichester, 1983.

Guidelines for Drinking Water Quality, 3 Volumes, Second Edition, WHO, Geneva, 1993.

Handbook of Gravity-Flow Water Systems for Small Communities, Jordan Jr. T.D, UNICEF/Nepal, Kathmandu, 1980.

Hand Dug Wells and their Construction, Watt S., Wood W., Intermediate Technology Publications Ltd., London, 1977.

Handpumps, Technical Paper Series 10, International Reference Centre for Community Water Supply and Sanitation, The Hague, 1977.

Principles of Water Quality Control, Tebbutt, T.H.Y., Pergamon Press, Oxford, 1973.

Stow Sand Filtration for Community Water Supply in Developing Countries, A Design and Construction Manual, Technical Paper Series 11, International Reference Centre for Community Water Supply and Sanitation, The Hague, 1982.

Small Community Water Supplies, Technology of Small Water Supply Systems in Developing Countries, International Reference Centre for Community Water Supply and Sanitation, John Wiley & Sons., Chichester, 1983.

Small Water Supplies, Cairncross S., Feachem R., Ross Bulletin No. 10 The Ross Institute of Tropical Hygiene, London, 1978.

Water Manual for Refugee Situations, Programme and Technical Support Section, UNHCR, Geneva, 1992.

Water and War, Report on the Symposium on Water in Armed Conflicts (Montreux, Nov. 1994), International Committee Of The Red Cross, Geneva, 1995.

(introduction...)


Figure

Overview

Situation

Overcrowding, a harsh environment and disruption of normal sanitation habits can threaten the lives and well-being of the refugees in emergencies. Proper sanitation is a key aspect of the hygiene cycle involving water and health and is fundamental to a multi-sectoral approach in emergency response.

Objective

To prevent the spread of disease and promote a safe environment for the refugees.

Principles of Response

· The co-operation of the refugees is essential for success. Programmes must be developed with them, and, to the extent possible, run by them. The measures taken must be culturally acceptable to the refugees;

· Swift provision of a basic system for human waste disposal is better than delayed provision of improved systems;

· Take full account of sanitation needs in site selection and layout;

· Make full use of locally available human, material and technological resources. This includes using both skilled and unskilled refugee labour, using public health or sanitary engineering expertise available in the national institutions, and relying on the traditional practices of the refugees and the local people;

· The materials and technology chosen should be as simple as possible;

· The sanitation programme must include provisions for continuous maintenance of the sanitation facilities and services;

· The best guarantee that latrines will be used and kept clean is to allocate them on an individual or family basis. Refuse disposal should be arranged on a community basis;

· Wherever possible, restrict the use of chemicals (for the control of rats, flies and other pests particularly) to specific places and for a limited period of time. Environmental measures should be favoured instead.

Action

· Localize defecation and prevent contamination of the water supply;

· Collect baseline data on the site and draw a sketch of the area to locate potential zones for sanitary facilities;

· Develop appropriate systems for disposal of excretia, garbage, and wastewater. Control vectors of public health importance such as mosquitoes, flies, fleas, lice, bugs, rodents and other vermin;

· Plan the amount of facilities and services to be provided. Optimum standards are: for excretia disposal: one latrine per family; for refuse: one bin of 100 litre capacity for 10 families or 50 persons; one sanitarian for every 5,000 persons, and one sanitation assistant for every 500 persons;

· Establish sanitation teams for the construction and maintenance of infrastructure;

· Set up services for vector control and burial of the dead;

· Establish a monitoring and reporting system for all environmental health services in co-ordination with the general health surveillance system;

· Include environmental sanitation as an integral part of health education.

Introduction

1. Environmental sanitation includes: safeguarding water quality; disposal of human excretia, waste water and garbage; insect and rodent control; safe food-handling practices; and site drainage. All these services, and the provision of health care, are very much interrelated and should be considered together. In particular, this chapter should be read in conjunction with the chapters on water, on health and on site planning.

2. Disruption and crowding people together who are accustomed to living in different and less crowded conditions, makes adequate sanitation of critical importance. Basic services are often lacking and habits may have to change. In these conditions, indiscriminate disposal of human and other waste poses a serious threat to health.

3. Due to unfavourable environmental factors or unfavourable socio-cultural habits the implementation of sanitation programmes in refugee camps can be difficult. Additional constraints include:

i. Sites that are easily flooded, barren and/or inaccessible;

ii. Lack of space;

iii. Limited availability of local materials due to either natural factors or considerations related to environmental protection;

iv. Limited time for the community to get organized if only in a rudimentary way; and;

v. Lack of qualified personnel.

4. The key to reducing health hazards is to have acceptable and practical waste disposal systems. These must be developed in co-operation with the refugees and be culturally appropriate, even if circumstances necessitate a departure from traditional practices. Special public health education may be required.

5. The refugees must also run the services to the extent possible. Monitoring will be essential: the effectiveness of the services will depend to a significant degree on regular and thorough maintenance and inspection.

Basic Principles And Standards

· Take full account of sanitation needs in site selection and layout;

· Analyse sanitation and environmental hygiene issues as part of the initial needs and resources assessment;

· Seek professional advice from those with local knowledge;

· Consult and involve the refugees in the design and location of sanitary facilities, and particularly their maintenance;

· Educate the refugees as part of the public health education programme and devote special attention to sanitation matters at school for refugee children.

6. As stressed in the chapter on site planning, environmental sanitation will be a very important consideration in site layout, and the organization and operation of the sanitation services must be integrated with other community services.

7. Developing adequate sanitation in a refugee emergency is difficult; but correcting mistakes is even more difficult. Expert advice should be sought from a public health engineer who is familiar with the habits of the refugees and nationals of the country of asylum, and if possible has experience of refugee emergencies. Assistance should first be sought locally from sources such as government departments, the UN system, NGOs, universities, consultants or contractors. If these cannot meet the need. Headquarters' assistance should be requested.

8. Good sanitation depends to a great extent on the attitudes of the community and the people who run the system. The systems and services developed should be able to operate effectively with a minimum of outside involvement. Refugees themselves must be trained to run the environmental sanitation programmes.

9. The public health education programme must place proper emphasis on the importance of sound environmental sanitation practices. The link between excretia contamination and disease must be clearly understood by all.

Whatever the success of the sanitation system with adults, children will present a special challenge.

Children are both the main sufferers from excretia-related diseases and also the main excreters of many of the pathogens that cause diarrhoea. Teaching environmental sanitation in schools is therefore essential.

Table 1 - Number and Types of Sanitary Facilities Required

FIRST OPTION

SECOND OPTION

THIRD OPTION

EXCRETIA DISPOSAL

1 latrine/family

1 cubicle/20 persons

1 cubicle/100 persons
or defecation

STORAGE

TRANSPORT

FINAL DISPOSAL

REFUSE/GARBAGE

1 bin, 100 litres /
10 families or 50 persons

1 wheelbarrow /
500 persons and 1 tipper /
5,000 persons

1 pit (2 m × 5 m and
2 m deep) / 500 persons
1 deep pit for each clinic

10. Measures to contain human excretia and to dispose of refuse should be taken immediately. Since it is almost impossible to estimate how long refugees will stay in a given site, more durable facilities should also be established simultaneously. For example, once a defecation field has been established, latrine construction should begin at once; the greater the time lag between those two actions, the more difficult to shift people from their previous habit (defecation in the open) to subsequent building and use of latrines. Even in hot, dry climates, human excretia disposed of on the ground can favour the transmission of diseases.

11. Communal facilities, especially latrines are difficult to maintain in a permanent state of cleanliness. However, refuse management (especially transportation and final disposal) is better to organize on a communal basis. Domestic wastewater drainage requires a combination of both individual and communal systems. Drains collecting wastewater from each household have to be connected to main ones which will channel those waters away from the living quarters.

12. General norms and standards related to specific activities (excretia disposal, solid waste, vector control, etc.) should be seen as indicative only and be adapted in each case to the prevailing social, cultural and physical conditions. Table 1 above gives standards which can help to work out a preliminary quantitative estimate of the most urgent needs.

13. Surveys of the status of environmental sanitation programmes should be carried out regularly and corrective action taken (see Annex 1, Environmental Sanitation Survey Form).

Human Resources And Organization

· Appoint a focal point;

· One sanitarian for every 5,000 persons and one sanitation assistant per 500 persons should be recruited from among the refugees or from other sources;

· Community participation is the key to successful sanitation projects.

14. A focal point for sanitation must be appointed at the very start of the emergency, and responsibilities of various partners clearly defined. There are not many agencies specializing in environmental sanitation.

15. The first step in appointing the focal point is to investigate the availability of local expertise (a civil engineer specialized in sanitary engineering as an ideal example). Recourse to outside assistance has to be contemplated if local expertise is not available.

16. At camp level, sanitation teams or brigades, provided with basic hand-tools, should be set up to carry out urgent tasks (digging trenches or pits for excretia and waste disposal). A health education programme should be launched simultaneously. Each team should be headed by staff who have good knowledge of sanitation (including medical and engineering aspects).

One sanitarian for every 5,000 persons and one sanitation assistant per 500 persons should be recruited.

17. It is always more efficient to have only one agency responsible for both sensitizing people to environmental sanitation and supervising related activities. Education for environmental sanitation should focus on the "how and why" of hygienic containment of human excretia, and simple methods for waste disposal and hygiene at household level (water storage in the home, habitat and personal hygiene, etc.) Women, teachers, leaders, and school children should be the first target of such a programme.

18. Community participation is a key to the success of sanitation projects. Health education and sensitization are a prerequisite to that participation. It should nevertheless be recognized that it takes time to convince both the community and individuals about benefits they can expect from a sanitary environment. Concrete examples such as pilot latrines near clinics, market or other places are therefore very important to support environmental health programmes.

19. Refugees should be provided with tools and basic materials (and incentives in some cases) to encourage them to contribute to the improvement of their own living conditions. They should be gradually integrated into the sanitation teams, the ultimate goal being that the refugees themselves should do most of the maintenance tasks.

20. Annex 2, Resource Inventory Form, gives a checklist of the human and material resources needed for environmental sanitation.

Human Excretia Disposal

· Take immediate action to localize excretia disposal and prevent contamination of the water supply;

· Carefully consider cultural and physical factors and ensure that appropriate anal cleaning materials and hand-washing facilities are available;

· Communal trench latrines may be needed initially, but in most circumstances pit latrines are much better;

· Ensure that latrines can be used at night and are safe for women and children.

Introduction

21. The priority is to create an efficient barrier against faecal contamination. This can be assured through a sufficient number of sanitary facilities, ensuring that these facilities are properly used and kept clean, and do not become the source of problems such as bad smells and flies, and do not collapse when it rains.

The most common cause of breakdown is inadequate maintenance, even for properly designed and installed systems.

22. The best guarantee of proper maintenance is the individual family allocation of latrines. Breakdown of latrines will lead to contamination of the environment and a high risk of infection and disease. There must be regular inspection and maintenance.

Even when in working order, latrines will not be used unless they are clean. Latrines must be cleaned daily.

23. Individual families will be responsible for their own units, but where communal latrines are unavoidable, special arrangements to keep them clean will be essential. Particular attention must be given to the maintenance and cleanliness of the latrines serving community facilities such as health centres. Refugee workers with proper supervision will be required. It may be necessary to pay or otherwise compensate those who are responsible for keeping communal latrines clean and operational.

24. Disinfectants would prevent the biological degradation of excretia. However the regular addition of soil, ashes or oil, if available, to trench or pit latrines may help control insect breeding and reduce odours.

Disinfectants should not be poured into the pits or tanks of latrines.

25. Two main factors will affect the choice of an excretia disposal system: the traditional sanitation practices of the refugees and the physical characteristics of the area, including the geology, the availability of water, rainfall and drainage. Failure to take proper account of these can easily result in the system itself rapidly becoming a health hazard.

26. The essential starting point is to find out the traditional sanitation practices of the refugees and how these can be modified to reduce health risks in a refugee emergency. The following information will be required:

Previous sanitation system and practices;

Method of anal cleaning;

Preferred position (sitting or squatting);

Need for privacy;

Segregation of sexes and other groups or individuals with whom it is culturally unacceptable to share a latrine;

Cultural practices for children;

Cultural taboos (for example, against contact with anything that may have touched excretia of others);

Social factors, including likelihood of community action to ensure proper use of proposed system;

Need for special orientation (direction) of latrines in some cultures;

Systems used locally in neighbourhood of site.

27. Arrangements must be made to assure the availability of appropriate anal cleaning materials at or near all latrines. This is essential for hygiene.

The latrines must be safe 'for children, and must be able to be used at night.

Pay attention to security for women: for communal units some form of lighting should be provided and it may be necessary to provide guards.

Immediate Action

28. Initially the refugees are likely to defecate indiscriminately, contaminating their environment and often the water supply. In consultation with the community leaders, the best first step is to demarcate defecation fields to localize and contain excretia.

29. Designate an area or areas (about 50 m × 50 m each) away from the dwellings and down wind, but sufficiently close to be used. Separate areas for men and women are usually desirable. Within the defecation field, strips of land - roughly 1.5 m wide, 20 m long, on each side of a central access path - will be used, one after the other, beginning with strips farthest from the entrance.

30. Based on a recommended surface area of 0.25 m2 per person per day, exclusive of access paths, defecation fields of the size above would be sufficient for about 250 people during a month, or 500 people during two weeks. Operating defecation fields beyond one month is not advisable.

31. Fence the area(s) and provide privacy by means of partitions and shallow trenches (in the strips) and spades, if possible. Covering excretia with ash, lime or just soil lessens health risks. Locate such areas where the surface water run-off will not cause contamination. Protect the area with cut-off ditches.

32. A publicity campaign will be required to encourage refugees to use these areas and not defecate indiscriminately near dwellings or the water supply. At least one attendant should be assigned to each defecation field. To the extent possible, hand-washing facilities should also be installed nearby.

Selection of a System: Basic Considerations

33. The selection of an excretia disposal system suitable for a particular situation requires consideration of a number of factors. In an emergency, however, time is the critical factor. Pollution of the environment by excretia, with all its attendant risks, cannot be stopped without immediate sanitation measures. Thus the range of choice is always much more limited at the very outset of an emergency.

34. Temporary systems, to meet the most immediate needs, will have to be improved or replaced by others as soon as possible, in order to maintain adequate sanitation standards.

In emergency sanitation, act first and improve later.


Figure 1 - Considerations in Excretia Disposal

35. Figure 1 illustrates some considerations to be taken into account in excretia disposal.

36. The design of sanitary facilities should be governed by cultural factors (discussed above) and by the following physical considerations:

i. Flies and smells: these can be reduced by: installing vent pipes topped with anti-corrosive screens; covering faeces regularly with ash; treating latrines with biological larvicides to control fly larvae; using fly traps, etc.;

ii. Flooded pits or collapsed walls: these can be avoided by ensuring proper construction including having a raised superstructure, well-built base and mound, pit lining, and good drainage. Sometimes these steps are not taken because of, for instance, financial considerations. However, a large number of latrines built quickly and cheaply will not necessarily solve environmental health problems;

iii. Life-span: to dig a pit for excretia is not a very exciting exercise. Normally, the pit should be designed to last two to three years (the capacity of a dry pit should be at least 0.07 cubic meters per person per year). If its dimensions have not been properly calculated, people will have to dig a new pit a short time later. Community members would understandably be reluctant to do this and the site would become covered with pits, some containing unstabilised faecal matter hazardous to human health. In addition, shortage of space limits the number of latrines which can be built;

iv. Cleanliness and privacy: Communal installations are rarely kept clean and become unusable within a very short period of time and encourage transmission of diseases. Therefore family latrines should be preferred whenever possible. Sanitary facilities should preserve users' privacy. Cubicles should be partitioned off within each block. At family and individual level, socio-cultural considerations often make it compulsory to build separated units for men and women. Disregard for these simple criteria might result in misuse and abandonment of facilities;

v. Location: groundwater pollution must be nil or at a minimum. Latrines should be at least 30 m from any groundwater source and the bottom of any latrine at least 1.5 m above the water table. Latrines must be close enough to users' shelters to encourage their use (not more than 50 m). They must be far enough from shelters and other buildings to prevent potential smells and pests from bothering or harming the population (at least 6 m from shelters if possible).

37. There are a number of latrine options: once cultural and physical factors have been taken into account, the key factors to consider are low cost, simplicity of construction and ease of maintenance.

Trench Latrines

38. Trenches can be used for a few months. If necessary, and where space is available, this solution can continue for longer periods, with new trenches being dug as old ones fill up.

Trench latrines should be dug 1.8 to 2.5 m deep and 75-90 cm wide. Recommended length per 100 persons is 3.5 m.

39. A platform and structure will be needed, providing a seat or squatting hole as appropriate, with lid. When the trench is filled to within 30 cm of the top, it must be covered with soil and compacted. Trench sides must be shored up if there is a danger of collapse.

Pit Latrines

40. The pit latrine is the most common excretia disposal system used around the world


Figure 2a

(see figure 2a). It has major advantages over a trench latrine. It consists of four basic components: a pit, a base, a squatting slab (or plate) and a superstructure.

41. If used by only one family these latrines are usually well maintained. Pit latrines can also be used in clusters as communal facilities.

42. Pit latrines are most suitable in conditions of low to medium population density -up to about 300 persons/hectare - but have been used satisfactorily in areas with twice this density. Space is needed not only for the construction of one pit latrine per family, but also for new pits when the old ones are full. This is an important consideration when pit latrines are used as communal facilities.

43. When the pits are three-quarters full, they must be filled with soil and the superstructure and squatting plate moved to a new pit. Applying layers of ashes as the pit fills will speed up the decomposition of excretia and in time the site can be used again.

44. The pit should be about one meter across and over two meters deep. The rim of the pit should be raised about 15 cm off the ground and ditches should be dug around the base to divert surface run off. The pit wall should always be reinforced for one meter below ground level to prevent collapse.

45. The basic variety has both odour and insect problems, but these can be considerably reduced by making the simple improvements of the ventilated improved version (VIP) (see figure 2b), and by adding oil and using lids.

Where pit latrines are used, the ventilated improved version should be built whenever possible.

46. In a VIP latrine the vent pipe should be at least 15 cm in diameter, about 2.5 m high, painted black and placed on the sunny side of the latrine for maximum odour and insect control. Blackening the external surface of the vent pipe only marginally increases the venting velocity, but this factor may be of greater importance under "no wind" conditions. The vent pipe must be fitted with an insect proof gauze screen (so it works as a fly trap). The hole should not be covered by a lid as this impedes the air flow.

Bore-Hole Latrines

47. Bore-hole latrines (figure 3) are dug with a hand auger or mechanical drill and require a smaller slab than a pit. The bore-hole is 35-45 cm in diameter and any depth up to 7 meters. The advantage of the bore-hole latrine is that it can be constructed quickly as a family unit if augers are available. The disadvantages are that the side walls are liable to fouling and fly breeding, they are smellier than vented systems and the risk of ground water contamination is greater because of the depth.


Figure 2b


Figure 3

Ventilated Improved Double-Pit (VIDP) Latrine

48. Raised (or built-up) pits can be used where it is not possible to dig deep pits because the water table is high or excavation is difficult (for example in rocky ground).

49. The VIDP latrine (figure 4) (also called alternating-twin pit ventilated latrine) has two shallow pits, both of which are ventilated by separate vent pipes capped with fly screens. It is a good option in crowded areas which may become even more crowded, as it preserves the space needed for replacement latrines.

50. Two pits give more flexibility. A pit fills up in two to three years, and it should then stand for at least one year. This gives enough time for the night soil to dry out and decompose, so that it can be removed more easily and not pose a health hazard. While the full pit is decomposing, the other pit is used. The two pits must not be used at the same time.


Figure 4

Pour-Flush (PF) Latrine

51. Pour-flush latrines (figure 5) are simple in design but need permeable soil for their soak-away. A water seal is made by a U-pipe filled with water below the squatting pan or seat. It is flushed by hand with some 1-3 litres of water into a pit or soak-away. This system is suitable where water is used for anal cleaning and where refugees are used to flushing. It is not suitable where paper, stones, corncobs or other solid materials are used for anal cleaning. Pour-flush latrines will be used properly only if water is readily available. A large container with a 3 litre dipper should be made available close by the latrines.


Figure 5

Stabilization Ponds

52. Where liquid effluent has to be disposed of in impermeable soil, stabilization (oxidation) ponds are a simple and cheap solution, particularly in hot climates. Various systems are described in the technical references. If ponds are used they must be securely fenced off.

Solid Wastes

· Improper garbage disposal increases the risk of insect and rodent-borne diseases, and an effective system must be established for the storage, collection and disposal of garbage;

· Garbage disposal areas must be designated and access to them restricted;

· Large amounts of dust can damage health. Preventing destruction of vegetation is the best preventative measure against dust.

General Considerations

53. The quantity of garbage generated by refugees is often not considered substantial and it therefore tends to be neglected. However, the daily amount of garbage as well as its weight can be significant, in market places in particular.

Uncontrolled accumulation of garbage is unhealthy, and promotes an increase in rodent and insect borne disease.

At the beginning of an emergency hygiene and waste disposal is usually poor, so vermin and other pests including rodents proliferate very rapidly.

54. Food is occasionally distributed to refugees in metal cans. How those are disposed of should be given particular consideration not only for aesthetic reasons but also because of health hazards (injuries to children, potential breeding sites for mosquitoes, etc.). In addition, this kind of garbage is far from biodegradable.

55. Medical waste (used syringes and needles, contaminated bandages, laboratory specimens, etc.) generated by health centres, are a hazard. Access to medical sanitary services should be well controlled, and the waste should be treated separately, without delay (see below).

The safe disposal of all medical waste requires particular attention.

There should be routines for the storage, collection and disposal of garbage - this will be particularly important in high-density sites.

Garbage Management

56. Storage: metal drums can be used as refuse bins at individual dwelling level. A 200 litre drum cut in half is often used. Bins should have lids if possible and drainage holes in the bottom. A ratio of one container (100 I capacity) per 10 families has proved to be effective. The containers should be placed throughout the site in such a manner so that no dwelling is more than about 15 meters away from one. Using concrete structures as refuse bins is neither economical nor practical: they are difficult to empty properly so rodents are encouraged and garbage is dispersed around the area.

57. Collection and Transportation: garbage should be collected from the containers regularly, daily if possible. Camps near a city could benefit from existing refuse-dump services. Using tractors with trailers is expensive and should be considered as a last option and only for large and densely populated camps. Wheelbarrows and/or carts (hand or animal carried) are usually more appropriate.

58. Disposal and Treatment:

i. Sanitary land-filling (also known as controlled tipping) remains the most advisable method. Areas designated for burying garbage should be well away from dwellings, and fenced off;

ii. Incineration is justified on a small scale and usually only for medical waste. After each incineration, cover the waste with a layer of soil;

iii. Composting is an attractive option but requires technical knowledge, which may not be available. In addition, garbage must be sorted to produce good compost.

Dust

59. Large amounts of dust carried in the air can be harmful to human health by irritating eyes, respiratory system and skin, and by contaminating food. The best preventive measure is to stop the destruction of vegetation around the site. Dust can also be controlled by spraying roads with water or oil, especially around health facilities and feeding centres, and limiting or even banning traffic.

Wastewater

· Sources of waste water must be controlled as soon as possible and drainage provided.

General Considerations

60. This aspect of environmental sanitation should always be considered from the beginning. Drainage prevents water from stagnating around water distribution points, and drains the rainfall as well as domestic waste-water originating from various sources (toilets, showers, kitchens, etc.). Other measures to help control vectors include eliminating ponds.

61. Drainage can very quickly become a problem and corrective measure are difficult once shelters and other infrastructure have been built. For example, people often wash next to water sources, causing problems which could be avoided if special separate washing areas are constructed with duckboards or stones and proper drainage.

62. Some families manage to channel waste-water away from their homes and use it to irrigate vegetable gardens. Although this should be encouraged it should not disrupt the main drainage system.

63. Good drainage should be a priority at the following locations:

i. Water points (standpipes, taps, hand-pumps);

ii. Sanitary facilities such as showers, toilets and washing areas. Waste water from these places should either be used to irrigate vegetable gardens and fruit trees or drained into absorption trenches or soak-away pits;

iii. Shelters: household members usually manage to protect their shelters from runoff waters by means of perimeter drains. It is nevertheless important to ensure that such water is collected and disposed of through main drains.

Treatment

64. In some circumstances, waste water should be treated, for example waste from sewers collecting effluent from pour-flush toilets. Some treatment package units are available on the market; but these are usually expensive, complex, and difficult to operate and maintain.

65. However, there is a broad range of waste water treatment technology. Sanitary engineering professionals should be consulted to select the most appropriate technology.

Pest and Vector Control

· Insects and rodents carry and spread diseases and can spoil food supplies;

· Physical screens are the best immediate measures;

· Preventive action to eliminate or limit breeding areas and conditions favourable to the vectors is the best long-term solution;

· Specialist supervision of all chemical measures and local knowledge of resistance is necessary;

· Avoid chemical control where possible.

General Considerations

66. The environment in a refugee emergency is typically favourable to the proliferation of disease-carrying insects and rodents ("vectors"), which can also destroy or spoil large quantities of food.

67. Flies tend to breed in areas where food or human excretia are present, mosquitoes where there is stagnant water, and rats where there is food, garbage and cover. As a result of overcrowding and inadequate personal hygiene, lice, fleas, mites, ticks and other arthropods may also cause health problems. Table 2 gives an indication of common vectors and related diseases.

68. Reducing the numbers of flies, mosquitoes and rodents quickly in an emergency is difficult and physical screens may be the best immediate measure. Over the longer term, the most effective method of controlling insects and rodents is preventive: to improve personal hygiene, sanitation, drainage, garbage disposal and food storage and handling practices and thus make the environment less favourable for the vectors. Examples of practical measures are the removal of stagnant waste water, regular garbage collection, use of oil in latrines and provision of soap and sufficient water for washing. The recommended monthly supply of soap is 250 g soap per person per month. The programme should provide for regular inspection and be integrated with other public health measures.

69. The problems should be discussed with the refugees and education given on the significance of vector control. Where solutions unfamiliar to the refugees are employed, these must be carefully explained.

70. Whatever the nature of nuisances and pests, one should avoid having systematic recourse to chemical control by means of pesticides (insecticide, rodenticide, molluscicide, etc.). Such products are costly and toxic to both human beings and the environment. There is a risk of poisoning during transport, storage, handling and of course spraying the chemicals. Also, pests can develop resistance to the chemicals.

Table 2 - Vectors Which May Pose Significant Health Risks

VECTOR

RISKS

Flies

Eye infections (particularly among infants and children), diarrhoeal diseases

Mosquitoes

Malaria, filariasis, dengue, yellow fever, encephalitis

Mites

Scabies, scrub typhus

Lice

Epidemic typhus, relapsing fever

Fleas

Plague (from infected rats), endemic typhus

Ticks

Relapsing fever, spotted fever

Rats

Rat bite fever, leptospirosis, salmonellosis

Physical Control

71. Measures described in this chapter to deal with excretia and waste disposal will also help control pests (flies and rodents particularly).

72. The elimination of stagnant water and other breeding and resting sites for mosquitoes through drainage is important and the drainage network must be maintained.

Chemical Control

73. Obtaining precise information on chemicals which are used or authorized to be used in the country (i.e. registered list of pesticides if any) should be the first priority.

Insecticide spraying carried out on a routine basis must be avoided, and in any event should be consistent with the rules and procedures in force in the host country.

74. Advice from specialists, particularly medical entomologists, should be sought to minimize the risks and to maximize the impact on target-species.

75. Staff assigned to such tasks must be trained on technical aspects, informed about health hazards linked with handling and spraying of pesticides, and protected by means of adequate clothing (mask, boots, gloves, etc.).

76. The use of rodenticides should always be adopted in agreement with medical staff. Rats are favoured carriers of vectors (such as fleas) of bubonic plague and murine typhus. When these diseases may be present it is more important to take measures directly against the vectors themselves - i.e. the fleas, rather than the rats - because destroying the rats will simply cause the fleas to leave the dead bodies of the rats and become more of a threat to people.

77. The body louse is the only proven vector of louse-borne epidemic typhus and relapsing fever. If there is a serious increase in body louse infestation, quick action is required by properly trained personnel. This generally involves dusting individuals' inner clothing and bedding with an insecticide or the use of clothing fumigants. There is widespread resistance in lice to some insecticides and expert local advice must be sought.

General Hygiene

· Sanitary engineering must be complemented with sufficient health education, sensitization and community participation.

78. Habitat hygiene, food hygiene and personal hygiene, while being integral parts of environmental sanitation, are a matter of health education and community sensitization rather than of sanitary engineering. It is nevertheless worth underlining that the most effective manner to sustain "soft" activities such as education in general and health education in particular is to complement them with "hard", visible and concrete activities on the spot.

79. Community participation in sanitation activities is a key to successful implementation, however, to make participation work in practice, the community members must have the necessary resources - human, institutional and material - to enable them to take on their responsibilities.

80. Activities to improve living conditions should take place at all levels - site, community, family and individual - and not be restricted to just one level. Elementary rules of hygiene should be observed by everyone.

81. There are three essential steps to improve living conditions:

Avoid overcrowding and overpopulation, which increase transmission (through direct or indirect contact) of diseases brought about by vectors such as fleas and lice;

Reduce faecal/oral transmission risks by ensuring systematic hand-washing before cooking and eating;

Encourage personal hygiene including clean clothes by providing amenities such as showers and laundering areas and basins. This will also reduce contact with water bodies that have been polluted by excretia, reducing the risk of disease including bilharziasis (schistosomiasis).


Figure

Disposal Of The Dead

· Suitable arrangements for disposal of the dead are required from the start of an emergency;

· Action should be co-ordinated with the national authorities;

· Burial is the simplest and best method where acceptable and physically possible. Arrangements should be made to allow traditional rituals;

· Before burial or cremation, bodies must be identified and the identifications recorded.

82. Suitable arrangements for the disposal of the dead are required from the start of a refugee emergency. The mortality rate may well be higher than under "normal" conditions. The authorities should be contacted from the outset to ensure compliance with national procedures, and for assistance as necessary.

83. Dead bodies present a negligible health risk unless the cause of death was typhus or plague (when they may be infested with infected lice or fleas) or cholera. Funerals for persons dying from cholera should be held quickly, near the place of death. Efforts should always be made to restrict funeral gatherings of persons dying from any of these three diseases, and to restrict feasting and ritual washing of the dead, by intensive health education or by legislation, as appropriate.

84. Health considerations provide no justification for cremation, for which sufficient fuel may often not be available. Whenever possible, the customary method of disposal should be used, and the traditional practices and ritual should be allowed. Material needs, for example for shrouds, should be met. The necessary space for burial will need to be taken into account at the site planning stage, particularly in crowded conditions.

85. Before burial or cremation, bodies must be identified and the identification recorded, and, if possible, cause of death recorded. This is particularly important for the control, registration and tracing of disease. If the whereabouts of relatives are known, the most immediate relation should be notified; and steps must be taken to assure the care of minors who, as the result of a death, are left without an adult to look after them.

86. When handling corpses workers should protect themselves with gloves, face masks, boots and overalls. The workers should wash thoroughly with soap and water afterwards. Although the HIV virus cannot survive for long in a dead body, care should be taken with bodily fluids.

Key References

A Guide to the Development of On-Site Sanitation, WHO, Geneva, 1992.

Chemical Methods for the Control of Arthropod Vectors and Pests of Public Health Importance, WHO, Geneva, 5th edition 1997.

Manuel d'Utilisation des Dnfectants, UNHCR, Geneva, 1994.

Sanitation and Disease: Health Aspects of Excretia and Wastewater Management, Feachem & al, Wiley & Sons, 1983.

Vector and Pest Control in Refugee Situations (also in French), PTSS, UNHCR, Geneva, 1997.

Vector Control: Methods for Use by Individuals and Communities, WHO, Geneva, 1997.

Annexes

Annex 1 - Environmental Sanitation Survey Form

Country:

Date: ....../....../......

Camp/Settlement:

Camp Population:

Prepared by:

I. Living Areas

A. Excretia Disposal

Ratio of latrine seats to people: 1/......

Total

V.I.P.*

Rudimentary

P.F.**

Other

Private Latrines

Public Latrines



Comments:





B. Refuse Disposal


Capacity
(Litres)

Number

Max Distance
from dwelling (m)

- Individual pits:

- Garbage Bins


Wheel-barrow

Truck

Other

-Transportation:


Landfill

Incineration

Other

- Final Disposal

Dimensions

Number

Communal refuse pits long____x Wide____x Deep_____x



Comments:







* V.I.P. = Ventilated Improved Pit

**P.F. = Pour-Flush

Annexes

Annex 1

II. Public Places

C. Existing Facilities

Schools






*Latrine Type

P.F.

V.I.P.

Rudimentary

Other

1 seat/ ____________boys

1 seat/ ____________girls

1 urinal/ ___________boys






*Refuse collection

Yes

No

Hospitals

*Latrine Type

P.F.

V.I.P.

Rudimentary

Other






*Refuse collection

Buried

Burnt

Markets






*Excretia Disposal

Good

Poor

None






*Refuse collection

Good

Poor

None









Comments:






D. Drainage


- at water posts

Good

Poor

None





- around latrines

Good

Poor

None





- camp drainage network

Good

Poor

None





Comments:






E. General Characteristics

-topography

Flat


Moderate

Steep


-soil

Rocky


Clay

Sandy


- water table distance from

Rainy Season


Dry Season

ground surface

m


m



F. Community water supply





- sanitation at source

Good

Poor

None





-sanitation at distribution point

Good

Poor

None





- individual water containers

Capacity

litres






- storage at home

Capacity





Clean

Covered


litres

Y-N

Y-N





- chemical used for water disinfection

Chlorine

Other

None





- points of application of above chemicals

Source

Storage
Tank

Home
Container

Annex 2 - Environmental Sanitation - Resource Inventory Form

Country:


Prepared by:

Camp:


Population:


Date:....../....../......

A. Implementation

Name(s)

Governmental authorities

International organisations

Private sector

NGO's

B. Human Resources

Number of Workers

Is there a spraying team?

Y

N

Is there a drainage team?

Y

N

Is there a sanitation team?

Y

N

Is there an organised workshop?

Y

N

Number of sanitarians:

Number of health workers: